Iranian Journal of Medical Ethics and History of Medicine

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According to the professional definition of ethics, ethics is a sustainable and steady way of communication based on rights of both sides and also professional ethics is to know and act to your ethical responsibilities that every real or legal person has to others. Therefore, one of the measures of  the ethicality of a university is students rights and we can count those rights to find the ethical responsibilities.
From the very beginning of entering to the university and even when the student is admitted, he/she has rights which some of them are related to the educational system. (Of course the other parts are related to the environment, including family, friends, professors, different branches of university and totally other elements of society which are not the concern of this article). Students rights can be divided into two types: the first type is those rights which have been changed into rules and are in the form of regulations and instructions and need to be followed. The other type is those rights which are not official yet and they are just some ethical principles. These rights are called ethical responsibilities and in this article we deal with these responsibilities towards students. Therefore, it is necessary to know the students rightsin the educational system and they can be the basis of many ethical judgments for the university.
Students rights are not just related to the educational system and they surround other parts of university and society as well, but the students rights in the educational system have a straight relation to his/her learning and scientific development, so those are considered as the the most important rights of students and acting to them is also very crucial.
By counting the students rights in the educational system, the university would be aware of its duties practically and it will be the first step of implementation of ethics in the university. Total duties of university and educational system towards student's rights are as following:

• 1- To recognize the students right.
• 2- To comply and show sensitivity to the students rights.
• 3- To comply the characters
• 4- Make restitution for lack of compliance.
  

If we look at the students rights from the university's point of view, then we should consider the duties of university all based on professional principles which are like Copernican Revolution. According to this: "others have rights and we have duties." i.e. for determining the educational duties of universities towards the students, we should first consider the students rights and then the duties of the university.

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Nurses are confronted with numerous situations calling for moral decision-making in their workplace every day. Nursing students should therefore attain a satisfactory level of moral development during their university years. The present study was conducted to determine nursing students’ level of moral development, as there seems to be a shortage of similar studies throughout the country. This descriptive, correlational research was performed in 2010 study samples were 115 junior and senior students of the Department of Nursing and Midwifery of Tabriz University of Medical University who were selected by census. These students’ level of moral development was evaluated through the Nursing Dilemma Test (NDT), which has been created based on Kohlberg’s theory of ethical development. NDT assesses nurses’ moral development in three levels: pre-conventional, conventional and post-conventional, and evaluates their observance of clinical considerations at the same time. A number of the participants’ sociodemographic characteristics were also collected through a questionnaire. Data analysis was performed using SPSS statistical software, and descriptive and inferential statistics. According to the findings of this study, 13 students (11.3%) were in the pre-conventional, 33 (28.7%) in the conventional, and 55 (47.8%) in the post-conventional level, and 14 (12.1%) took clinical considerations into account more than others. There seemed to be no meaningful statistical relationship between the students’ moral development and their age (P = 0.49), sex (P = 0.21), marital status (P = 0.79), place of education (P = 0.32), and year of education (P = 0.92). These results showed that although approximately half of the students under study were in the post-conventional level, which is an acceptable level of moral development, a great percentage were still in the lower levels. This means that those in administrative positions in nursing departments need to pay more attention to the moral education of nursing students.

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Do not resuscitate order (DNR) is one of the most challenging issues in end of life care. The attitude of health care providers has an important role in legalization of this procedure. The aim of the present study was to investigate the viewpoints of nursing students on DNR orders. One hundred and eighty six nursing students from Tabriz University of Medical Sciences (TUOMS) and Kurdistan University of Medical Sciences (KUMS) participated in the present study. Data collection was performed by Attitude on DNR Order Questionnaire that consisted of 25 items. The results showed that nursing students have a negative attitude toward many aspects of DNR orders, had many misconceptions about this procedure and tended to acquire more information about it. Also, students reported a negative attitude about passive euthanasia and reported that cultural and religious factors are important in their attitude toward DNR orders. Moreover, there was no statistical difference between the attitudes of nursing students from these two universities with two different cultural and religious backgrounds (P > 0.05).Considering the lack of knowledge of nursing students about DNR orders it is suggested that nursing students should be educated on the subject. Due to little research evidence conducting further studies is recommended.

