فصلنامه اخلاق پزشکی
پیاپی 36 (تابستان 1395)

Phenomenon of moral distress in critical care environments, have different effects on the quality of care and good communication between members of caring team, especially Physician and nurses could to be effective in prevention of moral distress in nurses through creating desirable ethical atmosphere. This study aimed to determine the relationship between moral distresses with the Physician-nurses relationship in ICUs of the South Khorasan province.
215 nurses were recruited to the study by convenience method. Corly moral distress questionnaire and Shortell questionnaire of communication assessment between physician and nurses in ICUs were used for data collection. Data were analyzed by SPSS 16 software and using descriptive and inferential statistics.
Ethical Considerations: Participants verbal consent was obtained and anonymously and confidentiality of the completing questionnaires was assured to them.
Findings: The mean scores of moral distress severity, moral distress frequency and Physician-nurses relationship were 3±0/59, 3/66±0/5 and 3/2±1/1, respectively. There was significant direct correlation between mean score of communication between physician and nurses with moral distress frequency (r=-0/34, P regarding undeniable role of good communication between physician and nurses in reducing the frequency of moral distress, it is necessary to determine the effective factors on this relationship and also provide strategies to promote desirable ethical atmosphere, in order to diminish of this phenomenon.

The right of patients to make decisions about their medical care, based on informed consent rule and the principle of respect for autonomy rooted from philosophy of liberalism. Patients with capacity are responsible for decision-making, but in those lacking capacity, a surrogate decision maker is needed. This process consisted of three parts: choosing surrogate decision maker, how to make decision and its criteria, if they founded on the intellectual foundations of liberalism, will faced with the challenges, so, must be sought the its solution ways in other philosophical systems. This narrative research tries to analyze and criticize the process of surrogacy decision making based on theoretical essentials of liberalism, meanwhile descript epistemic sources of liberalism. In conclusion, although, medical ethics based on liberalism principles has been designed in a structured manner and can resolve some problems of ethical decisions in medicine, could be however faced with serious challenges.

Empathy plays an important role in the interaction between physician and patient. This study aimed to assess the empathic attitudes of medical students that studing in Medical Sciences schools of Tehran city, in 2015.
In this cross-sectional study, 373 medical students were selected using stratified random sampling. Data was collected using the Jefferson Scale of Empathy-the Student Version. Data was analyzed using descriptive and inferential statistics via the SPSS v.16 software. The significant level was set as pEthical Considerations: Participants verbal consent was obtained and anonymously and confidentiality of the completing questionnaires was assured to them.
Findings: According to the empathy scale (20-140), the medical students had a mean empathy score of 82.94 (SD=±7.08), with the highest level for perspective-taking dimension (26.81±2.80). Empathy scores among students varied depending on gender, age, and marital status (p Empathy with patients was different among medical students in various years of education. Such, the rate of empathy with patient was reduced with increasing the students’ age and educational level. Regarding to significance of empathy as a moral virtue, it is recommended planning to strengthent empathy with patients and inclusion of it in medical students’ curriculum, in order to improve the mental and spiritual health of patients.

Genetic manipulation of the embryo is a field of human knowledge, where that genetic engineering can provide an acceptable treatment for some disorders. This new technologies meanwhile, important developments in the treatment of some diseases, has been caused numerous issues in the field of bioethics; in the medical, biologic, ethical and legal aspects. Thus, this narrative review aimed to evaluate the challenges and disadvantages of the embryo genetic manipulation.
The present narrative study was conducted by using key words such as gene therapy or genetic manipulation or genetic engineering, and ethical and legal issues. This comprehensive search was conducted in the SID, PubMed, Scopus and Google Scholar databases and in the period 1990 to 2015. Then, 30 related articles were reviewed and analyzed.
Ethical considerations: Honesty and integrity in the search, analysis and reporting texts were taken into consideration.
Findings: we identified two issues under the embryo genetic manipulation: gene therapy and eugenics. This study showed that embryo genetic manipulation increased some problems such as the occurrence of viral infections, ‘eugenics’ and ‘children Order’ phenomena and also, high financial costs. These problems can causes ethical issues such as monopoly, discrimination against persons with disabilities, aggression to fetus autonomy and the conflict between private and public interests.
It is required to be Precise controlling in the genetic manipulation of embryo, especially by considering ethics and legislation.

The nurses need to possess moral reasoning besides the clinical skills. Therefore, this study was conducted to determine the moral reasoning ability of the registered nurses in academic hospitals affiliated by Shahid Sadoughi University of Medical Sciences, Yazd in 2012.
This cross-sectional study was carried out on 360 registered nurses at 4 Educational hospitals through convenient sampling. Data were collected by using Nursing Dilemma Test questionnaire. Spss software version 18 was applied to analyze the data.
Moral Considerations: The aims of the study and confidentiality of the data were explained to the participants and their verbal consent for participation in the study were obtained.
Findings: The mean score of the nurse's moral reasoning was (44/1±6/15). No significant relationship was found between the moral reasoning ability of the nurses and the frequency of their exposure with each of moral dilemmas (P>0.05, r=0.013). There was no significant relationship between the mean score of the moral reasoning and the participant's age and work experience (P>0.05). There is not significant relation between mean score of the participants with their sex and work place (P>0.05).
Since the nurse's moral reasoning ability in the current study was moderate, and given the importance of nurse's abilities in dealing with moral dilemmas, and also, its effect on delivering optimal care for patients, we suggest planning and putting into action proper strategies.

