فهرست مطالب

اخلاق پزشکی - پیاپی 39 (بهار 1396)

فصلنامه اخلاق پزشکی
پیاپی 39 (بهار 1396)

  • تاریخ انتشار: 1396/03/09
  • تعداد عناوین: 8
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  • مقاله پژوهشی/اصیل
  • سمیه شاه حسینی، فریبا برهانی، فروزان آتش زاده شوریده، امیر کاوسی صفحات 7-17
    زمینه و هدف
    افراد مبتلا به بیماری های تهدیدکننده حیات مانند سرطان با طیف وسیعی از مشکلات از جمله چالش های روانی، اجتماعی مواجه می شوند که سبب به خطرافتادن احساس کرامت در آنان می گردد. پژوهش حاضر با هدف ارزیابی کرامت انسانی در زنان مبتلا به سرطان پستان تحت شیمی درمانی در شهر تهران، در سال 1393 انجام شده است.
    مواد و روش ها
    این مطالعه توصیفی مقطعی روی 207 زن مبتلا به سرطان پستان تحت شیمی درمانی در سه بیمارستان منتخب وابسته به دانشگاه علوم پزشکی شهید بهشتی که به روش در دسترس انتخاب شدند، صورت گرفته است. جمع آوری داده ها با استفاده از سیاهه کرامت انسانی Chochinov انجام شد. برای تحلیل داده ها از آمارهای توصیفی و آزمون های آماری ANOVA، T test و Duncan استفاده شد.
    ملاحظات اخلاقی: پس از بیان اهداف پژوهش، تاکید بر محرمانه ماندن اطلاعات و کسب رضایت آگاهانه شفاهی از شرکت کنندگان، گردآوری داده ها انجام شد.
    یافته ها
    در این مطالعه نمره کلی کرامت 1/94 از 5 بود. میانگین نمره کرامت بیماران در بعد تجربه علائم تنش 2/40 و انحراف معیار 0/96 بود و پس از آن ابعاد تنش وجودی با میانگین (1/87 و انحراف معیار 0/75)، آرامش ذهن (با میانگین 1/87 و انحراف معیار 0/77)، وابستگی (با میانگین 1/71 و انحراف معیار 0/77) و حمایت اجتماعی (با میانگین 1/33 و انحراف معیار 0/55) بیشترین نمره را به خود اختصاص دادند.
    نتیجه گیری
    یافته ها بر شناسایی منابع مختلف تنش تجربه شده در زنان مورد مطالعه برای کمک به گروه مراقبتی درمانی به ویژه پرستاران در جهت اتخاذ تصمیمات مناسب دلالت دارد.
    کلیدواژگان: کرامت انسانی، سرطان پستان، شیمی درمانی، تنش، ایران
  • جواد خواجه مظفری، محمدباقر سهرابی، ربابه زروج حسینی، پونه ذوالفقاری، فاطمه نجفی، الهه یحیایی صفحات 19-25
    زمینه و هدف
    گزارش صبحگاهی از روش های رایج و ارزشمند آموزش بالینی در سطح جهان است. این مطالعه با هدف تعیین تاثیر آموزش موازین اخلاق پزشکی بر کیفیت جلسات گزارش صبحگاهی از دیدگاه دانشجویان پزشکی، دانشگاه علوم پزشکی شاهرود انجام شده است.
    مواد و روش ها
    این مطالعه مداخله ای قبل و بعد، بر روی 120 نفر از کارورزان پزشکی بیمارستان امام حسین (ع) شاهرود در سال 1393 انجام شد. ابزار گردآوری داده ها، یک پرسشنامه پژوهشگر ساخته بود که روایی و پایایی آن مورد سنجش قرار گرفت. وضعیت رعایت موازین اخلاقی در جلسات ارائه گزارش صبحگاهی قبل از آموزش و سه ماه پس از آموزش بررسی شد. سطح معنی داری کم تر از 0/05 در نظر گرفته شد.
    ملاحظات اخلاقی: رضایت آگاهانه شفاهی شرکت کنندگان، پس از توضیح در مورد هدف مطالعه، بی نامی و محرمانه بودن اطلاعات کسب گردید.
    یافته ها
    33 نفر (27/5 درصد) از شرکت کنندگان مرد و 87 نفر (72/5 درصد) از آن ها زن بودند. میانگین مدت دوره کارورزی گذرانده شده توسط اینترن ها 6/5±10/5 ماه (17-3) بود. میانگین موارد مطلوب از 17 مورد قبل از اجرای موازین اخلاق پزشکی، به 38 مورد بعد از اجرای موازین اخلاق پزشکی افزایش یافت (p=0.001). همچنین وضعیت متغیرهایی مثل عدم آسیب عاطفی (p=0.03)، عدم نقض حریم خصوصی (p=0.02)، رعایت اصول کلی جمع آوری اطلاعات (p=0.05)، معرفی بیمار بدون بیان مشخصات شناسنامه ای (p=0.001)، پیگیری بیماران معرفی شده قبلی (p=0.04) و عدم معاینات مکرر بیماران توسط دانشجویان (p=0.03) به طور معنی داری بهبود یافت.
    نتیجه گیری
    آموزش موازین اخلاق پزشکی سبب ارتقای معنی دار دیدگاه دانشجویان در زمینه کیفیت برگزاری جلسات گزارشات صبحگاهی گردید. به دلیل آشنایی ناکافی دانشجویان و برخی از اساتید با آیین اخلاق حرفه ای، برنامه ریزی برای آموزش آن توصیه می گردد.
    کلیدواژگان: اخلاق پزشکی، دانشجویان پزشکی، گزارش صبحگاهی، اخلاق حرفه ای
  • ملیحه کدیور، مرجان مردانی حموله، منصوره مدنی صفحات 27-35
    زمینه و هدف
    خشونت علیه کودکان یکی از چالش های عمده برای کارکنان مراقبتی است که سلامت جسمی و روانی کودکان را به مخاطره انداخته و مشکلات عدیدی را در آینده برای آنان پدید می آورد. این مطالعه با هدف تحلیل یک مورد کودک آزاری با رویکرد اخلاقی در سال 1395 انجام شده است.
    مواد و روش ها
    در این مطالعه موردی، یک مورد واقعی در جلسه ماهانه اخلاق پزشکی، مرکز طبی کودکان تهران معرفی گردیده، سپس تحلیل اخلاقی بر اساس ملاحظات اخلاقی مطرح شده توسط کارکنان درمانی و متخصصان حیطه های مختلف انجام شد. مورد، پسربچه 5 ساله ای است که مورد آزار جسمی قرار گرفته و با شکستگی های متعدد در نواحی مختلف دست ها و همچنین سوختگی دست و پا، توسط پدر و مادرش در شیفت صبح به واحد اورژانس مرکز طبی کودکان آورده شد.
    ملاحظات اخلاقی: ضمن رعایت صداقت و امانت داری در گزارش مورد، سعی گردید، محرمانگی اطلاعات فردی مورد و خانواده وی رعایت گردد.
