فصلنامه آموزش و اخلاق در پرستاری
سال پنجم شماره 4 (زمستان 1395)

The process of decision-making on DNR order is unique and complicated, since it is the only medical decision to be made prior to treatment with consultation and cooperation. Nurses are critical staff of medical team, who have a major role in the patients’ health and whose attitude toward DNR order is of great importance. Therefore, we would try to study their attitude through this study. In 2017, a descriptive cross-sectional study is conducted with 144 nurses working for hospitals related to Jahrom University of Medical Sciences by using random sampling. Our data-gathering tool has been demographic questionnaire and Dun standard survey. Data were analyzed by SPSS 21.00, using descriptive statistics (percent, mean and standard deviation) as well as inferential tests (T-test, chi-squared test, and Man-Whitney). Man-Whitney indicated that participants had a positive attitude to DNR order ( ), i.e. there was a meaningful relationship between DNR order and the nurses’ gender and clinical experience‑ women had a more positive impression than men towards DNR order ( ). Also, the longer their clinical experience was, the more positive their attitude toward DNR order became ( ). This study proved that most nurses had a positive attitude toward DNR order, so considering that nurses are a significant part of the medical staff, we suggest law bestowing them more authority in this regard are legislated by the Ministry of Health

One of the most important values of the nursing profession is commitment to the professional obligations, responsibility and conscientious at work. Conscientious objection (CO) to perform unethical interventions is an old concept in developed countries; however, it is a neglected concept in developing countries such as Iran. CO in health care has been defined as to avoid doing some interventions by health care professionals when these intervention are incompatible with the values, morals and cultural of doer. In nursing, this concept refers to the objection of nurse to perform an intervention or to participate in a situation based on the own informed conscience. CO includes three features: it is an internal sensation of distinguishing the right from the wrong; is internalizing of the family and social norms; is a reflection of moral integrity and sovereignty. Violation of these features could lead to ethical conflict because of threating of the individual integrity. The importance of maintaining moral integrity is one of the fundamental rights for conscientious objection. According to some instances of non-objection of unethical intervention in national nursing services, it seems that the rights of nurses to object conscientiously doing illegal interventions are neglected and nurses have knowledge deficit about their rights, including conscientious objection. Therefore, it is recommended to take this important concept scrutinized by researchers. Various aspects such as the frequency of its events, admission criteria, moral conflicts resulting from its acceptance and its risk factors through qualitative and quantitative research warrant further research.
Save the life of every human being in any situation is the duty of every Muslim. Moral includes principles and values that lead the individual behaviors. Ethics affects most medical sciences fields that will serve the people such as medicine and nursing. Ethical challenges of these professions have been a part of the daily care of patients. Therefore, health personnel need to know the knowledge of ethics of their profession (1). Today, with significant progress made in the treatment and care of patients, ethics in nursing care has become as an integral part of the nursing profession. Not resuscitation of patients with terminal illness, euthanasia, physician-assisted suicide, disconti-nuation of life procedures, palliative treatments, discontinuation of nutrition and hydration, and organ donation after cardiac death are examples of ethical issues with ethical challenges. The main task of nurses is taking care of patients, but they are legally and morally vulnerable due to the multidimensional aspect of job, complexity nature of the job, being a follower of orders for physicians and other factors. One of the most important values of the nursing profession is commitment to the professional obligations, responsibility and conscientious at work. Based on the nursing codes of ethics, nurses must be sensitive and responsible to the challenges and ethical issues in the workplace environment and society that undermined the sanctity of nursing care. They must be ready to respond appropriately when necessary (2). Conscientious objection to perform unethical interventions is an old concept in developed countries; however, it is a neglected concept in developing countries such as Iran.
The conscientious objection in health care has been defined as to avoid doing some interventions by HCP, when these intervention are incompatible with the values, morals and cultural of performer (3). In nursing profession, this concept refers to the objection of nurse to perform an intervention or to participate in a situation based on the own informed conscience. The conscientious objection includes three features: it is an internal sensation of distinguishing the right from the wrong; is internalizing of the family and social norms; is a reflection of moral integrity and sovereignty (4).
Violation of these features could lead to ethical conflict because of threating of the individual integrity. When a person listens to his/her inner conscience, hears only one answer "Do what you have to do". Respecting the conscience is similar to the ethical principle of respecting his/herself. Therefore, conscientious objection is one's commitment to the ethical principles or inner beliefs. The importance of maintaining moral integrity is one of the fundamental rights for conscientious objection.
Magelssen stated multiple situations for refusing to act conscientiously including: providing nursing care seriously violate his/her beliefs and moral integrity; have a valid moral and religious reasons, the proposed interv-entions are not as an essential part of professional work; burden of intervention to the patient is small. For example, the patient's condition is not life threatening, objection do not exclude patients to receive appropriate treatment; Burden to coworkers and health institutions is significantly small; the objection is rooted in nursing profession values; medical procedures are new or their moral status is unknown (5). According to some instances of non-objection of unethical intervention in national nursing services, it seems that the rights of nurses to object conscientiously doing illegal interventions are neglected and nurses have knowledge deficit about their rights, including conscientious objection.
A recent example of deception in this right was removing the sutures on the face of a child by nurse due to the inability of parents to pay fees. Patient dispel out of hospital with bleeding wound on the chin. State media reported this as a disaster. Of course in this case is quite clear that patients' rights are not respected by the medical team so this illegal and immoral act and was sentenced by the court. Therefore, it is recommended to take this important concept scrutinized by clinical investigators. In addition, various aspects such as the frequency of its events, admission criteria, moral conflicts resulting from its acceptance and its risk factors needed to be cleared through qualitative and quantitative research.

