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.

One of the most effective factors on organizational behavior is the Nurses’ job satisfaction. Spiritual wellbeing of nurses is an inseparable personal element that influences their job satisfaction. The aim of this study was assessing association between Nurses' spiritual well-being and job satisfaction in Educational-Therapeutic center of Tabriz Shohada. The study population was nurses of Shohada hospital. In this study, 155 participants were selected by stratified Simple random sampling method. The research tools consisted of two questionnaires including spiritual well-being scale (SWBS) and job satisfaction (MSQ). In order to analyze the data, descriptive (frequency, percent, mean, standard deviation) and inferential (independent t, Pearson, Spearman, ANOVA Tukey test) were used. The results showed that there is a positive and significant relationship between nurses' spiritual well-being and their job satisfaction (P<0.05). Also, mean score of nurses' job satisfaction was 61.89 (12.63) and mean score of spiritual well-being was 89.85 (13.64) and both were above average (P<0.05). Type of employment, age, and sex had significant relationship with job satisfaction (P<0.05). According to the findings of this study, it is recommended that the relevant stakeholders and authorities increase their nurses' job satisfaction, pay special attention to the issue of spiritual health and improvement of it, because increasing spiritual health increases nurses’ job satisfaction and ultimately lead to better Care services will be better for patients.

Professional nurse should be familiar with the principles of biomedical ethics and how to deal with situations of moral conflict. Nurses encounter a variety of ethical conflicts in their work environments, which, if not properly educated for that, may be destructive. One of the first steps to recognize and help resolve moral conflicts seems to be a better understanding of the underlying causes of these conflicts. For this purpose, this study compared the exposure of pre-hospital emergency staff and nurses of the ophthalmologic departments in Isfahan with ethical conflicts in their careers. This descriptive-analytic study was performed on 44 pre-hospital emergency personnel and 42 nurses in ophthalmic and postgraduate degrees. Data were collected using Falco's moral conflict questionnaire. The results were analyzed using descriptive statistics such as frequency distribution tables, dispersion indexes, and mean and analytical statistics such as T test and ANOVA. Data were analyzed using SPSS software version 8. The results of this study showed that the prevalence of ethical conflicts among pre-hospital emergency personnel with a mean of 61.65 was higher than nurses in ophthalmic departments with an average of 40.23. Therefore, according to the results of this study, the degree of exposure to ethical conflict situations for pre-hospital emergency personnel more common in comparison with the staff of the elective hospital units in more stressful situations. The degree of exposure to ethical conflict situations is also more significant for pre-hospital emergency personnel than nurses in the ophthalmic departments.

Emotional intelligence and critical thinking are important factors affecting professional performance and mental health of health care professionals. In this research, the relationship between emotional intelligence and critical thinking is investigated. This is a descriptive-correlational study. The statistical population of this study was all nurses working in hospitals affiliated to one of medical universities located in Iran in 2016. The sampling method was random. Using Cochran formula, 174 subjects were obtained. The main tool for data collection was the Bar-On Inventory and California Critical Thinking Skills Questionnaire. The validity of the questionnaire was confirmed by the professors and reliability was calculated using Cronbach's alpha coefficient for emotional intelligence and critical thinking questionnaire 0.82 and 0.79 questionnaire. The mean scores of emotional intelligence in nurses working in studied hospitals were 3.46±0.78 of 5 and the average score of critical critical thinking nurses was 22.66 out of 34. Also, Pearson coefficient confirmed the significant correlation of all components of emotional intelligence with critical thinking. Among the components of emotional intelligence, social skills have the most positive and meaningful relationship with critical thinking. There is a positive and significant relationship between emotional intelligence and critical thinking of nurses working in studied Hospitals. Therefore, selecting students and employing nurses based on the measurement of emotional intelligence and critical thinking will improve the performance of nurses.

