فصلنامه اخلاق پزشکی
پیاپی 29 (پاییز 1393)

The impact of clinical environment training is more than theoretical training curriculum, and the students do what the teachers do, not what the teachers say, so According to the role modeling of the teacher in transferring the professional features, the howness of teacher's interaction in the clinical environments, observed from the view points of the medical students, is a valuable subject for studying. Then this study investigates and classifies five dimensions of teacher's interactions in clinical curriculum from the view points of the medical students. The method of study is descriptive, surveying type. The population was all the stagers and interns of Shahed University, in the academic year 1391-2 (N=175), out of which, and with recourse to Krjsy and Morgan table, 123 sample were selected. The research instrument was researcher-make questionnaire on the interactive dimensions assessment of medical teachers. The form and content validity of the device was met and the coefficient Cronbach's alpha was 0/95. The less-than-half average of teacher's interactions with students (2/63) and the more-than-half average of his interactions with patients (3/29) in clinical curriculum were significant. But the average of howness of teacher's interactions with colleague (3/16), with people (2/95) and with himself (3/00) was not significant. The Inferential test, presented average ranking of teacher's interaction was as such: teacher's interactions with patient (3/72), with the colleage (3/44), with himself (3/18), with people (2/71) and finally with students (1/95) (P≥0/05). The necessity of improving the knowledge and practical skill of medical teacher especially with his student and with people, with himself and with colleague signifies the pure attention of the teacher being focused on an acceptable interaction with patient in Clinical educational environments. The less-than-average interation with student could, undesireably, result of unsuitable education of the teachers to the clinical students.

Hospital ethical climate is typically an organizational climate, comprising interpersonal relationships amongst treatment personnel as well as personnel’s rapport with patients and their families. Since ethical climate could be influenced by various working conditions and managerial policies, it may vary from one organization to the next. The present study was designed and implemented to investigate nurses’ perception of the ethical climate governing teaching hospitals in a centrally located town in Iran. This was a descriptive-sectional study using Olson’s hospital ethical climate questionnaire conducted on 370 nurses employed at selected hospitals in 2012.Study results revealed mean nurses’ perception of the hospitals ethical climates was (3/22±0/78). The most favorable climate was found among the management (3/56±0/98), and the least among doctors (2/83±0/78). Also, ethical climate significantly correlated with gender (P=0/05) and with marital status (P=0/001). Given the ethical climate score obtained in this study (that was lower than that obtained in previous studies), and given the importance of ethical climate and consequences of its deficiency, it is seems necessary for hospital officials and policy makers to adopt appropriate plans to enforce more favorable ethical climate in hospitals.

All health care systems around the world are faced with the problem of limited resources. Therefore a fair allocation of resources is one of the most important challenges of health systems and it is the main section in the decision-making process. Having a fair health care system and equitable allocation of resources in the health care systems needs to use ethical criteria for distribution of resources.This paper has been developed to present an overview of the financial allocation methods in an ethical perspective. We used some data bases(PUBMED and Google Scholar) and books and papers to study the methods used for the financial allocation in the health care systems. It seems an appropriate combination of population indicators, mortality and additional costs related to rural and remote areas and socio-economic indicators can improve fairness in allocation and distribution of funds in the health care systems

patients’ privacy is a very importance variable that effects patient satisfaction and their perception of quality of care. However, most of studies in this area were conducted in emergency units and among non-older age groups. The aim of this study was to evaluate the elderly patients’ perceptions of their privacy and their satisfaction in selected hospitals in Esfahan. This cross-sectional survey was conducted on 330 elderly inpatients in selected hospitals in Esfahan and Kashan cities that were selected conveniently. Data were collected using the patients’ privacy and satisfaction questionnaire that was previously validated and was reliable (Cronbach's alpha 0.84). The data were analyzed using descriptive statistics, Kruskal-Wallis, Mann-Whitney U and Spearman correlation testes. The overall privacy mean score was in poor level at 15.2% of cases. It was at moderate and good levels in 68.5% and 16.4% of cases, respectively. The privacy was at moderate level in physical dimensions (64.2%), information dimensions (70%) and psychosocial dimensions (72.7%). In total, patients’ satisfaction was at moderate level in all dimensions of privacy. The present study showed that elderly patients’ privacy was being observed at moderate level in most of domain. Consequently, the elderly patients’ satisfaction was also at moderate level. It is therefore necessary to pay more attention in the elderly patients’ privacy.