Among important factors in hospitalized patients’ satisfaction is respect for their privacy which can accelerate the healing process and reduce hospitalization time. This study aimed to determine the most important barriers of patients’ privacy in the management domain from nurses view point of in educational-therapeutic centers affiliated to Gilan University of Medical Science in Rasht city in 2015-2016. In this cross-sectional, descriptive, analytical study conducted on 186nursing managers chosen by census method and 230 nurses chosen by stratified random method .Data were collected using reliable and valid researcher-made questionnaires. SPSS21 data analysis software and descriptive statistics (mean, standard deviation) and
Factor analysis was performed. The results showed, Factor analysis of the 23words of the questionnaire , the most important barriers to patient privacy in the four areas were as follows: management domain with special value (7.6 )and variance percent pridected 24/7%. The results showed that the management domain is the most important effect is non – compliance with patient privacy

Secrecy and confidentiality of the information of the main patients are important in the medical profession. This has been a major challenge in patients with acquired latent impairment. However, the ethical aspects of protecting individual rights in relation to other people are very important to patients. Therefore, in this study, a case has been introduced with the ethical challenge of protecting the patient's patient with acquired immunodeficiency in the hospital by the medical staff. Case Report: A 44-year-old patient hospitalized in the urological part of the kidney stone. The patient was infected with two HIV-positive and hepatitis B deficiencies, and, knowing the other people in the hospital and failing to keep the secrets by the custodian, caused her dismay and disgrace, and after the cessation, treatment and surgery of the crusher from the hospital With your consent. The ethical challenge we face in this study is to protect the confidentiality of the patient from the principles of autonomy or autonomy, and on the other hand, because of the fatalities of these diseases, informing and maintaining the safety of the other treatment team is also very necessary. Be As a result of the solution, it is a secret to the staff and labels on the patient's case. Keywords: , Professional Ethics, HIV, Ethical Challenge, Acquired Impairment

In the therapeutic environment, the ethical atmosphere is said to be a condition that facilitates moral decision making. Persons working ina hospital also, as a health care organization, are responsible for complying with the ethics of their profession. Therefore, this study was conducted with the aim of investigating the ethical climate of the operating room environment from the viewpoint of the operating room and anesthesiology students of Jahrom University of Medical Sciences in 2018. This descriptive cross-sectional study was conducted in Jahrom University of Medical Sciences in 1397. 101 patients with an operation room and anesthesia who had a one-semester clinical presence in the hospital were enrolled in the study. Data were gathered using two questionnaires of demographic information and Olson's ethical climate questionnaire. Data analysis was performed using descriptive statistics (mean, percentage, standard deviation) and inferential statistics (independent t-test and one way ANOVA) using spss version 21 software at a significant level of p <0.05. The participants in this study were 101 people. The average age of the respondents was approximately equal to 21.5 years with a standard deviation of 76.1 years. Based on the results of this study, from the perspective of all students, the ethical situation of the operating room and its areas were undesirable. By comparing the average score of the operating room ethos with the operating room and anesthesia students 'viewpoint, based on the demographic characteristics, only the significant difference observed was the average score of the students' opinion of the operating room relative to the ethical atmosphere of the operating room based on different age groups ( p <0.05). Comparison of demographic characteristics with the mean score of ethical atmosphere did not show a significant relationship between the two fields of anesthesia and operating room (p> 0.05). Based on the results of this study, from the viewpoint of all students, the ethical situation of the operating room and its areas were undesirable. But in the general atmosphere of the operating room, the opinion of students in the field of anesthesia was more favorable to the students of the operating room. Given the existence of a negative ethical climate in the operating rooms, the hospitals under study, attention to the causes of this and planning to improve the existing ethical climate is necessary

The informed consent and the right of the patient to decide on medical care, based on the principle of respect for autonomy, is one of the most important issues in medical ethics. This decision is made by an individual in people who are not in capacity, and when decisions are made in other people's lives, a participatory decision is made. But if there is a conflict of interest between the individuals in the recent past, the ethical challenge that the present report deals with is something about it.
Patient

A 34-year-old woman, pregnant, and the first delivery, referring to the onset of labor pain, goes to the hospital. The doctor treats cesarean section as essential for the health of the fetus because it will be a risk of fetal loss, given the clinical condition of the mother giving birth. On the other hand, because of the past bitter experience of the complications of cesarean section for her sister, who after the cesarean section still suffers from severe headache and back pain, she is afraid of cesarean section and is not satisfied with cesarean section.

In this case, when deciding the prosecutor's representative at the hospital and setting the documentation, a decision is made to perform the cesarean section. On the one hand, the challenge to the hospital ethics committee is referred to to determine if the decision is effective in these cases. Ultimately, in consultation with the members and experts, the authorities of the Islamic Republic immitate, for such cases.