    یافته ها
    اخذ شرح حال کامل پزشکی و اجتماعی، معاینه کامل بدنی و بدون پوشش، عدم پنهان کاری آزارهای جنسی کودکان، احترام به کرامت انسانی، حقیقت گویی، حفظ حریم خصوصی، رازداری و محرمانگی اطلاعات، رفتار احترام آمیز با خانواده، احترام به استقلال کودک، بی طرفی و حمایت اجتماعی از مهم ترین ملاحظات اخلاقی مورد اشاره بودند. همچنین کمک به سازگاری خانواده ها در جهت پیشگیری از رخدادهای بعدی کودک آزاری، از دیگر یافته های تحلیل حاضر بودند.
    نتیجه گیری
    پیشنهاد می شود تا براساس ملاحظات اخلاقی طرح شده، برنامه مدونی در این رابطه توسط دست اندرکاران امر طراحی و در اختیار مراکز درمانی کل کشور قرار گیرد. همچنین یک گروه متشکل از متخصصین اطفال و اخلاق پزشکی، مددکار اجتماعی، روان پرستار و روانپزشک کودک نیازهای کودکان آزاردیده و خانواده های آنان را ارزیابی نموده و در جهت رفع مشکلات آنان برنامه ریزی نمایند.
    کلیدواژگان: اخلاق پزشکی، کودک آزاری، کرامت انسانی، رازداری
  • محبوبه خسروانی، محمد خسروانی، فاطمه رفیعی، محدثه محسن پور صفحات 37-44
    زمینه و هدف
    نیروی انسانی متعهد و وفادار به اهداف و ارزش های سازمان نه تنها عامل برتری یک سازمان، بلکه مزیتی برای رقابت پایداری برای بسیاری از سازمان ها تلقی می شود. این مطالعه با هدف تعیین میزان تعهد سازمانی پرستاران شاغل در بیمارستان های شهرستان اراک در سال 1395 انجام شده است.
    مواد و روش ها
    در این پژوهش توصیفی مقطعی،176 پرستار به روش نمونه گیری تصادفی ساده وارد مطالعه شدند. برای جمع آوری داده ها از پرسشنامه استاندارد تعهد سازمانی Allen and Myer استفاده شد. داده ها توسط نرم افزار آماری SPSS 16 و با استفاده از آزمون های آماری توصیفی و تحلیلی مورد تجزیه و تحلیل قرار گرفت.
    ملاحظات اخلاقی: رضایت شفاهی شرکت کنندگان برای شرکت در پژوهش کسب شده و درباره بی نامی پرسشنامه ها و محرمانگی اطلاعات به آنان اطمینان خاطر داده شد.
    یافته ها
    از کل واحدهای مورد مطالعه،2/3 درصد از شرکت کنندگان نمره تعهد خیلی پایین،25/6 درصد نمره تعهد پایین، 68/1 درصد نمره تعهد بالا و 4 % نمره تعهد خیلی بالا را کسب کردند. میانگین نمره کلی تعهد سازمانی برابر 77/77 محاسبه گردیده و در بین ابعاد تعهد سازمانی، تعهد عاطفی از میانگین بالاتری برخوردار بود (26/77±6/30) و میانگین تعهد مستمر (25/0±2/79) و هنجاری (25/19±4/51) در سطح متوسط قرار داشت. همچنین بین تعهد سازمانی با سابقه خدمت و نوع استخدام رابطه مثبت معنی داری وجود داشت (p<0/05).
    نتیجه گیری
    با توجه به سطح متوسط به بالای تعهد سازمانی پرستاران مورد مطالعه، ضروری است عوامل بازدارنده تعهد سازمانی پرستاران تا سطح عالی، شناخته شده و راهکارهای تقویت و ارتقای تعهد سازمانی آنان توسط مدیران ارشد اتخاذ گردد.
    کلیدواژگان: تعهد سازمانی، پرستاری، کارایی، اراک
  • لطفعلی خانی، سیدعلی هاشمیان فر، مظفر غفاری، رضا اسماعیلی صفحات 45-53
    زمینه و هدف
    نوع دوستی و باورهای اخلاقی و دینی نقش اساسی در فرهنگ سازی اهدای عضو دارند. این مطالعه با هدف تعیین تاثیر باورهای اخلاقی و نوع دوستی بر نگرش به اهدای عضو با میانجی گری عمل به باورهای دینی انجام شده است.
    مواد و روش ها
    این مطالعه توصیفی مقطعی مبتنی بر مدل معادلات ساختاریابی (Structural Equation Model)، بر روی 323 نفر از دانشجویان دانشگاه های علوم پزشکی، شهرستان های میاندوآب و مهاباد در سال 1394 که به روش خوشه ایچند مرحله ای انتخاب شدند، انجام گردید. برای جمع آوری داده ها از پرسشنامه محقق ساخته باورهای اخلاقی، پرسشنامه نوع دوستی Carlo، مقیاس نگرش به اهدای عضو Tihana و مقیاس عمل به باورهای دینی Nilson استفاده شد. جهت آزمون مسیرهای میانجی از روش Bootstrap استفاده شد.
    ملاحظات اخلاقی: پس از بیان اهداف و اهمیت پژوهش، تاکید بر رازداری اطلاعات، رضایت شفاهی دانشجویان برای مشارکت در پژوهش کسب شد.
    یافته ها
    بین نگرش به اهدای عضو با متغیر عمل به باورهای دینی (0/442=r و 0/001=p)، باورهای اخلاقی (0/416=r و 0/003=p) و نوع دوستی (0/298=r و 0/005=p) همبستگی مثبت و معنی دار وجود داشت. اثر مستقیم باورهای اخلاقی، نوع دوستی و عمل به باورهای دینی بر نگرش به اهدای عضو معنی دار بود. همچنین اثر غیر مستقیم باورهای اخلاقی و نوع دوستی با میانجی گری عمل به باورهای دینی معنی دار بود. در مجموع 57 % از واریانس متغیر نگرش به اهدای عضو، از طریق مدل پژوهش تبیین گردید.
    نتیجه گیری
    نظر به تاثیر باورهای اخلاقی، نوع دوستی و عمل به باورهای دینی بر نگرش به اهدای عضو، می توان با ارتقای باورهای اخلاقی از طریق آموزش های فردی و گروهی، نگرش مثبت دانشجویان نسبت به اهدای عضو را افزایش داد.
    کلیدواژگان: باورهای اخلاقی، نوع دوستی، باورهای دین، اهدای عضو، دانشجویان علوم پزشکی
  • مهدی هرورانی، پوران وروانی فراهانی، سیدآرش یزدانبخش، عبدالقادر پاک نیت، هاجر صادقی، معصومه نوروزی، محمد گلی طالب صفحات 55-61
    زمینه و هدف
    خشونت شغلی به صورت افزاینده ای به عنوان یک مشکل در نظام مراقبت سلامت شناخته شده است. این مطالعه با هدف تعیین عوامل مستعدکننده خشونت شغلی علیه کارکنان درمانی شاغل در اورژانس بیمارستان های آموزشی شهر اراک انجام شده است.
