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Futility in Complementary and Alternative Medicine: A Critical Review from an Ethical Perspective
Mohammad Hossein Asgardoon, Sepehr Azizi, Azin Ebrahimi, Mohammad Hossein Ahmadian,
Volume 12, Issue 0 (3-2019)
Abstract
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.

No to Ageism in Older People: A Review Paper
Fatemeh Estebsari, Maedeh Moradpoor Ivki, Mohadeseh Mokhtariyan Delooei,
Volume 17, Issue 0 (12-2024)
Abstract
While the concept of ageism has existed across centuries, countries, contexts, and cultures, the term itself is relatively new and lacks a universal equivalent in many languages. Ageism encompasses stereotypes (how we think), prejudice, and discrimination directed towards individuals based on their age. Given the recent emergence and growing attention to this concept, this study aims to establish a common and consistent understanding of ageism within scientific literature. This review examined the concept of ageism in older adults. A search of the PubMed, Scopus, Web of Science, and Embase databases was conducted using the keyword "Ageism" and "Older adult," yielding 18,945 English-language abstracts published between 2014 and 2024. Two researchers independently reviewed the articles in two stages. An initial review of titles and abstracts resulted in the selection of 77 relevant papers. A subsequent full-text review narrowed the selection to 34 papers, of which 17 were ultimately included after a quality assessment. The findings encompassed various aspects of ageism, including types of ageism, its effects, determining factors, and strategies recommended by the World Health Organization to mitigate ageism. Age discrimination significantly diminishes the quality of life for older adults, increasing social isolation and loneliness. Ageism has profound and widespread consequences for individuals' health, well-being, and human rights. For older adults, ageism is associated with shorter life expectancy, poorer physical and mental health, slower recovery from disability, and cognitive decline. Based on the findings of this study, it is recommended to implement policies and laws, integrate ageism education into curricula from elementary school to university and in both formal and informal settings, and invest in interventions that foster intergenerational contact to effectively reduce age discrimination.

Investigating the Factors Influencing Moral Courage in Nurses: A Systematic Review
Morteza Javanmardi , Seyede Elahe Karimipour , Zahra Bakhshizadeh , Mohammad Hossein Taklif, Negin Farid,
Volume 17, Issue 0 (12-2024)
Abstract
Moral courage, encompassing the ability to act ethically in the face of adversity and uphold ethical principles, is crucial for nurses. This systematic review aimed to investigate the factors influencing moral courage among nurses. A comprehensive literature search was conducted using keywords such as "moral courage," "ethics," "nurses," and "courage" in major databases, including PubMed/Medline, Web of Science Core Collection, Scopus, Google Scholar, Irandoc, SID, and Magiran. The search included publications in both English and Persian with no time limitations. After excluding duplicates and screening the initial 2577 studies, 21 studies met the inclusion criteria. The review adhered to the PRISMA guidelines for reporting systematic reviews, ensuring ethical considerations were maintained throughout the selection, extraction, and analysis processes. The review revealed that moral courage in nurses is influenced by a multifaceted array of factors. Individual factors such as age, gender, work experience, and type of employment (e.g., permanent vs. temporary) were found to influence moral courage. Higher education, particularly possessing a master's degree or higher, and participation in medical ethics training were significantly associated with increased moral courage. Ethical sensitivity, defined as the ability to recognize and appreciate ethical dilemmas, was a significant facilitator of moral courage. A supportive work environment, characterized by factors such as strong ethical leadership, open communication, and adequate resources, was found to positively influence moral courage. Conversely, ethical distress experienced in challenging clinical situations can negatively impact moral courage. This review demonstrates that moral courage among nurses is influenced by a complex interplay of individual, professional, and environmental factors. Enhancing moral courage requires a multi-pronged approach, including strengthening nursing education with a robust emphasis on ethics training, fostering a supportive and ethically sound work environment, and implementing strategies to mitigate ethical distress. These interventions can significantly contribute to improved clinical practice and enhanced patient care.