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Assessing nursing students’ level of respect for ethical codes of nursing is essential as these students are the future health care providers. There is a need to check observance of ethics codes among students, because that will determine ethics education and training needs. This study aimed to assess nursing students’ compliance with professional ethical codes and some of the relevant factors.This is a descriptive-analytic and cross-sectional study performed by census on 118 nursing students who were training in hospitals of Shahid Beheshti University of Medical Sciences. The data gathering tool consisted of a questionnaire including demographic information, and another questionnaire which was developed by the researcher based on studies in Iran and throughout the world.The ethical codes that were respected most included "principles of conflict management" and then "respect for the medical staff". "Respect for patients' rights" and "patient education" received less consideration. Grade point average, gender, marital status, interest in nursing and likelihood to work in nursing had significant association with respect for ethics codes.The results of this study can be used in developing courses on nursing ethics and educating nurses on the subject, and could be of special interest to health planners and policy makers.

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This study aims to develop a national questionnaire that measures the moral sensitivity of Iranian medical students. The questions were developed based on ethical vignettes in educational documents, the professional code of conduct in Tehran University of Medical Sciences and medical students’ workbooks in ethics course. A pilot study was conducted to evaluate the clarity and appropriateness of 7 primary questions. Next, 38 questions were reviewed for content and face validity by an expert panel including 7 expert teachers and 4 lay experts (medical students). In order to assess the reliability of the finalized 35 questions, a test-retest was conducted on 30 medical students with a 2 weeks interval. Through test-retest study, the median values of intraclass correlation coefficient (ICC), Spearman and Kappa were calculated at 0.81, 0.65 and 0.53 respectively. The final version of this instrument consists of 24 scenarios, each presenting an ethical challenge, and has a Cronbach’s alpha reliability score of 0.67. The final questionnaire could be used as a valid and reliable research instrument to determine the moral sensitivity level of Iranian medical students. Another application for this instrument may be evaluation of the effectiveness of curricular reforms by longitudinal studies. To the best of our knowledge, this is the first context-specific instrument on moral sensitivity assessment in Iranian medical schools.

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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 climate of clinical settings is one of the effective factors on the quality of clinical education and students' attitude toward their field of study. This research aims to determine the relationship between the ethical climate of operating rooms and the students’ attitude toward their field of study in hospitals of Tabriz University of Medical Sciences.All medical students in the operating rooms of Tabriz University of Medical Sciences in their second semester during the academic year 2013 - 2014 were entered into this analytic study. In addition to the demographic questionnaire, Olson’s Hospital Ethical Climate Survey and a student attitude questionnaire were used to collect the information. Data were analyzed by the SPSS 18 software using descriptive and analytical statistics methods including chi-square test and Spearman's ordinal correlation coefficient.Most of the students were female (61.4%) and single (86.8%) and the mean of their age was 20.87 ± 1.54. Additionally, 64.9% of the students had a negative perception of the ethical climate in operating rooms, while 51.8% had a positive attitude toward their field of study. Moreover, a significant relationship was found between the ethical climate and attitude of operating room students toward their field of study (P ≤ 0.001, r = 0.56). Despite the negative ethical climate of operating rooms, most of the students had a positive attitude toward their field of study. In view of the direct relationship between these two variables, improvements in the ethical climate of operating rooms and students’ attitude toward their field of study can positively affect their future career.

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The principal objective of the nursing profession is to provide evidence-based and competent care mainly based on humanitarian and ethical principles. Ethical care is contingent on a proper level of moral reasoning, which can be categorized into pre-conventional, conventional and post-conventional reasoning. At the pre-conventional level, individuals are mostly self-oriented and prefer obedience to avoid blame. At the conventional level people apply laws and social principles to decision-making, and at the post-conventional level they try to guide their actions and behaviors with regard to ethical principles and make humanist and ethical decisions. This study aimed to assess the level of moral reasoning in nurses and nursing students by providing an analysis of the existing literature on moral reasoning.For the purpose of this study, we conducted an extensive search of the papers published between 1980 and 2014 on international electronic databases including Scopus, Google scholar, Science Direct, PubMed, Proqust and Elsevier. We also reviewed papers published between 1985 and the autumn of 2014 on Persian electronic databases Sid, Magiran and Iran Medex. A broad range of search keywords were used such as: ethical growth, moral growth, ethical development, moral development, ethical reasoning, moral reasoning, nurse, and nursing student. In total, 35 studies were reviewed at this stage.Based on the results of the above-mentioned studies, most nursing students and nurses reason at the conventional and post-conventional level, and nursing students reason at a higher ethical level in comparison with nurses. We also found that teaching ethical concepts helps improve ethical reasoning, and that an inverse relationship exists between clinical experiences and ethical reasoning.Although in most studies, the level of moral reasoning in nursing students and nurses was found to be at the conventional and post-conventional level, this is not enough to provide superior professional care. It is therefore essential to apply the necessary measures such as improving clinical environments and the ethical education system to further promote the reasoning ability of nurses and nursing students, so that they can make their decisions based on ethical principles and at the post-conventional level