    مواد و روش ها
    در این مطالعه توصیفی مقطعی، 108 نفر از کارکنان درمانی شاغل در بخش اورژانس بیمارستان های منتخب اراک درباره خشونت های کلامی و فیزیکی در سال 1394 مورد مطالعه قرار گرفتند. برای جمع آوری اطلاعات از پرسشنامه خشونت محل کار در واحدهای سلامت، مشتمل بر چهار بخش (اطلاعات جمعیت شناختی، تهدید، خشونت کلامی و خشونت فیزیکی) استفاده شد. داده ها با استفاده از نرم افزار SPSS 21 تجزیه تحلیل شد.
    ملاحظات اخلاقی: هدف مطالعه برای شرکت کنندگان توضیح داده شده و درباره بی نامی و محرمانگی اطلاعات به آنان اطمینان داده شد. همچنین رضایت شفاهی کارکنان درکانی برای شرکت در مطالعه کسب گردید.
    یافته ها
    28/7 درصد از کارکنان درمانی در طی 12 ماه گذشته مورد خشونت فیزیکی و 77/7 درصد مورد خشونت کلامی قرار گرفته بودند. 13/1 درصد از شرکت کنندگان تعداد دفعات آزار لفظی را خیلی زیاد، 15/7 درصد زیاد، 28/7 درصد متوسط و بقیه آن را کم یا خیلی کم گزارش کردند. بیشترین علت محرک بروز خشونت شلوغی و ازدحام بخش بوده و بیشترین عامل منجر به خشونت فیزیکی (85/4 درصد) و کلامی (60/5 درصد) همراهان بیمار بودند.
    نتیجه گیری
    یافته ها نشان دهنده شیوع بالای خشونت به ویژه از نوع کلامی، علیه کارکنان اورژانس می باشد. در این مطالعه خشونت بیشتر از طرف همراهان اعمال شده بود که می توان با مدیریت و برنامه ریزی و آموزش همگانی از آن پیشگیری نمود.
    کلیدواژگان: خشونت شغلی، عوامل مستعدکننده، کارکنان درمانی، طب اورژانس
  • مقاله مروری
  • سیده سولماز موسوی، پرخیده حسنی صفحات 63-73
    زمینه و هدف
    هرچند اصول اخلاقی در تحقیقات کیفی، در گروه های مختلف مشابه است، اما فرآیند پیچیده تحقیق کیفی و ماهیت آسیب پذیر کودکان، ملاحظات اخلاقی را در این گروه حساس کرده است. این مطالعه مروری با هدف تعیین ملاحظات اخلاقی در پژوهش کیفی با مشارکت کودکان انجام شده است.
    مواد و روش ها
    در این مطالعه مروری مقالات فارسی و انگلیسی زبان منتشرشده در پایگاه های اطلاعاتی Scopus، PubMed، SID، Irandoc، Magiran و Google Scholar بدون بازه زمانی و با استفاده از واژگان کلیدی «ملاحظات اخلاقی و تحقیق کیفی» یا «تحقیق کیفی و کودکان» جستجو شد، سپس عنوان و چکیده کلیه مقالات مطالعه شده و پس از حذف مقالات تکراری و غیر مرتبط، محتوی مقالات مرتبط تحلیل گردید.
    ملاحظات اخلاقی: انتشار نتایج بدون سوگیری و استناد به منابع با صداقت و امانت داری و مراجعه به منابع اصلی انجام شده است.
    یافته ها
    مرور مطالعات استخراج شده نشان داد اصول کلی و ملاحظات اخلاقی در تحقیقات کیفی با مشارکت کودکان مشابه سایر تحقیقات کیفی و عبارتند از توجه به مشارکت کودک، اخذ رضایت آگاهانه، توانایی برقرای ارتباط دوستانه و توام با صداقت، محرمانه بودن و حساسیت محقق به چگونگی انتشار اطلاعات، و عدم تعادل قدرت.
    نتیجه گیری
    یافته ها نشان می دهد که توانایی برقراری یک ارتباط دوستانه و جلب اعتماد کودک نقش بسیار مهمی در مشارکت فعال کودک در روند تحقیق و همچنین، کاهش عدم تعادل قدرت بین محقق و کودک دارد. بنابراین تحقیق با کودکان باید در یک محیط باارزش، حمایتی و امن، با استفاده از روش های مناسب و در جهت حمایت از توانایی های اجتماعی و ذهنی آن ها باشد، به گونه ای که کودکان به راحتی عقاید خود را بیان کنند.
    کلیدواژگان: پژوهش کیفی، کودک، ملاحظات اخلاقی، گروه های آسیب پذیر
  • آزیتا فتح نژاد کاظمی، نسیبه شریفی، سمیه خزاییان، علی رمضان خانی صفحات 75-89
    زمینه و هدف
    یکی از چالش های سلامت باروری زنان سقط های غیر ایمن، ناشی از حاملگی های ناخواسته است. هدف از این مطالعه بررسی ابعاد مختلف سقط جنین و سیاست های سلامت مرتبط با آن در جهان است.
    مواد و روش ها
    در این مطالعه مروری، جستجو در پایگاه های اطلاعاتی PubMed ، Google Shcolar ،Iranmedex ، SID و سایت سازمان جهانی بهداشت با واژگان کلیدی «Abortion» ، «Policy» یا «Politic» در بازه زمانی 2010 تا 2015 انجام گرفت. پس از بررسی اولیه، مطالعه خلاصه مقالات و حذف مقالات تکراری و غیر مرتبط، در مجموع 20 مقاله فارسی و 38 مقاله انگلیسی دارای متن کامل وارد مطالعه و تحلیل شدند.
    ملاحظات اخلاقی: صداقت و امانت داری در تحلیل متون، گزارش نتایج و استناددهی رعایت گردید.
    یافته ها
    سقط جنین در ادیان مختلف به جز در موارد خاص منع شده است، اما تحولات اجتماعی و مشارکت زنان در عرصه اجتماعی اقتصادی منجر به ناسازگاری جنبه های نظری و عملی شده و زنان بدون توجه به قوانین، اقدام به سقط می کنند. زمینه های قانونی سقط شامل تهدید حیات مادر، تجاوز جنسی و اختلالات جنینی بوده است، اما موانعی مانند نداشتن اطلاعات، مجوز شخص ثالث، حذف پوشش بیمه ای، عدم دسترسی به ارائه دهندگان خدمات و یا اعتقادات آن ها، دسترسی به سقط ایمن را محدود می سازد. علی رغم اتخاذ سیاست های محدودکننده، تحولات رخ داده در سراسر جهان سبب گردیده است که درخواست برای سقط و میزان عوارض و مرگ مادری مرتبط با آن در قاره ها و کشورهای مختلف افزایش یابد.
