مجله ایرانی اخلاق و تاریخ پزشکی
سال هفتم شماره 3 (شهریور 1393)

It has been over five decades since the concept of “spiritual health” was first introduced in academic texts، and although many studies have been conducted on the subject، there exists no consensus on its definition and components yet. Nonetheless، this concept has been an inextricable part of Islamic Theology، which is more than several hundred years old. Therefore، it can be asserted that observation and analysis of the lifestyles of Muslim scholars may shed some light on this seemingly complex concept. This analytic-descriptive article was designed to provide a straightforward definition for spiritual health and explore its different components from the viewpoint of Ayatollah Hassanzadeh Amoli، a renowned Shiite scholar. In this article، spiritual health refers to the health of the soul and is related to both material soul and the body itself. The Ayatollah puts special emphasis on the importance of living a healthy lifestyle and on the health of the material soul in order to promote spiritual health. In this article، we endeavor to conduct a thorough analysis of the lifestyle and views of Ayatollah Hassanzadeh Amoli.

This study aims to develop a national questionnaire that measures the moral sensitivity of Iranian medical students. The questions were developed based on ethical vignettes in educational documents، the professional code of conduct in Tehran University of Medical Sciences and medical students’ workbooks in ethics course. A pilot study was conducted to evaluate the clarity and appropriateness of 7 primary questions. Next، 38 questions were reviewed for content and face validity by an expert panel including 7 expert teachers and 4 lay experts (medical students). In order to assess the reliability of the finalized 35 questions، a test-retest was conducted on 30 medical students with a 2 weeks interval. Through test-retest study، the median values of intraclass correlation coefficient (ICC)، Spearman and Kappa were calculated at 0. 81، 0. 65 and 0. 53 respectively. The final version of this instrument consists of 24 scenarios، each presenting an ethical challenge، and has a Cronbach’s alpha reliability score of 0. 67. The final questionnaire could be used as a valid and reliable research instrument to determine the moral sensitivity level of Iranian medical students. Another application for this instrument may be evaluation of the effectiveness of curricular reforms by longitudinal studies. To the best of our knowledge، this is the first context-specific instrument on moral sensitivity assessment in Iranian medical schools.

In the nursing profession، moral distress is a challenge thatc an have different consequences. The nurses’ moral courage to make the right decision can play an important role in the prevention of moral distress، and thus promote moral comfort. The present study examined the relationship between moral distress and moral courage in nurses. In this study، 313 nurses from hospitals in southern Khorasan Province were selected through quota sampling، and Corley’s Moral Distress Scale and the Professional Moral Courage Scale by Sekerka، et al. were used for data collection. The collected data were analyzed by descriptive and analytical statistics. The findings showed a significant relationship between the intensity of moral distress and moral courage (P = 0. 03، r = - 0. 44). From a range of 0 - 5، the mean of moral distress was 3. 7 ± 0. 5 in terms of intensity، and 3. 55 ± 0. 86 in terms of frequency. The mean score of moral courage was calculated at 3. 33 ± 0. 46 from a range of 1 - 5. The significant correlation between moral distress and moral courage strongly suggests that high levels of moral courage in nurses can play an important role in controlling moral distress. Determining the factors that create moral courage and developing strategies and circumstances such as promoting an appropriate moral climate could play a major role in encouraging moral behavior and controlling moral distress.

The nursing profession is based on ethics. Clinical decisions that most nurses have to deal with include cases that involve moral conflicts. Moral distress is a phenomenon that causes pain، suffering، anxiety، depression and psychological damage. Emotional exhaustion can cause moral distress and is a consequence of job stress that has even been investigated as a reason for the high turnover in nursing. Therefore، the present study investigated the relationship between moral distress and emotional exhaustion among nurses. In this cross-sectional study، 265 nurses who employed in teaching hospitals of Sabzevar University of Medical Sciences were selected through convenience sampling. Data collection tools included a questionnaire on personal information; a moral distress scale whose validity and reliability had been measured in previous studies (Cronbach''s alpha 0. 86); and a scale for emotional exhaustion that had also been tested for validity and reliability through content validity and test-retest (r = 0. 84). Data analysis was performed using SPSS version 18. In this study، mean and standard deviation of moral distress and emotional exhaustion of nurses were 4. 99 (0. 91) and 4. 17 (1. 58) respectively. A statistically significant correlation was found between moral distress and the nurses’ field of work (rho = 0. 338، P = 0. 000). There was also a significant correlation between emotional exhaustion and rotating working shifts (rho = 0. 385، P = 0. 000) and ward (rho = 0. 173، P = 0. 03). The moral distress and emotional exhaustion of the nurses in this study were found to be higher than average. Education، counseling and raising nurses’ awareness of these concepts seem to be necessary in order to empower them to better deal with ethical issues.