The importance of culture, tradition and spirituality has been well- known in pregnancy and childbirth. Cultural safety is met through actions which recognize, respect, and nurture the unique cultural identity of people, and safely meet their needs, expectations, and rights. Cultural safety empowers people and promotes self-confidence. This study aimed to investigate knowledge, attitude and practice of the nurses and midwives, about the mothers’ cultural safety.
In this cross-sectional study, 104 midwives and nurses working in hospitals of North Khorasan province were studied. A researcher-made check list and a three-part questionnaire including: Demographic information, knowledge and attitude were used to data gathering. Data was analyzed using SPSS ver.21 software in significance level Ethical Considerations: After presenting the objectives of the study and emphasize on privacy and confidentiality of data to participants, informed consent was obtained.
Findings: The mean score of the participants knowledge, attitude and practice were 4/32 from maximum 10 (inappropriate), 46/62 from maximum 60 (relatively appropriate) and 101/13 out of 150 (relatively appropriate), respectively. Correlation test results revealed significant relationship between knowledge, attitude and practice of the participants (P0.05).
Although, the practice of participants for observance of the cultural safety was Favorable, regarding to new national approach of the population policy, and cultural diversity of Iran society, educational planning for students, midwives and nurses, and other health care providers about mothers’ cultural safety is suggested.

Cultural diversity among patients is of the issues affecting nurses in clinical settings. Therefore, the cultural competence of nurses is essential to communicate effectively with patients and improve their health. This study was designed to evaluate the cultural competence among nurses employed in the hospitals affiliated with Ilam University of Medical Sciences, Iran, in 2014.
This cross-sectional study was conducted on nurses working in hospitals of Ilam University of Medical Sciences, in which 215 nurses selected by convenience sampling. Data were collected using Moulder's cultural competence questionnaire by self-assessment method, and then analyzed using descriptive tests, t-test and Spearman correlation coefficient via the SPSS 18 software.
Moral Considerations: Informed consent was obtained from the participants for attending and conducting research, after complete description of the research objectives and assuring that the information is completely confidential and has no effect on their professional evaluation process.
Findings: 55.81% of female participants had a bachelor's degree (95.34%) with 2 to 5 years of work experience (45.58%). Average score of cultural competence of nurses was at a moderate level (115.03±25.56). The results also showed the highest average score of cultural competence in terms of preparation for cultural care (50.16±13.16) and the lowest average for attitudes towards cultural care (12.69±2.50). In addition, there was significant difference in the scores of cultural competence between females and males (P=0.001), so that the level of cultural competence was higher in females compared with males. A significant correlation was found between cultural competence and years of work experience (P=0.040), so that the level of cultural competence improved with increasing work experience.
The cultural competence of nurses in this study was reported at the moderate level. Thus, according to the importance of culture in health and social relations, planning toward promotion of cultural competence among nurses is essential.

Privacy is one of the fundamental rights of human being that should be respected, particularly in health care organizations. However, most studies in this area have been in intensive care units and non-older age group. The aim of this study was to determine elderly patient’s views about the observance of the different aspects of their privacy during nursing care.
this descriptive-analytic study was done on 100 patients (by using Cochran) in the medical and surgical wards of the hospitals affiliated in Birjand University of Medical Sciences-Ferdows that were selected conveniently. Data were collected by a questionnaire consisted of two parts: demographic characteristics and privacy in the realm of human (12 questions) and personal space (18 questions). Data was analyzed by using descriptive statistics (mean and standard deviation) and inferential statistics (t-test, ANOVA, Mann-Whitney, Spearman tests) through SPSS version 18.
Ethical considerations: informed consent was obtained, after explaining about study aim, anonymously and confidentiality of the information, verbal consent of the participants was obtained. Data collection was done by persons with similar sex.
Findings: The most of participants reported weak rate of the observance of human area with a mean score of 16/95±5/73 (74%) and also, personal space with a mean score 11/55±2/15 (99%). The mean of the total score of the patient privacy was low (28/50±6/54). There was no significant relation between patient sex with the rate of the observance of human area and total score of the patient privacy.
the elderly patients’ privacy was being observed at low level. Therefore, it is necessary to educate nurses and health providers about observance of the elderly patients’ privacy and enhance of the supervisory practice of the managers in related area. Elimination of Shortage of human resources in order to improve the quality of care with respect of patients also is helpful.