Iranian Journal of Medical Ethics and History of Medicine

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Making decisions for recipients of health care while offering clinical care is an important part of nurses’ responsibilities. In order to ensure patient satisfaction, nurses are obligated to observe ethical standards in the decision-making process. This paper aimed to determine the effect of teaching professional ethical principles on ethical sensitivity in nurses’ decision-making. In this semi-empirical study, 80 Social Security nurses were selected through purposive sampling and were then randomly placed in two groups of 40 each, the intervention group and the control group. Research tool was the Ethical Sensitivity Scale Questionnaire for decision-making, the validity of which was assessed using content validity, and whose reliability was confirmed with a Cronbach’s alpha coefficient of 0.83 for internal consistency. At first the ethical sensitivity in decision-making was evaluated in both groups, and then an educational workshop on nursing ethics was held for the intervention group every other week the workshop consisted of 4 three-hour sessions, and upon completion of this workshop, both groups filled in the questionnaire once more, and data were analyzed using SPSS software. There was no significant difference between the average ethical sensitivity in decision-making of the two groups before the intervention after the intervention, however, the difference was meaningful (P = 0.001). Moreover, the average ethical sensitivity in decision-making of the intervention group was significantly different after the intervention (P = 0.001). Based on the findings of this study, teaching nursing ethical principles has a positive effect on nurses’ ethical sensitivity in decision-making. It is therefore recommended that this educational program be offered to nursing students and health care staff.

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Attempts to promote medical ethics principles on the national level should be consistent with the needs, expectations of the target audience, social orientations and determination of priorities. The present study was conducted through distribution of a questionnaire containing twenty medical ethics topics, and thus the priorities of instructors, researchers and policy makers regarding medical ethics were determined on a national level. Through determination of medical ethics priorities in the country, the study aimed to encourage a scientific approach to the issues and challenges faced throughout the nation based on the opinions of thinkers of this field, and to help resolve each of those issues according to national priorities. The findings revealed ten priorities in the field of medical ethics nationwide: patients’ rights, doctor-patient relationship, justice in the distribution of health care resources, autonomy and informed consent, the financial relationship between doctor and patient, hospital ethics committees, ethical considerations in public health, strengthening and capacity building in teaching medical ethics, ethical considerations in medical education, and medical research ethics.

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Medical ethics is an interdisciplinary knowledge which increasingly developed during the last 30 years, and nowadays it becomes a part of medical student’s curriculum. Although, the quality of medical education has improved in Iran, but medical ethics teaching has not accomplished effective alteration yet. For deeper and more actual recognition of the challenges of medical ethics curriculum, we interviewed medical ethics instructors in a qualitative study. The data was collected by semi-structured interview with fourteen medical ethics instructors of Tehran University of Medical Sciences in 1389 and analyzed by Mairing content analyzing approach. Results of this study shows weaknesses and challenges in medical ethics curriculum which presented under five themes: comprehensiveness of goals, composing organization, proportion of content, active teaching method, and comprehensive system of evaluation. According to this the existing weaknesses and challenges of medical ethics curriculum can be considered as important obstacles in moral development of students. Considering those challenges, can develop medical ethics curriculum and introduce new models for medical ethics teaching.

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Every organization has ethical codes and behavioral standards suited to its professional structure that are referred to as professional ethics. Higher education is a professional system and the faculty should be aware of ethical standards of teaching considering their role in developing students and their obligation to them. Applying professional ethics in education ensures the right teaching-learning process in higher education institutions and can result in more commitment to students' needs.The aim of this review article, which is based on literature and related books and articles, is to examine the professional ethics of faculty as teachers and their role in the education and moral development of their students in view of ethical standards. In order to do this, samples of Islamic ethical issues related to the subject and some educational ethical rules of other countries have been investigated. Based on the professional ethics of teaching, teachers should pledge to ethical principles in two dimensions: firstly, they should behave decently considering their role in the students' moral development, and should be aware that the most effective method to characterize positive values in students is being actual role models. Secondly, because of the teachers' responsibility in meeting the educational needs of their students, they should have maximal commitment to ethical principles to perform professional tasks in the best way possible.

