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A review of narrative ethics: an approach to medical ethics education
Leila Afshar, Alireza Bagheri,
Volume 5, Issue 5 (10-2012)
Abstract

Narrative ethics is an approach that is well known for ethical education and moral development.  In narrative ethics, by using a story, its components and characters, ethical knowledge and awareness can be achieved. This approach is very useful in medical ethics education and is helpful in dealing with ethical dilemmas. In fact, part of ethical development, in addition to moral judgment, is to reinforce the ethical sensitivity in which narrative ethics can play a significant role for this purpose.This approach has been widely used for teaching morality in Persian literature and history telling, such as Mathnavi. Narrative ethics can be applied by telling stories about patients' life and their experience of illness. It can also be used to criticize and analyze the clinical situation and explore ethical challenges that healthcare providers face in their daily practice. Thus, it can help to prevent ethical conflicts by establishing interaction between ethical principles and patients' values. This paper emphasizes the application of this method in medical ethics education and ethical decision-making.    


The Impact of Virtual Teaching of Ethical Principles in the Narrative Way on the Moral Intelligence of Nursing Students
Khadije Nasiryani, Najme Zamani, Ahdiye Bahri, Seyedeh Elham Fazljoo,
Volume 16, Issue 1 (3-2023)
Abstract
Considering the importance of learning ethical intelligence in nursing students as the future builders of this field and the valuable role that teaching ethical principles in the narrative way, as well as considering the practicality of virtual education in all disciplines, especially medical sciences, the study aimed at determining the effectiveness of virtual teaching of ethical principles in the narrative way on the moral intelligence of nursing students. the present study was of a semi-experimental type, with 40 nursing students entering the study in the available method. Before the intervention, immediately, after and two months after the intervention, participants completed the Lennick and Kiel's moral intelligence scale. Virtual training was held in 16 training sessions. The data was analyzed with the SPSS version 18 software. The Findings showed the present study involved 40 nursing students with an age range of 18-23 years. Comparison of the average overall score of moral intelligence before intervention (155/45±17/81) immediately after intervention (161/50±17/89) and two months after intervention (162/97±15/41) indicates an increase in this score during the study, which was statistically significant(P=0/02).the present study showed that the average overall score of moral intelligence in students increased immediately after and two months after the intervention, and differed from before the intervention, which is statistically significant. Studies show that optimal moral intelligence can portray a good perspective on people's success and progress. Therefore, it is necessary for university administrators to pay special attention to ethical education with new methods, along with clinical education.

Explaining Nursing Students’ Experiences of Professional Ethics in Relation to Psychiatric Clients: an Analysis Based on Narrative Writing-Reflection
Mina Gaeeni, Hamid Asayesh, Ahmad Parizad, Zahra Abedini,
Volume 17, Issue 0 (12-2024)
Abstract
Clinical education constitutes the cornerstone of nursing education. Enhancing students' theoretical and practical knowledge within the psychiatric department is crucial for improving their attitudes, acceptance, and delivery of care. The outcomes of effective clinical learning encompass the development and refinement of professional competencies, including communication and professional ethics, the cultivation of critical thinking for clinical judgment and decision-making, the enhancement of ethical sensitivity, and the fostering of effective team and group performance. Recognizing the significance of these factors, this study aimed to "explain the experiences of nursing students based on narrative writing-reflection during their first encounter with psychiatric clients." This qualitative study was conducted during the psychiatric nursing internship at the Faculty of Nursing, Qom University of Medical Sciences, over two consecutive semesters. Purposive sampling was employed, and data were collected through 10 semi-structured individual interviews and 2 face-to-face and virtual focus groups (n=5 per group). Data collection continued until data saturation was reached. Data analysis was conducted using a qualitative content analysis approach with the assistance of MAXQDA20 software. The clinical experiences of students during their initial psychiatric nursing training course, as reflected in their narrative writing-reflections, revealed a primary theme: "encouraging ethical and spiritual communication in nursing." This overarching theme encompassed four sub-themes: "enhancing empathetic communication," "enhancing ethical sensitivity," "respecting the dignity of clients," and "listening to the voice of clients' feelings." The experiences gained through the reflective method within the clinical education setting, particularly in specialized clinical environments such as psychiatric wards and during initial encounters with clients in these departments, can provide valuable insights into students' attitudes and perspectives towards these clients and their families. These rich experiences can be effectively utilized to cultivate and strengthen communication and professional ethics among medical science students.

