amirahmad shojaei

Physical and emotional stress during the residency period can have lasting negative effects on residents’ health as well as patient care. Such stress can cause emotional and psychological burnout, decreased physician productivity, impaired job performance, and poor social relationships. First-year residents have more burnout and stress due to many factors. This study aimed to investigate the reasons for the protest of this group of residents.

This qualitative study was conducted with the participation of residents and professors of obstetrics and gynecology in one of the teaching hospitals of Tehran University of Medical Sciences in spring of 2021. Data were collected through individual face-to-face interviews and group discussions. The conventional content analysis method was used to analyze the data. To ensure the accuracy of the qualitative data, the criteria proposed by Lincoln and Guba were considered.

A total of 14 participants were interviewed and 16 people participated in focus group discussion sessions. From the text of the interviews, two themes were extracted. Participants’ experiences showed unbearable pressure, domination, and anonymity as stressors in first-year obstetrics and gynecology residents.

The results showed that the main reason for the protest of the first-year residents was the wrong behavior of the second-year residents and the lack of supervision over these behaviors. Launching a kindness campaign was a suggested solution in this research that could help improve communication between residents and the educational atmosphere.

Organizational ethics focuses on the importance of how organizations behave when faced with specific situations and decisions. This study aims to identify and prioritize organizational ethics indicators in Imam Khomeini Hospital Complex (IKHC) in Iran.

This was a mixed‑method research project. To recognize hospital ethics indicators, 18 semistructured interviews were conducted and 38 indicators were identified through thematic analysis. In the next stage, a quantitative approach was adopted to use the importance‑performance matrix for data analysis. This part was a descriptive survey with a statistical population consisting of nurses, medical, clinical, and administrative staff. The questionnaire was distributed using the random sampling method, and a total of 349 samples were collected.

Based on the interviews and open coding, 73 themes were identified for organizational ethics indicators and classified into two main groups: “ethics drivers in hospital” and “personal ethics.” After measuring content validity, 35 indicators of organizational ethics in IKHC were examined in terms of importance and performance. The results showed that nine indicators had high importance and poor performance, 11 had high importance and performance, nine had low importance and performance, and finally six indicators had low importance and high performance, and according to these findings, practical suggestions were put forward.

Based on the identified indices and by applying importance‑performance analysis, it is recommended to continually assess the status of ethics in hospitals and offer strategies for improving organizational ethics.

Psychology is one of the important disciplines dealing with mental health. Psychology students develop a set of professional competencies during their studies. The present study sought to explore the experiences of psychology students and assess the development of their professional competencies in the workplace. This qualitative study was conducted using a thematic analysis approach. The data were collected through 27 in-depth semi-structured interviews with 24 Ph.D. candidates in psychology who were completing their dissertations and 2 interviews with 2 professors of psychology. The data were analyzed using Braun and Clarke’s six-step thematic analysis. The findings revealed the main themes, subthemes, and main categories. Lincoln and Guba’s criteria were used to increase the trustworthiness of the findings. The core theme identified in this study was professional competencies developed during academic studies. Besides, the five subthemes underlying professional competencies were creating and maintaining empathy, building a mutual understanding, enhancing confidentiality, being human and seeing others as human, and getting out of absolutism. The findings reported in the present study suggested that professional competencies are developed in psychology students during their studies according to their professional and clinical experience. Accordingly, providing adequate experiences can contribute to developing and promoting professional competencies in students.

Moral distress is one of the issues facing the medical staff; means the inability of an individual to act on internal and professional values ​​due to internal and external pressures. Healthcare professionals may face challenging situations where they have ethical doubts about the rightness or wrongness of decisions; While feeling helpless in the face of changing circumstances that they consider immoral. Moral distress is recognized as one of the main causes of burnout syndrome among the medical staff. This study was performed to investigate the moral distress of the Orthopedic ward of Imam Khomeini Hospital.

Methods and Materials: 

This qualitative study was performed by content analysis through semi-structured face-to-face interviews with the participation of physicians, orthopedic residents and nurses of the Orthopedic ward of Imam Khomeini Hospital. The interviews were typed, coded and categorized carefully. Then the similar codes were placed in the same classes and subcategories.

23 interviews, 18 subclasses, 7 classes and 3 themes were formed: Care challenges, communication challenges of the treatment team, and educational challenges.