Nursing ethics is one of the most basic aspects of nursing profession, which nurses are required to follow the principles receiving nursing care with confidence by patients. This study was conducted to determine the level of moral development of nurses and its contributing factors. This descriptive, analytic study was performed in 2017, study samples were 310 nurses working in educational hospitals of Ardabil University of Medical Sciences. Samples were selected by convenience method. The data was collected using a Kohlberg’s nursing dilemma test. The questionnaire included six scenarios: newborn with anomalies, forcing medication, adult's request to die, new nurse's orientation, medication error, and uninformed terminally ill adult. The data was analyzed by IBM SPSS 18 using descriptive and analytic tests. In this study, 51 nurses (16.45%) were in the pre-conventional level, 101 nurses (32.58%) in the conventional level, 132 nurses (42.58%) at the post-normal level and 26 nurses (8.38%) at the level of clinical considerations. Moral thinking mean score was 42.58 ± 5.6 and the mean score of the clinical considerations was 21.53 ± 4.3. The present study showed that the majority of nurses are in the post conventional and conventional level; but this is less than 50% of all nurses, which shows that the level of moral development of nurses is in the moderate level. It requires further investigation of the causes and related factors and more efforts for improving it.
 

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.
 

Communication with patients is an important issue in nursing meaning that to realize the truth from their viewpoints. This study was performed to compare levels of nurses’ empathy with patients at drug abuse treatment centers (DATCs) and the internal ward of hospital. The present research was a cross-sectional and descriptive-analytic study conducted at two environments of the internal ward and DATCs. A total of 60 subjects comprised research participants and were listed in the study through census method. A two-part scale was used including personal information and Jefferson scale of empathy with verified validity and reliability. Data were analyzed using SPSS16 software. The scores of nurses' empathy with patients recorded in the internal ward and at DATCs were 67.84±6.32 and 79.73±9.21 (out of 100), respectively (P=0.001). Male nurses (76.80±9.88), married nurses (75.93±9.98), ages of >40 years (79.1±11.12), masters’ degrees (75.5±3.78), job experiences of >10 years (83.53±8.53) and overtime hours of <50 h (80.61±9.9) attained the highest empathy scores with significant differences (P<0.05). The scores of nurses’ empathy with drug-dependent patients at DATCs were higher than those of internal wards indicating that the care of addicted patients in a specialized ward leads to increased empathy. Considering the relationship between empathic communication, educational levels and occupational experience of nurses, it is essential to consider training empathy skills to nursing students from the first semester and to provide in-service training to nurses working at hospitals and centers by nurses of higher educational qualifications and experiences.

Patient safety is one of the basic principles of health care and its evaluation and promotion are one of the main goals of the health system development plan in Iran. Therefore, the present study was designed to determine the status of patient safety culture in nursing staff of three hospitals, A and B, Shahrekord and C Borojen hospitals. This was a descriptive-analytical study performed from September to February 2018 and 359 eligible nurses were evaluated based on a multi-stage sampling method based on Patient Safety Culture Questionnaire. The collected data were analyzed by descriptive and inferential statistics using SPSS 20 software. The mean age of participants was 23.33 ± 7.79 years. The overall score of patient safety culture was 123.23 ± 16.15 for nurses, with the lowest score being 8.40 ± 1.86 for communication channels as well as feedback and informing others about errors 8.72±2.23 reported. Also, there was no statistically significant difference between different dimensions of patient safety culture and overall score in three hospitals (p> 0.05). Leadership is a key element in prioritizing patient safety. How to respond to mistakes determines the hospital safety culture. To promote a good hospital safety culture, the fear of being blamed for mistakes must be eliminated and the atmosphere of open communication and continuous learning must be implemented in the hospital.

Increased patient satisfaction can promote patient’s compliance with prescribed treatments and improve patients’ health. The aim of this study was to determine the patients’ satisfaction with nurses in surgical departments of Imam, Razi, and Golestan hospitals of Ahvaz city in 2018. In this descriptive-analytic study, patients over 18 years of age with at least 3 days of hospitalization were studied. Data including age, sex, marriage status, level of education, type of illness, hospitalization time, number of hospital admissions, and health status were collected through a demographic form. Patients’ satisfaction with nurses was obtained by the satisfaction questionnaire of nursing services. Chi-square, one-way analysis of variance, Kruskal-Wallis analysis, Mann-Whitney test, and Spearman correlation coefficient were used to analyze by SPSS software. Patients’ satisfaction in Imam, Razi and Golestan hospitals were 78.25±12.09, 68.30±11.24, and 58.09±17.42, respectively. Highest level of patients’ satisfaction was with Razi hospital nurses (P-value<0.05).There were no significant difference between patients of different hospitals regarding age, marriage status, place of residence, hospitalization history, and education level (P-value>0.05).With increasing age, having a history of admission, an increase in the duration of hospitalization, the patients’ satisfaction score decreased significantly (P-value<0.05), but there was no significant difference between the patients’ satisfaction by marriage status, place of residence and level of education (P-value>0.05). It is suggested that effective strategies for increasing patients’ satisfaction be applied through more care and attention of more sensitive people. Also, increasing awareness of  the community about the duties of patients, nurses, and medical staff is recommended.