    نتیجه گیری
    با توجه به تحولات اجتماعی، سیاستگذاری ها می بایست مبتنی بر فهم عوامل اجتماعی موثر بر سلامت باشد. ایجاد تسهیلات انجام مشاوره ای و زمینه های مناسب برای سقط قانونی، و دسترسی اقشار آسیب پذیر به خدمات سلامت باروری توصیه می گردد.
    کلیدواژگان: سقط جنین، سیاست سلامت، سلامت باروری
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  • Somaye Shahhoseini, Fariba Borhani, Foroozan Atashzadeh-Shoorideh, Amir Kavousi Pages 7-17
    Background And Aim
    Despite the remarkable advances in medical science, cancer continues to be one of the most important challenges in the field of health, the cause of eight million deaths between 1990 and 2010 in the world and the third leading cause of death after heart diseases and accidents in Iran. According to the World Health Organization, the number of patients and deaths will reach from 11.3 and 7.9 million in 2007 to 15.5 and 11.5 million cases in 2030, respectively. Breast cancer is the most common cancer among Iranian women. Iranian women catches the breast cancer at least a decade earlier than their counterparts in developed countries that shows the importance of this disease. Studies show that people with life-threatening diseases such as cancer are suffering from with a range of problems, including mental, social and existential challenges, which endangers their sense of dignity. The fundamental nature of caring is to protect the dignity of patients and this issue has not been studied in women with breast cancer undergoing chemotherapy in Iran, so this study aimed to assess the different aspects of dignity from the perspective of women with breast cancer who underwent chemotherapy in hospitals affiliated to Shahid Beheshti University of Medical Sciences, Tehran, Iran, 2015.
    Materials And Methods
    In this cross sectional study, the study population consisted of all women with breast cancer undergoing chemotherapy in hospitals affiliated to Shahid Beheshti University of Medical Sciences. Purposive sampling method was used to select hospitals; 207 patients selected using convenient sampling method. The research instrument included Patient Dignity Inventory (PDI) designed in 2008 and includes 5 dimensions, including experiencing symptoms of tension, existential tension, peace of mind, dependency and social support. The validity of the instrument was confirmed using confirmatory factor analysis. The instrument enjoyed good fit in all aspects (0.47). Its reliability was confirmed with Cronbach's alpha coefficient of 0.76. Data collect was carried out using the translation of human dignity inventory designed by Chochinov. This inventory contains 25 statements covering 5 dimensions, including experiencing symptoms of tension, existential tension, peace of mind, dependency and social support. Each question is assigned a score of 1-5. A lower score means that the patient is less benefited from the dignity. Also, the demographic questionnaire which included age, marital status, occupation, educational level, level of satisfaction with the family income, duration of diagnosis and presence or lack of mastectomy surgery, was used. Data analysis was analyzed using descriptive statistics and T-test, ANOVA and DUNCAN.
    Ethical Considerations: This study is the product of master's thesis with number of.... . Data collection was carried out after explaining the purpose of the study, emphasizing confidentiality and obtaining the oral informed consent from participants.
    Findings: The response rate was 100% in the studied group whose demographics were as follows: married women (68.1%), high school diploma or less (64.7%), housewives (84.5%) and low satisfaction of their monthly income (67.6%). In 56.5% of patients, the disease was diagnosed less than 1 year ago. Dignity overall score of 1.94 out of 5 was obtained. The dignity score of patients in dimension of experiencing tension symptoms was (mean of 2.40 ± 0.96). Existential tension, peace of mind, dependency and social support were assigned highest scores respectively with mean of (1.87± 0.5), (1.87±0. 77), (1.71±0.77) and (1.31±0.55). Existential tension score was higher in educated women, though there was no statistically significant difference between the different levels of education and dignity score. Also, peace of mind and social support in different educational levels differed significantly (P=0.004). There was no significant difference in overall dignity score of patients in the different occupational levels. Despite the lack of a significant relationship between overall dignity score of patients and their degree of satisfaction with their income, it was observed that patients who were satisfied with their income, reported less tension in three dimensions of experiencing symptoms of tension (P=0.005), existential tension (P=0.029) and social support (P=0.004). There was a significant relationship only between the existential tension dimension of dignity and the hospital's type (P=0.004). There was a significant relationship between patient's dignity score and degree of social support and patients showed the least concern in the social support dimension.
    Discussion and
    Conclusion
    Given that most patients were concerned about the experiencing symptoms of tension dimension and then the existential tension, peace of mind, dependency and social support dimensions, identifying different sources of tension experienced by patients with breast cancer undergoing chemotherapy, contributed greatly to group therapy and care, especially nurses to make right decisions. It also seems necessary that health care team, especially nurses take measures to meet dignity-related needs of this group of patients, especially in the dimension of experiencing symptoms of tension.
    Keywords: Human Dignity, Breast Cancer, Chemotherapy, Tension, Iran
  • Javad Khaje Mozaffari, Mohammad Bagher Sohrab, Robabeh Zaroug Hossaini, Pouneh Zolfaghari, Fatemeh Najafi, Elahe Yahyaei Pages 19-25
    Background And Aim
    Morning report is one of common and valuable clinical training methods worldwide. In this method, participants attempt to resolve a diagnostic puzzle by discussing the patient's conditions. Morning report sessions are held in the form of scientific conferences containing material on cases and their evaluation by the head of a hospital ward, professors, assistants and interns who have been on duty the night before in such a manner that the students report the measures taken and the related professors resolve their weaknesses and shortcomings. The morning report is known as a tool to evaluate clinical services and to ensure their quality. It is essential to observe the medical ethics in all aspects of education and professors, while observing the principles of medical ethics, teach them to their students theoretically and practically. One of the most important aspects of clinical training is morning report sessions. It should be noted that medical ethics is not merely expression of moral traits, or physician's treatment with the patient or codification of professional laws on religious and behavioral customs of physician-patient communication. In other words, medical ethics is an analytical activity, in which thoughts, beliefs, commitments, behavior, emotions, reasoning and various discussions are carefully and critically examined in the field of medical ethics decisions and instructions are issued, if necessary. Since patients complete information such as demographic data, family history, current situation and potential diagnoses are fully expressed during the morning report sessions, students need to learn how to properly report patient's history and their privacy and fully implement it. This study aimed to determine the effect of ethical standards on the quality of the morning reports sessions from the perspective of practitioner students of Shahrood University of Medical Sciences.