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Values in the nursing profession improve the quality of patient care and enhance job satisfaction among nurses. Therefore, promoting professional nursing values is an important aspect of nursing education. The purpose of the present study was to evaluate the professional values among nursing students in their last semester in nursing schools across Kerman province.A total of 152 students in their last semester in five schools of nursing across Kerman province (cities of Kerman, Bam, Jiroft, Zarand and Rafsanjan) participated in this cross-sectional study. Data were collected using a two-part questionnaire that included demographic variables and Nursing Professional Values Scale - Revised (NPVS-R) in five dimensions (caring, activism, trust, professionalism and justice). The reliability of the questionnaire using Cronbach's alpha coefficient was calculated at 0.91. Data were analyzed using descriptive statistics (mean and standard deviation) and inferential non-parametric statistical tests (Mann-Whitney and Spearman’s rho correlation coefficient) in SPSS 18.Of the five dimensions of professional values, the highest mean score (37.8 ± 4.6) pertained to the caring dimension and the lowest mean score (12.68 ± 1.92) was related to the justice dimension. There was a significant negative correlation between age and professional values (r = - 0.02, P = 0.01). Results of the Mann-Whitney test showed a statistically significant difference between the mean scores of the justice, activism, trust and professionalism dimensions and sex (P < 0.05) and between the total mean score of professional values and the place of education (P = 0.003).From the perspective of students, the dimensions of professional values were prioritized in the following order: caring, trust, activism, professionalism and justice. Nevertheless, the majority of students were not aware of the importance of some dimensions of professional values. Therefore, appropriate planning and teaching methods and strategies are required to enhance all dimensions of professional values.

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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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In the nursing profession, ethical practice is contingent upon the nurses’ ability to determine the ethical issues in their vocation, and their sensitivity to these issues in the nurse-patient relationship. In order for the health system to have a strong and solid foundation, this sensitivity must be formed in nursing students during the early stages of their education. Educational environment and clinical experience each affect ethical sensitivity in their own way. The purpose of this study was to determine and compare the ethical sensitivity of third and fourth year nursing students and nurses in Islamic Azad University, Mashhad branch during 2014.

In this cross-sectional study Lutzen’s Moral Sensitivity Questionnaire was used, and its validity and reliability was confirmed. According to the formula for sample size, 110 persons were sampled in each group. Sampling was performed randomly among the third and fourth year students, and in two stages among the nurses: first cluster, and then randomly. Data were analyzed using descriptive and analytical statistics by SPSS software.

The mean and standard deviation of moral sensitivity was 3.33 ± 0.36 in nursing students, and 3.27 ± 0.35 in nurses, and the independent t-test showed no significant difference between the two groups (df = 218, t = -1.06, P > 0.05). Moreover, there was no statistically significant difference between the mean scores of moral sensitivity based on demographic characteristics.

It was concluded that the ethical sensitivity of nurses and nursing students of Islamic Azad University, Mashhad branch was satisfactory, which can be considered as a point of strength for policy makers of the health system.

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Ethics of care are the central core of nursing values and a fundamental concept in the nursing profession. Since the outlook of nurses on ethics can affect the quality of care, the present study was conducted to investigate the attitude of nursing students to codes of ethics for nurses, their commitment to ethics of care, and academic dishonesty in Abadan School of Medical Sciences. 

This descriptive analytical study was performed among 150 nursing students of Abadan School of Medical Sciences by census sampling in 2016. After giving their informed consent, the students completed the questionnaire designed by McCrink in 3 sections: 1) demographic information, 2) attitude to ethics codes, commitment to ethics of care and neutralization behaviors, and 3) outlook on academic dishonesty. Data were analyzed using descriptive statics, chi-square test and Pearson’s correlation coefficient in SPSS version 21.