Investigating the Relationship Between Moral Intelligence and Clinical Competence of Nurses and Nursing Students: A Systematic Review
Zahra Abdollahi, Marzieh Barahooei Noori, Mohammad Hossein Khani, Mohammad Hossein Taklif, Negin Farid,
Volume 17, Issue 0 (12-2024)
Abstract
Moral intelligence encompasses an individual's ability to discern right from wrong, possess ethical values, and demonstrate ethical behavior in practice. Clinical competence, a crucial aspect of nursing practice, encompasses a combination of knowledge, skills, and attitudes, including adherence to ethical principles. This systematic review aimed to investigate the relationship between moral intelligence and clinical competence among nurses and nursing students. A comprehensive literature search was conducted using keywords related to "moral intelligence," "clinical competence," "nurses," and "nursing students" in major international databases, including Web of Science Core Collection, PubMed/Medline, Scopus, and Google Scholar, as well as national databases such as Irandoc, SID, and Magiran. The search included publications in Persian and English with no time limitations. After removing duplicates and screening the initial 150 identified studies, five studies met the inclusion criteria. Ethical considerations, including minimizing bias in the selection, extraction, and analysis of evidence, were adhered to throughout the review process. The abstract adheres to PRISMA guidelines for reporting systematic reviews. The review revealed a significant positive correlation between moral intelligence and clinical competence across various dimensions. Studies demonstrated that higher levels of moral intelligence were associated with improved clinical competence, including ethical reasoning and clinical self-efficacy. Factors such as age, work experience, educational status, and individual rank were found to influence this relationship. Additionally, some studies indicated that moral intelligence could predict clinical competence scores, while others demonstrated that it could be a significant predictor of clinical competence alongside other factors such as Grade Point Average (GPA). This systematic review provides evidence for a significant positive relationship between moral intelligence and clinical competence among nurses and nursing students. Enhancing moral intelligence through targeted educational interventions can contribute to improved clinical competence and ultimately enhance the quality of patient care. Future research should focus on developing and evaluating educational programs designed to enhance moral intelligence in nursing education and practice.

Investigating the Effects of Spiritual Care on Death Anxiety: A Systematic Review
Mohammad Hossein Khani, Zahra Abdollahi, Marzieh Barahooei Noori , Mohammad Hossein Taklif, Negin Farid,
Volume 17, Issue 0 (12-2024)
Abstract
Death anxiety, characterized by persistent fear of death, is a significant psychological burden. Spiritual care, encompassing compassionate listening, fostering trust, and addressing spiritual and existential concerns, has the potential to alleviate this anxiety. This systematic review aimed to investigate the impact of spiritual care interventions on death anxiety in various patient populations. A comprehensive literature search was conducted using keywords such as "spiritual care," "death anxiety," "spirituality," and "patients" in major databases, including Web of Science Core Collection, PubMed/Medline, Scopus, Irandoc, SID, Magiran, and Google Scholar. The search included publications in English and Persian with no time limitations. After screening and removing duplicates, eight studies met the inclusion criteria. Ethical considerations, including minimizing bias in the selection, extraction, and analysis of evidence, were adhered to throughout the review process. The review followed the PRISMA guidelines for reporting systematic reviews. The findings suggest a potential positive impact of spiritual care on reducing death anxiety. Studies conducted among patients with chronic kidney disease, multiple sclerosis, and stroke demonstrated that spiritual care interventions, including individual counseling and group support, can effectively alleviate death anxiety and improve overall well-being. However, some studies, particularly those involving patients with cardiac problems and gastrointestinal cancer, did not show a significant reduction in death anxiety. Furthermore, research conducted during the COVID-19 pandemic highlighted the potential effectiveness of tele-nursing interventions for providing spiritual care and alleviating death anxiety in older adults. This review provides evidence suggesting that spiritual care interventions may be effective in reducing death anxiety in certain patient populations. Further research is warranted to investigate the effectiveness of different spiritual care modalities across diverse patient groups, including those with chronic illnesses, terminal diseases, and those facing end-of-life care.