    Materials And Methods
    The current study is an interventional study with before and after design that was conducted on 120 medical interns in Imam Hossein Hospital, Shahrood in 2014. To prepare the research instrument, a researcher-made questionnaire, the validity and reliability of which were respectively measured by medical ethics experts and Cronbach's alpha coefficient of 0.79 after conducting a pilot study, was used. In addition to demographic data such as age, gender and duration of internship, this questionnaire contains 19 specific 5-option questions on the standards of medical ethics, including maintaining the patient's dignity, confidentiality, lack of emotional harm, lack of discrimination, lack of gender differences, lack of stigmatization, lack of violating privacy, lack of extra costs, and etc. 5-item Likert Scale was used for the assessment with Always, Usually, to some extent, sometimes and never options. Considering the number of questions, minimum and maximum scores of 19 and 95 are considered, respectively. This gap is divided into three equal parts and grouping is carried out based on scores obtained so that if the total scores between 20-45, 46-70 and 71-95 are respectively considered as undesirable, average and desirable. After the pre-test, an orientation training workshop on medical ethics was held for the participant students for 12 hours. Also, a booklet containing regulations and standards of medical ethics and its application in the patient's presentation was given to all professors working in Imam Hossein Hospital and participating interns. The posttest was held after three months of morning reports sessions, in which the respected professors and medical ethics professors with ethics group style participated. After being collected, data was analyzed using SPSS v.16. Frequency tables were used in the descriptive part, and to compare the average rank in the analytical part of statistical tests, Fisher and one-way ANOVA were used. Significance level was considered at 0.05.
    Ethical considerations: This study has been approved by Ethics Committee of Shahrood Medical University with code of 93.167. Verbal informed consent of participants was obtained followed by an explanation about the purpose of the study, anonymity and confidentiality of patient's information.
    Findings: Male and female participants account for 33 (27.5%) and 87 (72.5%) of the participants, respectively. The average internship time spent by interns was 10.5 ±6.5 months (range 3-17 months) and the mean age of students was 26.6±4.6 years (range 22-31 years). Before the training, the average number of desirable cases was 17 cases from the perspective of students and reached to 38 cases after the implementation of medical ethics standards (p = 0.001). Before teaching ethics in the morning report, 45.8% of participants evaluated that the rate of compliance with these standards are not desirable. While unfavorable situation of morning report presentation was reduced to 19.2% after in-hospital intervention from the perspective of students. Also, the following items were significantly improved from the perspective of the participants: situation of lack of emotional trauma (p = 0.03), lack of privacy violation (p = 0.02), compliance with general principles of data collection (p = 0.05), referral of patients without expression of birth certificate specifications (p = 0.001), follow-up of recently admitted patients (p = 0.04) and lack of repeated examinations of patients (p = 0.03). Medical ethics education led to a significant improvement in student's views on the quality of the morning reports sessions.
    Discussion and
    Conclusion
    Since students and some professors have insufficient knowledge regarding code of professional ethics, it is recommended to design interventional programs. These findings suggest that the morning report sessions led to desirable changes in observing principles of medical ethics at Shahrood University of Medical Sciences following teaching the fundamentals of medical ethics. However, due to lack of experience of the students in the application of the principles of medical ethics in the morning report, it is recommended to form a scientific committee and consider the views of professors and students in order to improve the quality of the morning report sessions based on medical ethics. Also, it is recommended to implement continuous training program on compliance with the principles of medical ethics during the morning report sessions on the arrival of medical students in the clinical setting.
    Keywords: Medical Ethics, Medical Students, Morning Report, Professional Ethics
  • Maliheh Kadivar, Marjan Mardani Hamooleh, Mansure Madani Pages 27-35
    Background And Aim
    Human rights issues are based on human dignity. In this regard, Rights of the Child are considered by most of world's organizations and the scientific communities. Different types of child punishment are prohibited according to international conventions as well as national legislation. Historically, the first legal action to protect the rights of children was taken in 1924. Then rights of the child were briefly referred to in the Universal Declaration of Human Rights approved in 1948. Afterwards, United Nations General Assembly adopted, in a resolution, the draft prepared by the Human Rights Commission under the Declaration of the Rights of the Child in 1959. Iran is also among the states that signed and approved this declaration in 1993. However, child abuse has become a global problem and violence against children is one of the major challenges for health care providers that has endangered their physical and mental health and creates serious problems for them in the future. According to Islamic-Iranian culture, children counts as trust and the family is responsible to take care of them and strive for their excellence. This study aimed to analyze a case of child abuse in 2016 with an ethical approach.
    Materials And Methods
    In this case study, a real case was referred to Tehran Children Medical Center in a monthly session of medical ethics, and the ethical analysis was later carried out based on ethical considerations raised by the medical staff and specialists in various fields. The case is a 5-year-old boy who was physically abused and was brought to the emergency department at Children's Medical Center in the morning due to the multiple fractures in different parts of the hands as well as cigarette burn caused by his parents in his hands and feet. According to his mother, she first noticed the swelling of the child's hands and referred to the physician. After exact examination and radiography of the child's body, physicians noticed old and new fractures in the arm, the elbow and wrist. The mother claimed that the child's fractures were caused by falling off the swings and slides. The physicians also saw scars of old wounds on the child's head, as the mother claimed, they were caused as a result of fractures associated with falls. The child's physical examination showed that part of the back and posterior side of the thigh of one of his legs was burned and traces of cigarette burns were seen on one of the child’s hands. Thus, physicians requested help from forensic experts. After examining the child's condition and examining him thoroughly, they, while acknowledging the child physical abuse, found that the victim underwent sexual harassment by some of the family boys.
    Ethical considerations: While observing honesty in the case report, attempts were made to respect the confidentiality of personal information of the case and his family.
    Findings: The mother has rejected the occurrence of physical child abuse in the form of for multiple fractures in areas of the hands and feet as well as multiple burn cases on the child's body and tried to mislead the medical staff. Investigations suggest that the child's father was responsible for the physical abuse, but the mother denied it. On the other hand, the mother tried to hide the child molestation by male relatives, and following this sexual abuse, the father also resorted to unethical manner and has punished the child rather than appeasing and supporting the child as well as denouncing the actions of those who commit this immoral act. Employees participating in the study, said that it is essential to examine all surfaces of the child's body in cases of child abuse. It is essential to monitor vital signs of the abused child, particularly his temperature because high temperature could be the reason for this accident and the fact that child abuse is committed through exposing him to high temperature. Physical examination must also include any examination of external genitalia and anal area. Considering that the sexual abuse is a hidden conduct, if there is suspicion of rape, the assessment is necessary. The child's privacy must be respected during a physical examination, and explanations should be provided regarding measures that are going to be taken. Considering the foregoing, obtaining thorough medical and social history, thorough examination of the naked body, lack of secrecy about sexual assault on children, respect for human dignity, honesty, privacy, confidentiality and privacy of information, respectful conduct, respect for the child's independence, neutrality and social protection are considered as the most important ethical considerations referred to in this analysis . Also, helping families adapt in order to prevent further incidents of child abuse is another finding of the present analysis.
    Conclusion
    In this study, it was found that the families of abused children deny and distort the facts about the children instead of supporting them for some reasons. However, medical staffs are usually the first individuals who are informed about the child abuse, so it is logical to consider their views in order to find appropriate solutions to help these children. In this case, one can provide better education and adequate facilities to properly deal with this vulnerable group. The relevant authorities are also recommended to design a written programs based on the ethical considerations raised and submitted it to the medical centers of the country. Also, a group consisted of pediatrics and medical ethics, social workers, psychiatric nurse and psychiatrist should assess needs of abused children and their families and plan to solve their problems. The importance of this lies in the right to social protection and care of abused children and their families to improve their quality of life. Effective measures can be taken in this regard through awareness raising at different levels of society, training for child rearing free from any violence, amending the Child Protection Act, identifying vulnerable families and providing rehabilitation services for victims of child abuse and finally take steps to prevent this phenomenon.