Moral distress is a prevailing phenomenon in nursing which can cause conflict on care and facing the patient and presenting qualified care and this case can interfere in the process of access to care system objectives and finally have negative impacts on the society health model too. In this descriptive study, 153 of nurses employed in selected training hospitals of Shaheed Beheshti University of Medical Science have been studied in census method. In order to study the data, the questionnaire of individual data and standard Corley's Moral Distress questionnaire were used. The reliability of the questionnaire was studied through intra-class correlation coefficient which was equal to 0.88,Also in order to determine the internal stability of the tools, Cronbach's alpha coefficient has been used which was equal to α=0.87. The results of the research showed that the average score of moral distress of nurses was 44.8±16.6 which shows the moderate level of moral distress. Considering the outcomes of moral distress in nurses, further familiarity with this phenomenon and presenting approaches to combat against it seems to be essential.

A healthy and successful society is formed by healthy and knowledgeable mothers. How mothers deliver babies plays a great role on their own health. Women should be free to choose knowingly during their pregnancy and child delivery. Doctors are to help women, not to control them or decide on their behalves. According to the general principles of medical ethics, in order to preserve and respect the “right to decide” of patients capable of making their own decisions, medical teams must provide their patients with all their required information and complete, unbiased and reliable facts about their condition so they can make their own decisions with freedom and awareness. Medical teams must also bear in mind the basic principle of “Assessment of risks and benefits” in their medications and prescriptions, and they must try to find the most optimized condition by fine-tuning the two parameters, in order to treat the needs of their patients. Cesarean is a method of child delivery that, in recent years, has attracted many women, without having any knowledge of how it is done or what the consequences are. This paper tends to study social elements that have tempted women into Cesarean during recent years. The research methodology is a survey. The sample volume came to 200 women, using Cochran Formula. The statistical population included 3-month pregnant women going to hospitals of district1 in Tehran. The tools of data gathering were questionnaires firs, demographic characteristic of the samples (age, education, marital, status) were described and frequency and percentage charts were drawn. Finally, descriptive statistical charts were used to describe variably like Cesareans encouraged by physicians, body fitness and fear of natural delivery, modeling and fading of motherhood duties, advantages of natural delivery and disadvantages of Cesarean.Findings are as follows: There is a noticeable relationship between the selections of Cesarean and knowing the consequences, doctors encouragements, fear of natural delivery, modeling, keeping body fitness, social and economic level of women; there is no such noticeable relationship between selection of Cesarean and knowing the advantages of natural delivery and fading of motherhood duties.

One of the aspects of clinical communication is the process of delivering bad news. Informing bad news has subtle psychological details that the informer has to be aware of them. So the researcher conducted this study to assess nurses’ knowledge about how to convey bad news to patients and their companions in Persian Gulf Martyrs’ hospital of Bushehr in 2013 In this descriptive-analytic study which was done in a cross-sectional form, knowledge of nurses working in Persian Gulf Martyrs’ Hospital of Bushehr. Data collected by a researser made questionnaire. Data analyze was by descriptive and analytic statistics. Analysis of the data revealed that most nurses had good knowledge. On the other hand a significant difference was seen between the gender groups (p=0.004), the groups of job experience (p=0.041) and the workplace (p=0.031) in knowledge level. Although there wasn’t seen any significant differences in knowledge level in order of the rate of interest in the job (p=0.104) and degree (p=0.189). According to the results obtained from this study and also with an emphasis on the importance of transferring bad news, we can be hopeful that with the development of appropriate training programs in this field, more desired results can be achieved.