The results indicated the existence of various moral challenges, which affected the patient and the staff and caused distress, frustration and dissatisfaction. Addressing and managing these challenges raised the need for serious measures in regulating the health care system, job responsibilities, and improving interpersonal relationships. Recognizing the moral distress in system can be effective in planning and reforming the management and communication structure and ultimately improving the quality of care and patient`s outcomes.

Since professional development is one of the goals of any medical school, an essential element in this regard will be the evaluation of professional behavior which is important as one of the most important competencies in the medical profession. Therefore, the present study was conducted with the aim of determining the level of observance of behavior and professional commitment of specialized physicians from the perspective of patients in 2020.

This descriptive study was performed on 150 patients admitted to Imam Khomeini Hospital in Tehran who were selected by simple random sampling. Data collection tools included two sections: demographic variables and 18-item 5-point Likert scale professional behavior and commitment. Data were analyzed using descriptive statistics, Pearson and Spearman correlation tests and multiple linear regression.

The mean and standard deviation of the score of the instrument for observing the behavior and professional commitment of specialized physicians from the patients' point of view was 70.55 ± 9.68 with the lowest score of 49 and the highest score of 90. More than half of the patients 67.3% (101 people) determined the level of professional behavior and commitment at a good level and 32.7% (49 people) at a moderate level.

  Based on the results of this study, professional commitment and behavior are at a good level. The lowest level of compliance was related to not accepting responsibility for diagnostic and treatment errors. Therefore, the relevant authorities should pay attention to identifying the causes of these shortcomings and taking measures to gain experience from the errors.

Although ethical practice is critical in anesthesiology, few practical measures have been presented to implement ethical clinical practice to this specialty.

This study was performed aimed to identify Iranian anesthesiologists' perceptions of moral distress in caring of anesthetized patients.

This qualitative study was performed using conventional content analysis approach based on semi-structured interviews of 15 anesthesiologists which worked in the hospitals affiliated to Tehran University of Medical Sciences in 2019. The sampling method was purposive and the data were analyzed based on Granheim and Landmann method.

Ethical distress perceived by anesthesiologists was classified into the following eight categories: (i) Ethical distress regarding informed consent and respect for patient autonomy, (ii) Ethical distress regarding the cancellation or postponement of patient's surgery, (iii) Ethical distress regarding the anesthesiologist's relationship with patients undergoing surgery, (iv) Ethical distress regarding surgical patients' companions, (v) Ethical distress regarding patients' privacy and confidentiality, (vi) Ethical distress regarding surgeon's colleagues and other OR colleagues, (vii) Ethical distress regarding end-of-life patients, and (ix) Ethical distress regarding fair distribution of resources and equipment.

Implications for Practice: 

The findings of the present study can provide a better understanding of situations that cause moral distress for anesthesiologists and can be used in policy making and preparing ethical codes and ethical guidelines for working in the operating room. Identifying ethical distresses of anesthesiologists in the hospital is the first step in conducting managerial interventions to improve the state of clinical ethics and organizational ethics in a care provider setting.

 Non-observance of ethics in society causes many problems for the general public, and on a smaller scale in the hospital, non-observance of ethical points will result in harmful issues. In order to promote ethical goals in the organization or in other words to promote ethics in university hospitals based on scientific and management recommendations, it is absolutely necessary to use new technologies, which will be investigated in the last step of the research.

 In this research, methods of library studies, in-depth interviews with experts, surveying experts, and observation are used to collect data. Considering the nature of the study, "content analysis ofobtained data" was performed in the hospitals of the University of Medical Sciences and health care services. The opinions of organizational ethics experts in the healthcare industry and other ethics academic experts, ethics and organizational culture, and strategic management were researched.

 In coding the text of the interview, the researcher used natural or live codes, which were the same as the interviewees' sentences, or expressed his understanding of the sentences. This is called confirmation code, which is based on the materials that have been formed from past researches. Appropriate codeswere assigned. The main question of the current research was to obtain fundamental concepts in the field of organizational ethics breaches in the hospital, and this goal was also kept in mind during coding. Moreover, the dimensions of the model and the relationships between the dimensions were also in acknowledged, andwere taken into account in the coding. The ethics of the treatment staff does not only pertainto the doctors, but also to other departments that treat the patient in some way. In the meantime, nurses have the most interaction with patients and their and companions, and due to the nature of their work, they must be morally restrained and self-controlled in order to be able to behave ethically, so as not tocause discomfort to the patient, but also relieve him mentally.