    Keywords: Medical Ethics, Child Abuse, Human Dignity, Confidentiality
  • Mahboobeh Khosravani, Mohammad Khosravani, Fatemeh Rafiei, Mohaddeseh Mohsenpour Pages 37-44
    Background And Aim
    Human capital is the most critical strategic element and most basic way to improve the performance and efficiency of the organization. Human resources committed and loyal to the goals and values of the organization is not only considered as a factor positively affecting the organizational excellence, but also a sustainable competitive advantage for many organizations. Considering the importance of human resources, it is obvious that human resources, in addition to having skills and expertise, should have high sense of belonging and commitment so that health system goals are achieved. Organizational commitment is among constructs that affects the behavior of employees in organizations. It also affects many organizational variables such as employee relocation intention, clinical practice, organizational behavior, absenteeism rate as well as job conflict and stress. Components such as attaching importance to organizational goals and values, a sense of belonging and loyalty to the organization, replication and identification with the organization and the desire to stay in the organization are the core of the organizational commitment construct. According to the desirable results of employee's organizational commitment, organizational commitment has special place in many studies and attitudes and its different aspects have been taken into consideration. This study aimed to determine the organizational commitment of nurses working in hospitals of Arak city in 2016.
    Materials And Methods
    In this descriptive-analytical study, 176 nurses were enrolled in the study using simple random sampling. The main inclusion criterion was having a university degree in nursing. To collect data, Allen and Meyer's Organizational Commitment Questionnaire was used. The questions included 24 questions in three dimensions (affective, intellectual and normative commitment). Each dimension consisted of 8 questions that measure the organizational commitment based on 5-point Likert scale ranging from “Strongly Disagree on one end to Strongly Agree on the other. The scores obtained from this questionnaire ranged from 0 to 100, and the best score of this instrument is 100. A demographic questionnaire relates to the characteristics of the subjects, which consists of questions related to gender, age, marital status, education, employment history and employment status. The reliability of the Organizational Commitment Questionnaire (OCQ) in three subscales of affective, continuance, normative commitment was confirmed by Abbaszadeh in his PhD thesis in 2011 with Cronbach's alpha of 85%, 79% and 77%, respectively. The reliability of questions was evaluated and confirmed in a sample size of 20 and Cronbach's alpha equal to 86%. To ensure the validity of the questionnaire, which were used by various researchers (including Bahrami, 2011, Abbaszadeh, 2012), the researcher used the opinion of 10 professors of the field. The process collecting data from all hospitals lasted for 15 days. Data were analyzed using descriptive and inferential statistical tests in using SPSS v.16.
    Ethical considerations: Participant's oral consent to participate in the research was obtained and they were assured about the anonymity of the questionnaires about the confidentiality of their information.
    Findings: The average age of participants and their age range was 28 years and 20-50 years, respectively. Female and male participants accounted for 88.3% and 11.7% of the subjects, respectively. The average overall organizational commitment score was estimated 77.77%.
    Among organizational commitment dimensions, affective commitment has higher average (6.30±26.77) and continuance commitment (with an average of 2.79 ±25.80) and normative commitment (with an average of 4.51± 25.19) were at a moderate level. Of the total subjects of study, 2.3%, 25.6%, 68.1% and 4% of the participants obtained too low, low, high and very high commitment score, respectively. Fisher's exact test showed that there was a significant positive correlation between organizational commitment and type of employment and work experience (p 0/05).
    Discussion and
    Conclusion
    Considering average-to-above organizational commitment of nurses and their higher affective commitment than the other dimensions of organizational commitment, the findings provide valuable guidance to researchers and managers to effectively increase the organizational commitment of nursing staffs and ultimately increase their organizational attachment and to improve the quality of services provided to patients. Affective commitment represents employee's affective bond, their identification with the values and goals of the organization and the extent of their involvement with the organization. Therefore, employees who have strong affective commitment maintain their membership in the organization and continue to work in the organization. On the other hand, the normative commitment implies a sense of faith and commitment to stay in the organization and individuals who have this kind of commitment, believe that they should continue working in the organization. They also feel obliged to stay in the organization. Therefore, strengthening the normative dimension can prevent the turnover of nurses in the workplace. Continuance commitment also reflects the costs of leaving the organization compared to the interests of staying in it and the individual who has continuance commitment will likely leave the organization and join new organization by comparing investments and income obtained from new business. Holding in-service training sessions, division of labor based on merit and competency, continuous performance assessment and focusing on the abilities and talents of nurses usually have a role in enhancing the normative commitment. So, given the above-to-average organizational commitment of nurses, it is essential to identify the factors hindering the improvement of organizational commitment of nurses to an excellent level and senior managers adopt mechanisms to strengthen and improve their organizational commitment.
    Keywords: Organizational Commitment, Nursing, Efficiency, Arak
  • Lotfali Khani, Seid Ali Hashemianfar, Mozaffar Ghaffari, Reza Smaili Pages 45-53
    Background And Aim
    Donation and transplantation of the human organ are a subject of discussion in scientific-social circles and the need for it grows day by day. Many variables affect the attitude toward organ donation, one of which is moral beliefs. In fact, what the majority of people admire, is considered moral by ones adhere to moralities, while what the majority of people condemn, is considered as immorality. Altruism is another variable that is associated with attitudes to organ donation. There are two distinct forces in every human being. One of them is focused on the self and in the pursuit of self-interest, and the other is focused on the interest of others which is called altruism. A significant relationship has been observed between altruistic motivation and the tendency of people to donate organs. Another variable that can be associated with attitudes to organ donation, is the practice of religious beliefs. The religion is a truth that has a significant presence in human life, and religious beliefs are determining factors in the decision to donate organs, especially in the families of patients with brain death. Altruism and moral and religious beliefs have fundamental roles in the culture of organ donation. This study aimed to determine the role of moral beliefs and altruism in explaining attitudes toward organ donation with the mediation of act to religious beliefs.
    Materials And Methods
    This descriptive cross-sectional study which is based on Structural Equation Model, was conducted on 323 medical students of medical sciences of Azad and Public Universities in the cities of Miandoab and Mahabad in 2015, who were selected using Cochran formula and multi-stage cluster method. First, from the educational groups, 7 groups were randomly selected; then, from each cluster, 46 patients were selected by simple randomization. Researcher-made questionnaire of moral beliefs, altruism questionnaire of Carlo, Tihana scale of attitude to organ donation, and Nilson scale of practice of religious beliefs were used to collect information. In order to describe demographic data and calculate the Pearson correlation test, SPSS ver.22 software was used, while AMOS ver. 22 was used to draw and evaluate the fitting of the proposed model, and to study the direct and indirect effect of variables. Bootstrap method was used to test the mediation routes in the proposed model.