Educational Strategies to Enhance Moral Sensitivity in Nursing Students: A Systematic Review
Pooriya Samadzadehshahri, Reza Mohammadpourhodki, Zahra Delir,
Volume 17, Issue 0 (12-2024)
Abstract
Nursing students, as future healthcare professionals, must develop not only clinical competencies but also ethical competencies to deliver appropriate and professional care. Moral sensitivity is a critical aspect of professional competence, enabling nurses to recognize and respond sensitively to ethical situations as patient advocates. Consequently, fostering moral sensitivity should be prioritized from the beginning of nursing education to ensure quality care. This study aimed to examine the characteristics and effectiveness of educational interventions designed to improve the moral sensitivity of nursing students. In this systematic review, articles were retrieved using Persian and English keywords from international databases, including PubMed, Web of Science, and Scopus, as well as Persian databases such as SID and Magiran, from inception until October 2024. Keywords used in the search included "moral sensitivity," "ethical sensitivity," "nursing students," "ethics," and "moral sensitivity in nursing students." A total of 2,321 articles were identified in the initial search. References for each study were also manually reviewed. Based on inclusion criteria, experimental and quasi-experimental studies published in Persian and English focusing on effective interventions to improve the moral sensitivity of undergraduate nursing students were selected for analysis. Ultimately, six articles met the criteria for thorough review, and relevant data were extracted. Two researchers independently extracted the data and assessed the quality of the studies using the Joanna Briggs Institute (JBI) checklist. A total of 190 nursing students from six selected studies participated in the research, with 60% in intervention groups. The six educational interventions identified included:
  1. Two studies on nursing ethics workshops.
  2. A nursing ethics workshop conducted through a seminar.
  3. A motivational ethical education program.
  4. A virtual narrative ethics workshop.
  5. Problem-based learning.
However, the nursing ethics workshop conducted through a seminar was not effective in improving the moral sensitivity of nursing students. Evidence suggests that while the positive effects of educational interventions on the moral sensitivity of nursing students are limited, they are nonetheless encouraging. This review highlights various approaches to ethics education and moral sensitivity development. The findings can be utilized to enhance students' preparedness and ability to navigate ethically challenging work situations. However, further research is necessary to confirm the effectiveness of these interventions in fostering moral sensitivity among nursing students.

Home-Based Care Ethical Issues and Solutions: A Review Study
Shima Yadegar Tirandaz, Azam Shirinabadi Farahani,
Volume 17, Issue 0 (12-2024)
Abstract
In recent decades, care delivery has shifted from hospital settings to community and home-based care due to factors such as an aging population, cost control, patient preferences, and advancements in technology. While home care offers advantages like patient independence and care aligned with individual values, it also presents unique ethical challenges. These challenges arise from the home environment, which may not be designed for medical care, as well as potential conflicts between the values of patients and care providers. This study aims to explore the ethical issues in home-based care and propose solutions. This review was conducted by analyzing original articles from PubMed, Scopus, WOS, and Google Scholar, using the keywords "Home-Based Care" and "Ethical Issues" until November 2024. A total of 10 studies relevant to the study’s focus were included. The studies identified several ethical challenges in home-based care, including: respecting patient autonomy, establishing trust, managing patient resistance to care, balancing autonomy with benevolence, the risk of harm, justice concerns, limited resources, managing patient expectations, decision-making capacity, disagreements on treatment, access to healthcare providers, caregiver roles, maintaining professional relationships, providing truthful information, conflicts between families and patients, self-medication, medication access, sudden changes in condition, care coordination issues, inadequate treatment due to resource limitations, insufficient psychosocial support, life-saving decisions, communication problems, ineffective care, and cultural conflicts. To address these challenges, the following solutions were proposed: respecting patient values, beliefs, and preferences; supporting patient rights in family conflicts; promoting independence; building trust through respectful communication, empathy, and encouragement; ensuring patient dignity; maintaining healthcare workers' moral obligations; avoiding coercion; adhering to legal and ethical principles; facilitating patient participation; reducing caregiver burden; providing adequate resources; and educating and guiding patients and families. Ethical challenges are inherent in home-based care. If not properly identified and managed, these issues can negatively impact the quality of care. Home care organizations and providers must implement ethical strategies to uphold patients' independence and dignity within their home environment.
 

Proposing a Charter for Ethical Peer Review of Scientific Works in the Field of Health: A Commentary
Zahra Kazempour, Hasan Ashrafi-Rizi, Mohammadreza Hashemian,
Volume 17, Issue 1 (3-2024)
Abstract
The ethics of reviewing scientific works is a crucial aspect of research ethics in the field of health, where the outcomes significantly impact prevention, diagnosis, treatment, rehabilitation, and management, highlighting the importance of the quality of research results. Accordingly, this study aimed to develop a charter for the ethical peer review of scientific works in the field of health. The significance of this commentary lies in that researchers’ and reviewers’ adherence to ethical principles can contribute to enhancing the quality of scientific works aimed at prevention, diagnosis, treatment, rehabilitation, and management in the field of health. This charter can serve as a framework for scientific work review systems, assisting research managers in identifying the ethical components essential for reviewing scientific works in the field of health to develop effective research policies and plans. Moreover, it would help reviewers and practitioners at journals, research centers, and institutes, facilitating accurate, fair, and unbiased reviews of scientific works in the field of health.

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