 This plan is comprehensive and helps recognition of the fact thatdevelopment of ethics in hospitals is comprehensive, requires prioritization, has various dimensions, and that it should be considered as an organizational goal.

Considering the importance of professional commitment in medical services, it is necessary to provide an appropriate questionnaire to measure professional commitment and behavior. Therefore, the present study was conducted with the aim of investigating the psychometric properties of the questionnaire "Patients' views regarding the observance of professional behavior by specialist doctors".

The present study is a psychometric research that was conducted in four phases. The first phase of this study was based on a professional behavior tool guide, review of texts and collection of experts' opinions. in  the second phase , determining the validity of items in the form of the face and content validity, in the third phase , the pilot study, and in the fourth phase,instrument reliability was conducted in two ways: internal consistency and instrument stability.

A pool of 50 items was formed to design the questionnaire. After interviewing the study population and removing overlapping items, the number of items was reduced to 31 items. The results of CVR calculation showed that out of the total of 31 items, 13 items had a cutoff point less than 0.42, which were removed, and 18 items with a CVR score > 0.62 remained according to the opinion of the research team. In the face validity stage, the Impact factor < 1.5 was used as the basis for exclusion, and all the items had a high impact factor, and finally, the draft of the questionnairewas approved with the same 18 items. Cronbach's alpha coefficient was 0.88 and the internal correlation coefficient of the questionnairewas 0.93, which indicated the appropriate reliability of the questionnaire.

Based on the results of the present study, the questionnaire on "Patients' views regarding the observance of professional behavior by a specialist physician" in Iranian society has the necessary content and face validity and adequate reliability. By using this questionnaire, hospital officials can check the status of professional ethics of their specialist physician from the patients' point of view and take effective measures to eliminate the shortcomings.

Effective and acceptable practice in Legal Medicine (LM) requires special attention to ethical and professional behaviors. In LM, the importance of practitioners’ compliance with ethical standards is higher. LM covers a wide range of practices, requiring specific ethical considerations. This study aims to identify the ethical principles for considerations in Iranian Legal Medicine Organization (ILMO) from the perspective of experts in LM.

This is an applied and qualitative study using in-depth interviews and conventional content analysis. The study was conducted in three steps: 1) Determination of the main areas of work by reviewing academic texts، surveying 131 experts in this field with a questionnaire. 2) Qualitative Study for determination of ethical considerations of these areas by structured and in-depth interviews with 49 owner’s Forensic and medical ethics experts obtained by purposive sampling and theoretical saturation and analysis of interviews by the conventional approach of content analysis to specify propositions and confirm the reliability of 80% research in coding through the double-coder agreement method. 3) Drafting ethical guidelines by the research group (students، supervisors، and consultants) in the focus group meetings based on the results of the second step.

The ethical principles of LM were categorized as general and specific principles according to the perspective of experts in LM. General ethical principles included virtue ethics, professional and ethical behavior, and proper environment and working conditions. The specific ethical principles included six principles related to the entire organization, legal physical examinations, legal mental examinations, dissection rooms and crime scenes, LM laboratories, and LM commissions.

Developing and implementing general and specific ethical guidelines for ILMO is recommended. The comprehensive and holistic view of ethical considerations for main practices of LM in Iran provided by this study can be seen as a good taxonomy and a preliminary step to develop local ethical guidelines.

One critical tactic that leads to a better understanding of the ethical status of dentists is to assess their ethical attitude by using an appropriate scale. This study aimed to design and evaluate the validity and reliability of the ethical attitude of dentists scale (EADS).This study was conducted based on a mixed‐method design. The first qualitative part of the study was conducted in 2019 and the items of the scale were produced from the ethical codes compiled in a previous study. In this part, the psychometric analysis was conducted. The reliability was evaluated by Cronbach's alpha coefficient and intraclass correlation coefficient. Factor analysis was used to assess the construct validity (n = 511), and the following three factors were extracted with a total variance of 48.03. (1) Maintaining the standing of the profession in relationships. (2) Providing dental services while maintaining trust in the profession, and (3) Providing information for the benefit of the patient.In confirmatory factor analysis, appropriate values were obtained for the goodness of fit indices, and Cronbach’s alpha was 0.68 - 0.84 for the various factors. Based on the results mentioned above, this scale showed an appropriate validity and reliability for measuring the ethical attitude of dentists.