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Documentation of accepted ethical behavior in special settings is one of the strategies employed to foster ethics in organizations. Such documents, known as codes of ethics, vary in different societies according to their cultural and ideological differences. Medical educators have dual professional roles (as physicians and teachers) that sometimes seem ethically incompatible. Therefore, having codes of ethics is essential in this profession. The aim of this study was to develop codes of ethics for clinical medicine educators with an Islamic-Iranian approach. This was a three stage developmental research. First, a comprehensive literature review was conducted. Using content analysis method, the first draft of a code of ethics for clinical medicine educators was prepared. Second, the draft was thoroughly and critically reviewed and revised in experts’ focus group discussion and the 2nd draft was devised. This was further reviewed by a group of 24 experts at the national level (validated) and revised according to their comments, and thus the 3rd draft was prepared to be presented for formal approval process. The final document includes 55 codes of ethics in 18 topics (conscientiousness, accountability, respectfulness, scientific excellence, respect for others’ freedom, equity, patience, religious commitment, modesty, trustworthiness, humility, contentment, relationship with coworkers, attentiveness toward patients, attentiveness toward learners, kindness, confidentiality, and discipline). It seems that extracting ethical concepts from the rich Islamic-Iranian cultural resources is feasible, and provides an appropriate basis for the development of ethical codes for medical educators. Compared to Western codes, such codes may be better accepted in Iranian contexts and will be implemented more readily if the organizational settings are prepared simultaneously.

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Organizational justice is of great importance particularly for hospital personnel, and job stress has the potential to put their health at risk. The purpose of this study was to determine the relationship between organizational justice and job stress among the personnel of a hospital in Isfahan. In this correlation study, the samples consisted of 150 personnel that were working in a governmental hospital in Isfahan. Samples were selected through convenience sampling in 2012. Data were gathered by personal data questionnaire, Niehoff organizational justice questionnaire and job stress questionnaire. Data were analyzed by descriptive and analytical statistics. Results showed that job stress among hospital personnel varied from 48.6% (moderate) to 39.4% (mild) and 12% (severe). Moreover, findings showed there was a relationship between organizational justice in the domain of interactional justice and job stress among hospital personnel (r = - 0.18, P = 0.03). According to the findings, it is essential to pay attention to the concept of organizational justice in hospitals in order to decrease job stress among the personnel.

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One of the key strategies in the students’ process of learning is being affected by role models. Recognition of the spiritual strategies of role model instructors for when nursing students are exposed to threats and obstacles to spiritual growth can enable nurses to deal with such situations. This study was conducted to investigate the experiences of nursing students about the spiritual strategies of role model instructors in the role modeling process. In this qualitative study, 22 nursing students were selected based on purposive sampling in 2012. Data were analyzed through content analysis. Data from three focus group discussions (n=20) and two individual interviews with nursing students were collected from five nursing schools in Tehran. Spiritual strategies for role modeling were classified in two main categories: religious beliefs establishment and commitment to ethics. The use of teaching strategies based on spirituality by role model instructors in hidden curriculum was an expression of their religious beliefs in the face of the challenges and obstacles that nursing students confront in their profession, and these strategies helped the spiritual growth of nursing students. It is therefore recommended to promote spiritual development in nursing education, and employ the spiritual strategies of role model instructors to encourage the spiritual growth of nursing students, on whom public health depends.

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In order to achieve teamwork-based and integrated care, one of the issues in health care is the implementation of ethics and values in teamwork. The aim of this study is to develop the interprofessional collaborative ethics framework.This cross sectional study was conducted in two phases. In phase one, core competencies of the interprofessional collaborative ethics were determined by literature review. In phase two, Delphi rounds of experts were undertaken to validate the competencies and calculate content validity indexes through Content Validity Ratio (CVR) and Content Validity Index (CVI).The interviews and Delphi rounds identified 12 competencies categorized in three core themes including patient-centered values, interprofessional collaborative ethics, and team-based values. In phase two, based on the mean scores of importance, utility, and clarity, patient center value (4.9), interprofessional ethics competencies (4.6), and team-based values (4.5) were determined as essential themes.In conclusion, the validation of the inter-professional ethics framework was found to be acceptable in the Iranian context. Therefore, the framework for teaching and evaluating inter-professional ethical competencies is an applicable tool in the Iranian context.