    Ethical Considerations: After explaining the objectives and the importance of research, and putting emphasis on the confidentiality of information, verbal consent was obtained from the students for participation in the research.
    Findings: There was a significant and positive correlation between the attitude toward organ donation with the variable of act to religious beliefs (r=0.442 and p=0.001), moral beliefs (r=0.416 and p=0.003), and altruism (r=0.298 and p=0.005). According to the index of fitness, chi-square to degrees of freedom ratio was calculated equal to 2.22, Comparative Fit Index equal to 0.99, Incremental Fit Index equal to 0.97, Normalized Fit Index equal to 0.96, and Root Mean Squared Error of Approximation equal to 0.08, indicating that the final model has a good fit. Also, direct route of the all routes existing in variables in the model is significant at p
    Conclusion
    Findings in the final model confirm the direct impact of altruistic and moral beliefs on the attitudes to organ donation, and also the indirect effect of altruistic and moral beliefs with mediation of practice of religious beliefs on the attitude toward organ donation. It can be concluded that the students show the moral and popular behaviors as preferring he interests of patients in need of organ donation, listening sympathetically to their concerns, and trying to mitigate the suffering of these patients through organ donation reception. According to the effect of moral beliefs, altruism, and act to religious beliefs on attitude toward organ donation, student's positive attitudes towards organ donation can be increased by promoting moral beliefs through individual and group educations. Correlation study was seen as a limitation, and it cannot be said that predictor variables are the main cause of the criterion variable. Therefore, it is suggested to study the effect of other psychological and social characteristics on attitude toward organ donation. Moreover, since questionnaires were completed in a self-reported method, there was no possibility of bias in the response. Hence, in order to increase the generalizability of the findings, it is recommended to conduct the study in a more broadly using the methods of interview, observation and application of their results.
    Keywords: Moral Beliefs, Altruism, Religious Beliefs, Organ Donation, Medical Students
  • Mehdi Harorani, Pouran Varvanifarahani, Seyed Arash Yazdanbakhsh, Abdol Ghader Pakniyat, Hajar Sadeghi, Masoomeh Norozi, Mohammad Golitaleb Pages 55-61
    Background And Aim
    Occupational violence increasingly has been known as a problem in health care system. Emergency personnel, because of direct contact with patients and their relatives are exposed of the most invasions. Multiple refers to emergency unit than other hospital parts increase threat occurrences, physical and verbal violence and cause to physical and mental injury in medical personnel. In Gerberich et al viewpoint, working in ICU (intensive care unit), psychological and emergency unit is of important factors for exposure of violence. This study aims to determine the vulnerable factors of occupational violence against practitioner medical personnel in the emergency units of training hospitals of Arak city.
    Materials And Methods
    In this descriptive-sectional study, 108 of practitioner medical personnel of the emergency units were studied in verbal and physical violence in 1394. Studied society were practitioner medical personnel of emergency unit of training hospitals of Vali-Asr, Amir- Almumenin and Amir-Kabir of Arak. Entry measures were self-desire of personnel in all educational levels and occupational grades with one year work experience in current unit in turning shift. In order to collect information of violence in work place questionnaire in health units were used which include four parts (demographic information, threat, verbal and physical violence). This questionnaire is derived from standardized questionnaires of international labor office, WHO, international council of nurses, public services international which are balanced based on environmental and social conditions and its reliability and validity were confirmed. Data were analyzed by SPSS software version 21.
    Ethical Considerations: This paper is a part of issued investigational plan of medical sciences of Arak University, by ethical committee confirmation of IR.ARAKMU.REC.1394.148. The goal of study was explained for participants and secrecy and anonymity were ensured to them. Also, verbal satisfaction was obtained from medical personnel for contribution in study.
    Findings: Participants had average age of 31.45±6.26 years, total work experience mean 6.85±5.09 years and work experience mean 3.49±3.22 years in emergency unit. 28.7% of medical personnel were exposed of physical violence and 77.1% of them were exposed of verbal violence. 17.9% of participants reported verbal violence very much, 20.2% moderate and 36.9% low or very low. The most motivating reason of violence was crowdedness of unit and the most factors resulted to physical and verbal violence was patient's relatives. The most physical violence factor (856.4%) and verbal (60.5%) were for relatives.
    Conclusion
    Findings showed high prevalence of violence, especially verbal violence against medical personnel. According to occupational characteristics of practitioner personnel in emergency unit, it can be said that violence emergence in work place is inevitable and impossible work. Therefore, the best approach is to identify amount and vulnerable factors in regions violence and to program for reducing its occurrences as low as possible. It should be noted that workplace violence is a multidimensional problem which its destructive dimensions has adverse effects on emergency personnel performance and also on hospital performance. Thus, creating a supportive environment, preparing continual training programs, financial resources and enough human force, restricting visit hours, also observation and answering in patients care are recommended in order to successful performing care programs. In this study, violence was forced from patient relatives more which can be prevented by managing, planning and public training.
    Keywords: Occupational Violence, Contributing Factors, Health Personnel, Emergency Medicine
  • Soolmaz Moosavi, Parkhedeh Hasani Pages 63-73
    Background And Aim
    Researchers tend to understand children’ response to disease, hospitalization and their health and disease experiences for various reasons. The importance of information has increased the demand for qualitative research on children in order to gain sufficient and deep knowledge and understanding of their insights in this age group about health and disease so that we can plan for better physical, mental care and finally improve their quality of life by acquiring of necessary knowledge and information. Although ethical considerations in qualitative research are similar in different groups, ethical considerations are critical in this group considering the complex process of qualitative research and children’s vulnerable nature. This study was designed to determine the ethical considerations in qualitative research with children’s participation.
    Materials And Methods
    In this review, Persian and English articles published in Scopus, PubMed, SID, Irandoc, Magiran and Google Scholar databases were searched with no time limit using main keywords of "Ethical Considerations and Qualitative Research "or" Qualitative Research and Children ". The title and abstract of all articles were studied, duplicate and non-related articles were deleted, and contents of related articles were later analyzed.
    Ethical Considerations: This study has been approved by the Vice Chancellor for Research and Technology, and Ethics Committee of Shahid Beheshti University of Medical Sciences with the identification code: IR.SBMU.RESEARCH.REC1395.514. Publication of the results is carried out without bias, honestly and by citing the original reliable resources and references.
    Findings: Review of extract studies revealed general principles and ethical considerations in qualitative research with children’ participation are similar to other qualitative research and include attention to children’s participation, obtaining informed consent, ability to establish friendly and honest relationships, confidentiality and researcher’s sensitivity regarding publication of information and the imbalance of power.