Moral sensitivity is the first step in making a moral decision and taking a moral judgment. An effort to promote nurses' moral sensitivity, education of ethical concepts, and using appropriate approaches to teaching ethics is still under discussion. Thus, this study was conducted to determine the effect of virtual teaching of ethical principles through narrative method on the ethical sensitivity of critical care nurses. In this quasi-experimental study, 60 critical care nurses were studied in two groups of test and control in 2 hospitals. The experimental group was taught ethical principles through virtual narrative method. Demographic information and Latezen moral sensitivity questionnaire were completed by nurses on three occasions (before, immediately after and two months after virtual education). Data were analyzed by SPSS 20 software. Results showed that the mean and standard deviation of nurses' moral sensitivity were 61.53 ± 9.24 before intervention and (60.60 ± 7.76 for the control group, and the association was not statistically significant (p> 0.05). However, there was a significant difference between the experimental group (77.50 ± 6.05) and the control group (60.83 ± 8.07 in the first post-test. In addition, there was a significant difference between the experimental and control groups (p <0.05) in the second post-test. Repeated measure analysis showed a significant difference between the ethical sensitivity scores in the experimental group, but no significant difference in the control group. According to the findings, the nurses' moral sensitivity was moderate at the beginning of the study, but after the intervention, the test group was at a high level and the control group was still at a moderate level. Thus, it is necessary to motivate nurses for recording and sharing their ethical challenges. Accordingly, they can promote their own ethical performance. Furthermore, their narratives can be used for education of other nurses and students of nursing.

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.

Communication skills are recognized as an essential part of nursing services and as they are faced with an extended range of referees, they have to communicate with them in a specific way. This study was performed to determine the communication skills of nursing staff of pediatric wards with their colleagues. This descriptive-analytic study as cross-sectional was performed on 110 nursing staff of pediatric wards from Persian Gulf’s hospital during 2019, in Bushehr, Iran, by using census sampling method. Data collection tool was a communication skills’ questionnaire including demographic part and items for self assessing communication skills of nurses with their colleagues. The validity and reliability of the questionnaire were confirmed in previous studies. Data were analyzed by SPSS software using independent t-test, Pearson correlation and one-way ANOVA at the significant level of 0.05. The mean score of professional communication was 54.33 ± 7.26 which was relatively significant. Scores of professional communication were not statistically associated with age, work experience, educational degree, employment status, type of responsibility, interest to job and marital status. The results showed statistically significant relationship between the mean scores of professional relationship with workplace (p <0.013) and shift work (p <0.020). The highest professional communication score was 58.83 in the nursing office and the lowest score was 50.21 in the pediatric emergency department. The Pearson correlation between age and work experience was positive with the mean score of professional communication, and the highest score of professional communication was related to staff working in shift work. According to the findings of the present study, the status of professional communication among nursing staff of pediatric wards was relatively desirable and therefore, based on the results, it is suggested that nursing authorities and planners plan and endeavor to enhance nurses' professional communication.

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.

Ethical climate is an important part of organizational culture which affects all aspects of individual characteristics and its improvement in health care centers causes better response of nurses to moral stress and ultimately promotes the quality of medical services. The aim of this study was to determine the nurses' perception of the ethical climate governing in clinical environment in the teaching hospitals of Shahrekord University of Medical Sciences in 2018. This study was a descriptive-correlational study performed on 300 nurses by purposive sampling method. Two questionnaires used for data collection included demographic information and Olson ethical climate questionnaire. Data analysis was performed using linear regression and mean (SD) tests and by SPSS version 20. The results of the study showed that the overall score of moral climate in the participants was 3.79 ± 0.67. The highest and lowest ethical climate scores in this study were related to the dimension of nursing managers (3.86± 0.74) and physicians (3.58 ± 0.79), respectively. Also, a significant relationship was observed between variables such as years of experience and age with the dimensions of the ethical climate (p<0.05). According to the score of ethical climate obtained in this study, which is less than some studies conducted in this field in Iran. Considering the importance of the ethical climate and the consequences of defects in this issue, it is necessary for hospital managers to make appropriate plans to set up a favorable ethical climate on clinical environment in their most important priorities.