Decision making is an important part of nurses’ responsibilities in providing clinical interventions for patients. Religion is among the moral factors that affect the performance and clinical decision making of nurses. The present study aimed to investigate the relationship between religious orientation and moral sensitivity in the decision making process among nurses. This study was a cross-sectional، analytical research that was carried out on 170 nurses working in Gonabad hospitals. Subjects were selected by census، and data were collected using the Allport Religious Orientation Scale and the Moral Sensitivity Questionnaire. Data analysis was performed using SPSS version 16. In the present study، internal religious orientation mean was 36. 39 ± 4. 65، external religious orientation mean was 33. 77 ± 6. 89 and moral sensitivity mean was 159. 21 ± 14. 1، and therefore internal religious orientation was higher among the nursing staff. Moreover، Pearson''s correlation test showed that there was a significant، positive relationship between internal religious orientation and moral sensitivity (P = 0. 01، r = 0. 17). Nevertheless، no significant relationship was found between external religious orientation and moral sensitivity (P = 0. 86، r = - 0. 01). Based on the findings of this study، it seems that authorities need to develop and implement strategies to educate nurses on morality and spirituality، since members of this profession play an important part in the health and well-being of the community.

Patience is a moral construct and is related to persistence، tolerance، restraint، contentment and transcendence in difficult and unpleasant situations. It can be discussed in the field of medical ethics and is related to many variables. The aim of the present study was to examine the role of patience and its components (transcendence، tolerance، contentment، persistence، and restraint) as moral constructs in predicting hope among university students. The study population of the present study consisted of all of the university students studying at Shiraz University. Three hundred and ninety university students were recruited via cluster sampling. The participants completed the patience scale and hope scale. According to the findings of the Pearson’s correlation test، patience and its components correlated positively and significantly with hope and its subscales (pathway and agency). Moreover، the total patience score effectively predicted the total hope score (β = 0. 58، P ≤ 0. 001)، pathway (β = 0. 52، P ≤ 0. 001) and agency (β = 0. 52، P ≤ 0. 001). Transcendence، contentment، and persistence were important predictors of hope and its subscales. It can be concluded that reinforcing patience as one of the most important and valuable moral constructs can increase hope and lead to success. Thus، applying educational strategies of patience in order to curtail despair and promote hope among patients is recommended for clinicians working in the fields of psychology، health and medical ethics.

In order to face the challenges of today’s health system، it is extremely important to promote collaborations among disciplines. Nevertheless، it seems that nurses and physicians cooperate more effectively in academic areas، and their partnership in the actual work place and clinical settings is associated with challenges. This cross-sectional study aimed to determine the attitudes of doctors and nurses in hospitals affiliated with Shahid Beheshti University of Medical Sciences toward collaboration with each other. For this purpose، the Jefferson Scale of attitudes toward physician-nurse collaboration was used after it was translated and its validity and reliability were examined on 59 physicians and 164 nurses. Data were analyzed using the SPSS software version 18. The results showed a more positive attitude toward the concept of collaboration among nurses (3. 49) than physicians (3. 12) (P = 0. 02). Moreover، a significant difference was observed between the attitudes of physicians and nurses toward working together across various items of the questionnaire (F = 5. 06، P = 0. 02)، with the exception of the area of nursing autonomy (F = 0. 95، P = 0. 32). An appropriate nurse-physician relationship and agreement over treatment plans can increase the quality of care، and lack of cooperation can lead to stress in the workplace. Therefore، in-service training for doctors and nurses and attention to the importance of cooperation among members of the medical team must be incorporated into the nursing and medical curriculum. Thus، the traditional views on the role of nurses will change، and nurses will be able to perform their professional duties more effectively. Consequently، the cooperation between physicians and nurses and the fortified synergy between the roles will improve the quality of care.