    Conclusion
    The findings suggest that the ability to establish a friendly relationship and win the child's trust play a very important role in the child's active participation in the research process as well as reducing the imbalance of power between the researcher and the child. So, it is essential to directly obtain information from the child. Obviously, the participation of children in research play a very important role in empowering and valuation to view of this vulnerable group. Thus, children' research must be carried out in a valuable, supportive and safe environment using appropriate methods to support their social and mental abilities, so that children easily express their opinions. Obtaining informed consent is an ongoing process that requires researcher’s patience and the guarantee that the child has understood the necessary information. In fact, obtaining children’ consent and encouraging them to make a decision strengthen the right to participate in or withdraw from the study, even if the parents are not willing to participate in the study. Therefore, the researcher must ask children in the process of research regarding their consent and participation in the study and must pay attention to their body language and gestures. The ethical principle of confidentiality of information is the challenging part because most children are not independent of their parents; therefore, interviewing with children alone is associated with some problems. Sometimes a child may also disclose information and researchers in support for vulnerable children, are forced to disclose certain informationin some cases. Two other very important concepts in the process of qualitative research with children’s participation include freedom, power, and thus an imbalance of power between researcher and participant. Establishing a friendly false relationship is immoral, so the way in which the researcher introduces him/herself, the language and clothes used and body language and manner of interacting with children have an impact on their relationship. The difference in children’s perception and experience of the world’s, compared with adults, and their different ways of communication, make it different and challenging to implement and observe ethical principles. Long tradition of the research on children mainly focused on getting information from families and caregivers instead direct research on children. Today, researchers should know that the concept of children research is defined as study ‘’with’’ child instead of "on" child. This fact highlights the importance of Children's participation and consent in the process of research. Even if researchers attend to active participation of children in the process, the concept of vulnerability is still dominant in them that require more caution for children's participation in the research. Children’s research must be conducted in a supportive and safe environment using appropriate methods, but different from adults, in order to support their social and mental abilities, so that, children easily express their opinions. The researcher must frequently review the thoughts and process through self-reflection and ask questions regarding whatever is doing in this process. Also, the researcher must clearly explain his/her motivation regarding the involvement of children. He must win trust and honesty of adults responsible for children and to do so, all forms of applied ethics should be completed in research and child-centered approach must be used in their study. Also, in qualitative research with children’s participation, in addition to the fact that methodology and ethical considerations should be assessed by knowledgeable individuals, the Research Ethics Review Committee should carefully examine the capacity and strength of children in a proposed research project.
    Keywords: Qualitative Research, Children, Ethical Considerations, Vulnerable Groups
  • Azita Fathnezhad Kazemi, Nasibeh Sharifi, Somayyeh Khazaeian, Ali Ramazankhani Pages 75-89
    Background And Aim
    One of the challenges for women's reproductive health is unsafe abortions resulting from unwanted pregnancies. The losses due to abortion complications are sometimes irreparable and their imposed costs to the health system is high. The aim of this study was to explore various aspects of abortion and related health policies in the world.
    Materials And Methods
    In this review, observational studies published in Persian and English were searched in Google Scholar, PubMed, Iranmedex, SID databases and WHO website using the keywords Abortion" and "policy" or "politic", in the time limit of 2010-2015. After the initial assessment, abstracts of articles were studied, and duplicates and irrelevant articles were removed. Finally, the full text of 21 articles in Persian and 38 articles in English were enrolled and analyzed.
    Ethical Considerations: Honesty in the literature and citation analysis and reporting were considered.
    Findings: Abortion pattern has long been the same around the world and women accept the risks of abortion when they face with unwanted pregnancy, despite the legal bans. According to reports, 22 million unsafe abortions occur around the world annually among which 98% occur in developing countries. Abortion has been prohibited in various religions except in special cases. But social changes and socio-economic participation of women lead to their incompatibility in the theoretical and practical aspects and women apply to induced abortion without regard to the rules. Legal aspects of abortion has been included threatening the mother’s life, rape, and fetal abnormalities, but obstacles such as lack of information, third party permissions, elimination of insurance coverage, lack of access to providers or their beliefs has limited access to the safe abortion. Despite restrictive policies, developments occurring around the world have been caused increasing requests for unsafe abortion and therefore associated maternal mortality and morbidity rates in the different continents and countries.
    Conclusion
    Developments of abortion laws from 1996 to 2013 represents an increase in licensing of therapeutic abortion in almost all legal areas that approximately two third of the countries in the cases of physical and mental endangerment of the mother health, half of the cases of pregnancy resulting from rape and anomalies, and only one third of the countries for socio-economic causes or due to the requests of the women are allowed to implement abortion. During this period, 56 countries have increased legal bases of abortion. While 8 countries have reduced the legal fields in a way that policy constraints in developing countries than in developed countries, has been 4 times higher. Studying the abortion laws and the situation in different continent and countries show that most European countries except Malta permits abortion in all fields of law. Abortion rate is between 1.4 and 25.5 per thousand women of childbearing age in Europe and lowest in Austria and highest were observed in Estonia. However, in European countries achieving legal permission for abortion needs certain circumstances, for example, in France less than 12 weeks of pregnancy, 10 weeks in Portugal, 90 days in Italy, 18 weeks in Sweden, 22 weeks in the Netherlands, and less than 24 weeks in Finland after fertilization is deadline for abortion licensing. Among different countries in the America region, the Dominican Republic, El Salvador, Nicaragua and Chile, abortion is not permitted in any area. On the contrary, in Cuba, Mexico, Canada and America in all fields abortion is licensed. The lowest abortion rate has been reported in Mexico as 0.05 and the highest rate as 28.9 per thousand women in Cuba have been recorded. In Africa, the annual rate of induced abortions has been between 2003 and 2008, from 5.6 to 6.4 million, much of it in East Africa and lowest in southern Africa have been happened. The situation in Asia indicate that although most residents are Muslims, and in Islam viewpoint abortion without indications for treatment is religiously forbidden, but since in the two countries of India and China, abortion in all areas of law is legal and most of the women live with free abortion laws, most abortions are observed in south Central and east Asia, and the annual number of abortions in Asia has increased between 2003 and 2008, from 25.9 million to 27.3 million. In Iran there are no accurate statistics of the unsafe abortion.
    There is a wide range of behavior among the people because of its functions, and dysfunctions of the related structures. The findings suggest that severe restrictions on access to services related to the abortion has not only failed to prevent it, but also increased unsafe abortions by unskilled people and even cause women to migrate to other countries for this action. There is no accurate statistics regarding the rate of abortion, even in countries with free policies. Hence, more research is needed to learn about various aspects of the abortion completely. Also, preventive policies in this area are helpful. So that using primary measures such as increasing health literacy in communities, the establishment of programs to protect the poor and vulnerable groups, increased counseling facilities appropriate to increase women's awareness about spacing between births, sexual education of young people and couples, facilitates the process of marriage, educational programs about the complications of abortion, increased monitoring of offices and private training health care providers about the areas of abortion law and the conditions of safe abortion and access to services, and postoperative care miscarriage, abortion and its adverse consequences can be prevented. Regarding social changes, policies must be based on understanding the social determinants of health. Facilitating consultation and lawful grounds for abortion, and access vulnerable groups to reproductive health services is recommended.
    Keywords: Abortion, Health Policy, Reproductive Health