The Heart of Healing: How Narrative Medicine Deepens Nursing – A Systematic Review of Clinical Trials
Negin Farid, Nazanin Nazari, Narges Jafar Malek,
Volume 17, Issue 0 (12-2024)
Abstract
Narrative medicine has emerged as a transformative model in healthcare, emphasizing the role of patient stories in enhancing the quality of care. By recognizing the individuality of each patient's narrative—shaped by personal experiences and cultural contexts—this approach fosters deeper connections between caregivers and patients. Despite its growing recognition, narrative medicine remains underutilized in nursing, where the psychological and emotional dimensions of care are often overlooked. This systematic review examines clinical trials that investigate the integration of narrative practices into nursing education and care delivery, with the aim of assessing their clinical and educational impact. A comprehensive literature search was conducted across international and national databases including PubMed, Scopus, Web of Science, SID, Noor, Magiran, Irandoc, and Google Scholar, using relevant English and Persian keywords. Eligible studies were clinical trials published in English or Persian. After removing duplicates and applying inclusion criteria, eight studies were included for analysis. Selection and data extraction were conducted independently by two researchers, with discrepancies resolved by a third reviewer. The review adhered to PRISMA guidelines and ethical standards were maintained throughout. The studies, published between 2018 and 2024, involved nursing students (mean age 17.96–21.5 years), patients with lung tumors (mean age 49.31 years), and elderly patients (aged 61–89 years) with complex fractures. Findings were synthesized into three main domains. First, narrative-based education significantly enhanced empathy and academic performance among nursing students. Second, the implementation of narrative approaches led to measurable reductions in anxiety and depression among patients, particularly those with lung tumors. Third, improvements were observed in overall quality of life, pain management, and cognitive function, especially in elderly patients. These findings suggest that narrative education plays a critical role in improving both clinical and psychological outcomes. Narrative-based interventions enhance the empathetic capacity of nurses and contribute to higher standards of patient care. Incorporating narrative approaches into nursing curricula and clinical practice is recommended as a strategy to foster more holistic and human-centered care.

The Effect of Using Student Reflective Narratives to Observe Dignity and Respect for Patients’ Rights in Clinical Education
Hoda Ahmari Tehran, Ahmad Mashkoori, Tayebeh Ilaghinezad, Maryam Tajadini,
Volume 17, Issue 0 (12-2024)
Abstract
Research shows that stress in medical students leads to burnout and a loss of respect for patients’ rights. These declines in mood and an increase in malpractice are particularly evident during the internship period. On the other hand, literature highlights the importance of reflective practice in education. This study investigates the effect of using student reflective narratives on observing dignity and respect for patients’ rights in clinical education. A mixed-methods study based on reflective learning theories (Gibbs' Reflective Model) was conducted over 12 months with 48 intern students. In a quasi-experimental design, 38 medical students were randomly assigned to either an intervention or a control group. Only students in the intervention group were allowed to engage in conversations with patients and inquire whether they had properly respected the patients’ rights and dignity. The students then reflected on their performances. In the first week, a pretest was conducted in both groups. The intervention group received reflective education and participated in reflection writing during the second and third weeks. In the final week, a post-test was conducted for both groups. To explore students’ perceptions of the effectiveness of reflecting on their performance, a qualitative content analysis was carried out, including 12 semi-structured interviews and 144 reflection notes. The mean scores of students’ performance regarding respect for patients in the intervention group improved significantly in the post-test (12.32 ± 1.21) compared to the pretest (9.85 ± 1.39) (p < 0.05). An independent t-test indicated that the difference in post-test scores between the two groups was significant (p = 0.01). From the interviews, four main themes emerged: improving empathy and understanding patients’ feelings, paying attention to patients’ humanistic dimensions, respecting patients’ autonomy and rights, and promoting interpersonal communication skills. This study demonstrated the positive emotional effects of reflective narrative writing interventions on medical students in observing dignity and respecting patients' rights. It is recommended to incorporate reflective narratives into medical education programs to enhance these qualities.

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