A key element in therapeutic communication is trust and it needs to be created and maintained between health care providers and recipients reciprocally. This study aimed to identify the factors that can enhance and improve trust between pharmacists and patients. This study was a qualitative study consisting of an in-depth semi-structured interview followed by a focus group discussion. In the first phase of the study, a semi-structured open-ended interview was conducted with patients, pharmacists, and pharmacy technicians. The interview phase was followed by transcribing verbatim and content analysis and a focus group discussion. Finally, 49 items of trust-building factors between the patient and the pharmacists were obtained. A questionnaire was designed and distributed among 80 people for transparency and relevance, similar to the participants. The necessary corrections and changes were made in the items after collecting the answers. The study achieved two main themes; external and internal trust-building factors. Internal factors include the category of the factors related to human resources and managerial factors. Finally, 49 trust-building factors were developed. Internal factors are those factors in which the pharmacist, the pharmacy technician, and the pharmacy's management system play a key role in building trust between pharmacists and patients.

Facing a devastating infectious outbreak like COVID‑19, the command of “stay at home” was recommended by some officials as a self‑voluntary quarantine strategy for controlling the outbreak, but the people perceived and act differently. In this study, we aimed at ethnographic evaluation of public response to this command.

This research used ethnography for observing the public response to the recommendation of “stay at home” in the COVID‑19 outbreak. Data were collected via observing public behavior and documentation; then, the data were qualitatively analyzed.

Our findings showed 10 different ignored dimensions in this moral statement including lack of legal and administrative support, diverse perception and contradictory reactions of the people to the epidemiological forecasting and recommendations, different response to moral statements, various perceptions of the people about health and wellbeing, feeling exhausted of staying at home, not including justice and fairness in the moral statement, not clarifying the meaning of necessary matters, not considering the COVID‑19 infected patients and their requirements, assigning the responsibility of government to the public, and halting other scientific activities and investigations in charge of COVID‑19.

Taken together, the officials should take an active role in implementing this moral statement by strict regulations, public education about the disease, its control, and the importance of quarantine, considering justice and fairness in implementation.

Codes of ethics are a set of moral standards based on a value system widely accepted by members of a profession. In order to choose the right course of action and resolve potential ethical challenges, these codes will need to be developed so that ethical values can be identified and prioritized. Medical ethics covers all areas of medicine, and surely, rehabilitation is not an exception. This study aims to codify the ethics of the rehabilitation profession while considering the cultural and religious issues in Iran. For this purpose, we used a qualitative research method, including literature review, questionnaire, targeted interviews, content analysis, group discussion, and code extraction. The results were categorized into seven sections: “respect and empathy”, “autonomy”, “offering responsible care and reducing suffering”, “doing the right thing”, “beneficence”, “privacy and confidentiality”, and “social responsibility”. The development of ethical codes for rehabilitation determines moral norms in order to protect the rights of people who need rehabilitation services. These codes can also be used as a guide to the ethical challenges of the profession.

The dental profession has a special place of trust in the society, and dental clinicians must adhere to ethical standards in all dental procedures. Ethical conduct is one of the main expectations of individuals from this profession. The aim of this study was to design and develop dental ethical codes for national implementation in Iran.

  This qualitative study was performed using directed content analysis method and purposive sampling.Data were collected until saturation through 15 semi-structured face-to-face individual interviews and two expert panels with academic staffs from dental faculties in Tehran, Iran.

Data were classified into five principles and 90 codes. The principles included consideration of patients’ interest as a priority, respect for human dignity and patient autonomy, confidentiality of patient information, the excellence of knowledge and skills, and building trust.

The ethical codes for Iranian dentists were drafted considering Islamic teachings and the prevailing culture. Some codes were exclusively developed for the cultural atmosphere of Iran especially on topics such as interaction with patients previously treated by other dentists. Some codes addressed the principles of consultation and continuing the therapeutic communication with such patients. Some items have not been considered in codes released by other associations, such as religious considerations in Islamic cover and alcohol consumption that were taken into consideration in this draft. These codes can serve as a guide for professional practice of dentists. It seems that these sets can help us reach the standardized code.