The results showed that the students had the most positive attitude to ethics codes and commitment to ethics of care, and the most negative attitude to neutralization behaviors. Less than half of the participants had a negative outlook on academic dishonesty. Moreover, about 40 percent of the students reported academic dishonesty among their classmates. Ethics codes are moral values in academic and clinical settings and should therefore be considered as major components of initial nursing education programs. Additionally, it seems necessary to make efforts in order to change nursing students’ attitude toward academic dishonesty.

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Moral intelligence is the ability to utilize principal criteria that can lead to effectiveness of individual reactions. The aim of this study was to determine the relationship between moral intelligence and communication skills among bachelor’s students in nursing at Tehran University of Medical Sciences, Iran, in 2016-2017. 

This was a descriptive-correlational study. The study population consisted of all nursing students studying at the School of Nursing and Midwifery of Tehran University of Medical Sciences. Among the study population, 204 subjects were selected through convenience sampling method and based on the inclusion criteria (direct acceptance in the field of nursing, absence of any illness, and willingness to participate). The data collection tools consisted of a demographic characteristic questionnaire, the Moral Intelligence Scale (Lennick & Kiel), and the Communication Skills Inventory (Jerabek). The validity and reliability of both instruments had been approved in similar studies in the country using Cronbach's alpha coefficient (α = 0.88 and α = 0.71, respectively). The reliability of the two questionnaires was calculated in the current research using Cronbach's alpha (α = 0.85 and α = 0.81, respectively). Data were analyzed using descriptive (average and standard deviation) and inferential statistics (t-test, Pearson correlation coefficient, and ANOVA test) in SPSS software. The mean moral intelligence score was 71.98±7.12 and ranged from 20 to 100 and mean communication skills score was 114.9±9.67 and ranged from 34 to 170. Pearson correlation coefficient revealed a significant and positive relation between moral intelligence and communication skills of nursing students (r=0.54, P ≤ 0.001). Thus, the communication skills of students can be improved by strengthening their moral intelligence. Therefore, it is suggested that the grounds for the strengthening of moral intelligence among nursing students be provided.

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Empathy is a necessary condition for an effective nursing care. An empathetic relationship between nurse and patients leads to positive treatment outcomes and moral sensitivity among students in clinical and educational environments. This study was conducted in 2014 to determine the level of empathy among nursing students and its relationship with their demographic data. A cross-sectional study (Descriptive analysis) was undertaken using paper-based versions of the Jefferson Scale of nursing Empathy. By using stratified random sampling, 320 undergraduate students from the first to forth-year of their program in Tehran University of Medical Sciences were selected.

The result shows that participants reported good empathy levels, and the average of empathy score was 103 ±11. Empathy scores increased with increasing academic year. There was a significant relationship between sex and empathy. Students who did not passed the effective communication course scored higher than their counterparts. Empathy score increased with age, and older students recorded higher scores than their younger colleagues. Single and employed students recorded higher empathy scores than married and unemployed students.

There were no significant differences between the place of living (dormitory versus personal house), Interest in nursing education as well as their marks.

Regarding the relationship between empathy with students’ academic years, the finding offers insights into the importance of incorporating and promoting empathy in nursing curricula from the first year of training.

In addition, it is necessary to pay more attention to teaching empathy to male students.

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Maintaining the privacy is one of the most fundamental rights of the patients, based on the need for respect to human dignity. Considering that today's students are tomorrow's nurses who are directly involved with patients during and after their education, it is necessary to review their performance regarding the privacy of patients. Therefore, the present study aimed to investigate the privacy practices of patients among trainees and interns of the Faculty of Nursing and Midwifery of Bushehr University of Medical Sciences. This was a descriptive analytical and cross-sectional study. A total of 283 nursing and midwifery students of Bushehr University of Medical Sciences who had the necessary features to enter this study were selected by consensus method. The data collection tool was privacy questionnaire made by Heidari (2000), which validity and its reliability was confirmed. Data analysis was performed using SPSS software version 23 as well as statistical tests (T-test and ANOVA). The results of this study showed that the average score of patient's privacy was 09.24 ± 11.97. Also, students' performance in the area of personal, human, and in general the patient privacy was approximately good, and there was a significant difference between the average performance of trainees and interns in the domain of human (p-value = 0.002) and, in general, the privacy the patient (p-value = 0.018). There was a significant difference between the demographic factors of the educational level, ethnicity and occupation of students with practice of patient's personal privacy. Since the students' performance regarding the privacy of the patients was good, the administrators and clinicians should plan and take the necessary measures to maintain the present situation.

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