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Medical ethics is a set of moral values that apply principles and responsibilities to the practice of medicine and is a fundamental part of medical education. The current study investigated the effectiveness of the medical ethics curriculum and the best method for its implementation from interns’ point of view. The current cross-sectional descriptive study was carried out in July 2012. The research tool was a questionnaire developed in the medical ethics department and handed to all interns. The validity and reliability of the tool was confirmed using content validity and internal consistency (α= 0.72) methods respectively. Data was analyzed using SPSS software and reported by the use of descriptive statistics, particularly mode, as a measure of central tendency.Seventy-one interns (60%) responded to the questionnaire, 54% of whom were female and 55% in the second internship year. In response to the achievement rate of expected outcomes such as the extent to which the educational objectives have been reached, and the suitability of content with the needs felt in real clinical situations, modes were all ranked in the ategory of "low". The modes of the responses to the stressfulness of different ethical situations were mainly ranked in the category of "high". To assess the best methods for teaching knowledge as well as medical ethics skills and attitudes, the following were the mode of interns' responses: group discussion (38%) for teaching the basics, and presentation of a case with the solution (70%) for teaching clinical ethics. The most appropriate methods of student evaluation were considered patient management problem and performance evaluation in the ward by 25 (36%) and 21 (31%) of interns respectively.The current study showed the effectiveness of medical ethics curriculum was low and the students requested presenting this course in a more practical way. It would appear that a two unit theoretic course does not have the efficiency to modify students’ attitudes and behavior to encounter challenging ethical situations, and therefore fundamental changes are suggested.

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Empathy and communication between dentists and patients are among the major concerns of dental health educators. The present study aimed to evaluate the empathy levels of dentistry students with their patients in the city of Tehran during 2014.In this descriptive cross-sectional study, 410 dentistry students of various universities throughout Tehran were selected randomly. Data were collected using the questionnaire of demographic data and Interpersonal Reactivity Index to assess dispositional empathy. Data analysis was performed using SPSS 16 statistical software.The students had a mean empathy score of 53.06 (SD = ± 1.03), with the highest level pertaining to the imagination dimension (14.41 ± 4.65). Age, gender, and educational level had significant relationships with empathy (P < 0.01). Female students reported higher emotional empathy (P < 0.01), but no significant relationship was found between empathy and the university of attendance.Empathy scores of undergraduate dentistry students were lower than ideal and acceptable levels. Therefore it seems necessary to design proper educational programs to improve empathy among dentistry students.

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The precepts of Islamic education are founded on a practical and all-inclusive system that is aimed to develop man in all aspects of his life based on Quranic guidance (Quran and Ravayat). The individual is at the heart of Islamic education, and therefore has a specific place in Islam and is considered sacred and blessed.As a rule, medicine is targeted at the physical wellbeing of man. Consequently, Islamic education can play can play an important role in medical training and may be traced in the Quran and Revayat.Instructors and students are at the core of education and learning, and their development will result in the moral, spiritual and technical advancement of the society. Medical schools aim to cultivate young talents and educate experts in the health industry, and are naturally essential for the development of a nation. This can be achieved through the attempts of capable and motivated instructors within the educational system.The present study is a review of the Islamic approach to medical training and the techniques of developing motivated and capable scholars and students in order to achieve Islamic educational goals.

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Nurses face numerous patients with different cultural backgrounds and needs on a daily basis. Cultural diversity can be an obstacle in the way of providing quality healthcare services. Cultural competency is the proper response to cultural and ethnic diversity in the society. This research was conducted to define the concept of cultural competency in nursing education.

In this study, Persian and English keywords related to cultural competency, nursing education and nursing curriculum were first searched separately and in combination on the internet and in existing literature. Consequently, papers that were more directly related to the topic were chosen and their concepts were extracted. Cultural competency refers to a set of knowledge, views and skills used simultaneously to enable the individual to work efficiently in different cultural conditions. In this study, first cultural competency was defined and then the process of its acquisition, the facilitating factors, barriers and consequences were described.

Considering that in Iran cultural variables are affected by many different factors, it seems necessary to investigate cultural competency in the existing cultural conditions. Moreover, there seems to be a need for comprehensive planning to provide solutions for professors and students in this respect.

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In evolution and innovation program of medical education which has been announced to the medical universities of the country since 2015, as a part of the health sector reform in IRAN, promoting professionalism is one of the emphasized subjects. This study aimed to evaluate activities conducted in this university to promote professionalism. In this descriptive research, all activities performed in Babol University of Medical Sciences in the years 2015 and 2016 in order to achieve the objectives of professionalism were recorded in a data collection form. The subject, target group, the extent of each activity, and outcomes were recorded and compared with data related to years before 2015. Totally, 19 major activities have been recorded to promote professionalism in this university in these two years. Sixteen activities (84.2%) have been implemented after medical education reform of IRAN. The extent of activities was calculated as 10088 person-hour and most of these major activities (12 activities, 63.2%) was attributed to achieve the objective of "implementation structural and program requirements, an organized system for need assessment, pathology and improvement of the values of ethics and professionalism". After implementation of medical education reform in IRAN, Babol University of Medical Sciences has adopted multiple new activities to promote professionalism in this university.
 

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