Physiotherapy requires close and prolonged contact of physical therapist with patient during several sessions. For this reason, many associations in other countries have formulated code of ethics for physiotherapy which referred to the most important responsibilities in this field. Despite formulation of ethical codes in many countries, these codes have not yet been outlined in Iran. Therefore, this research has been conducted to identify the physiotherapy ethical imperfections and challenges and in Iran. This study was a qualitative research in which methods of interview with authorities and focused group discussions were used. Participants in this study were 15 persons, who were purposefully selected from four professional groups including physicians, physical therapists, specialists on medical ethics and directors of physiotherapy centers. After data saturation, texts of interviews were typed verbatim. These texts were repeatedly studied by the interviewer and their results were 187 raw and rudimentary sentences. Extracted data were analyzed, reviewed and revised by the authorities on the subject and eventually the data were arranged in 4 domains of patient, physician, physical therapist, and treatment center. Findings of this research indicate the ethical challenges present in our country in the field of physiotherapy in four domains. To promote professional ethics in physiotherapy, all four parties should be aware of their rights and duties and follow ethical principles and regulations.

Medical ethics in a reductive look can be handed to physician’s ethics and then call a physician who adheres to medical ethics attributed to the moral virtues. Moral virtues are counted to be about 137 in the teachings of Shiite, most of which are not related to the practice of medicine but nearly eighty virtues are linked to the practice of medicine. This number is too much to be handled in a paper and analyzed by verses and hadiths. Therefore, we should take two steps: 1-Limit the virtues of physicians 2- Analyze the virtues of physicians. Believe and practice the virtues emphasized in the teachings of Shiite leads to a monotheistic look to the practice of medicine and provides physicians with a different and transcendental worldview. This insight that stood upon the teachings of the Quran and hadiths by Imams (AS) considers the practice of medicine a divine relation and then shows the communication between a physician and others. The current paper analyzes the divine relation of the physician and its impact to the practice of medicine. First literature review performed to find three most virtues. Then Factor analysis method was used and therapeutic virtues were limited to thirteen virtues. Then library study and focus group discussions were used to analyze the selected therapeutic virtues. The practical conclusions is that if we consider medical ethics practice based on virtue, and define and interpret virtues based on the teachings of Shiite, then we will get to a monotheistic view in the practice of medicine that distinguishes Shiite medical ethics monotheistic feature and the secular one, and helps to link between faith and morals.

Although, physicians have a duty to treat their patients, sometimes the cure is not possible in medicine and there is no result in attempt to cure patient. In this situation, we face with two types of patients: first, patients who are conscious but suffering with advanced disease and will survive only for a short time. The second group, are patients who are unconscious and may not be cured with the standard treatment based on physician experience.
The latter are the subject of the present article. So what a Hospital should do in dealing with these patients? How the hospital, should develop a community-based policy on providing care for these patients. Finally, how should inform the public to adhere to these policies.

Trust is an important factor in the relationship between physician and patient. Trust between physician and patient is an important factor in improving patient and physician satisfaction, but it will not materialize unless we define trust and its criteria. Since trust fulfillment is dependent on its criteria, in this study we tried to define these criteria. First, we explicated the meaning and concept of trust through review articles, then we proceeded to content analysis, and lastly, the logical conclusion was obtained. In this article we have expressed scientific opinions and extracted 23 components from the cited opinions. We concluded that trust can be analyzed from three perspectives: the perspective of patients with 5 criteria, the physicians’ view with 2 criteria and the perspective of an observer of the physician-patient relationship with 9 criteria.

Theoretical studies and actual usage of morality lies in our conception of morality. This paper has centered on the definition of morality in a comparative method. The word akhlaq, morality, has different meanings. In this paper, by the word is meant the characteristics of human behavior. It had been traditionally known as an actually rooted ability of human soul of which moral behavior originates. Nowadays, however, it has been regarded as a behavior example for communication founded on human rights. The views, both, have known the definition of morality unconditioned with regard to goodness and badness. Moreover, stability, freedom and gradation of morality have been accepted in both. They, however, differ in some aspects; the traditional knows morality as inner quality, while the modern as outer. The latter, contrary to the former, shows the numerous subjectivity of morality. In the traditional definition, mentally rooted characteristics have been known as the origin of moral behavior. Inserting the cause in definition, makes principles unconditioned and, contrary to modern definition, omits view`s state of being comprehensive.