Applying the principles of professional ethics by nurses creates a suitable social and psychological environment for patients. The purpose of this study was to determine the level of nurses' awareness of the principles of professional ethics and barriers towards its observance in public hospitals in South Khorasan province in 2019.The present study was a cross-sectional study that was performed on 230 nurses in South Khorasan province by multi-stage sampling method. Data collection tools were a checklist of demographic information and a questionnaire about nurses' awareness and barriers of the principles of professional ethics. Data were analyzed by SPSS V.22 software using descriptive and inferential statistics. In this study, the mean ± SD age of participants was 32.34 ± 5.73 years. The mean score of participants' awareness was moderate level and the first obstacle to professional ethics from the perspective of nurses was the environmental domain. The most important obstacles to professional ethics were dissatisfaction from basic needs, unreasonable expectations of patients and their attendants from nursing staff and nursing staff shortages, respectively. Since nurses' awareness of the principles of professional ethics is moderate level, so holding professional ethics workshops, removing environmental barriers, and providing favorable conditions for nurses including improving the conditions of wards and increasing staff and meeting their expectations in the fields Various such as adequate rest, adequate income and planning appropriate shifts are recommended.

Nurses are among the members of the treatment team who have the most contact with Corona Virus Disease- 2019 (COVID-19) patients and their ethical decision-making is inevitable during patient care. On the other hand, nurses' motivation to implement end-of-life care is influenced by their attitude, awareness, and moral reasoning. The aim of this study was to investigate the level of ethical decision making of nurses and its relationship with the attitudes of end-of-life care of patients with COVID-19 in hospitals affiliated to Hamadan University of Medical Sciences in 2021. In this study, 180 nurses working in hospitals affiliated to Hamadan University of Medical Sciences were selected by convenience sampling method. Data collection tools included: demographic Information questionnaire, Nursing Dilemma Test (NDT) questionnaire, and Frommelt Attitudes towards End-of-Life Care questionnaire. According to the results, there is a direct relationship between nurses' ethical decisions and the attitude of end-of-life care (<0.05, r=0.819). The mean score of nurses' ethical decision-making indicates the low level of ethical decision-making (39.19 (5.3)) and the mean score of nurses' practical considerations (20.62(4.2)) showed that the process of nurses' ethical decision-making is relatively influenced by environmental factors. Also, the average score of nurses' exposure to moral challenges indicates that nurses are familiar with similar situations. The mean score of nurses' attitudes toward end-of-life care was reported at an undesirable level (81.58(7.8)). According to the results, by identifying the factors affecting nurses' ethical decision-making and educational planning to improve their decision-making level, it is possible to improve the quality of patients care while improving nurses' attitudes toward end-of-life care.

Human is spiritual dimensions that has legal status in health and disease. The purpose of this study was to evaluate the knowledge of nursing and midwifery students about patient rights in Iran Universities of Medical Sciences teaching hospitals’ in 2017. This study was a descriptive cross-sectional study in 2017 with convenience sampling method. Data was collected by a three-part questionnaire including demographic information, Knowledge about the Patient Rights Charter, and strategies for student information to deal with patient rights. Mann-Whitney and Spearman tests were used for data analysis. A total of 1219 undergraduate students participated in this study. The mean score of students' awareness of the Patient Rights Charter was 13.54±4.45 out of 29 points. 1007 students (82.61%) reported that education about patient right was sufficient. Direct correlation was between patient knowledge awareness score with pre-internship training (r = 0.461) and learning from instructor information (r = 0.512) and there was a negative correlation between self-education (r = -0.151) and other methods of information acquisition (r = -0.067). Given that most students did not consider the educational content taught in the field of patient rights to be effective, it can be concluded that these methods were ineffective and failed to convey the correct information. Therefore, revising of the Patient Rights Curriculum for Nursing and Midwifery students is recommended