akhlāq-i pizishkī i.e., Medical Ethics

One of the emerging global challenges in infectious disease management is addressing coronavirus disease. The coronavirus spread to all countries of the world and Iran and quickly endangered mental and physical health. With the creation of the coronavirus pandemic, human society and the physical effects of this disease also faced widespread psychological effects of this disease, which can be referred to as social stigma. Stigma is an essential aspect of a person's life; Human status, social status, job opportunities, marriage, family relationships and friendships were affected. Although stigma does not directly cause chronic disease, it significantly increases the level of anxiety, which may exacerbate clinical symptoms and even lead to recurrence. Stigmas are highly influenced by environmental information and Internet news.The World Health Organization (2020) states that an almost constant flow of news about the outbreak of coronary heart disease causes everyone to feel anxious or distressed. Therefore, information updates and practical tips should be sought from health professionals and the WHO website at specific times and avoids rumors that cause people discomfort and anxiety. Given that Covid 19 experiences many psychosocial consequences and this reduces their quality of life, the use of psychologists and counselors in the treatment environment to reduce these consequences seems necessary. Also, considering the importance of educational media, especially new media, in increasing awareness and empowerment of society, it is recommended to pay attention to the educational needs of society and new opportunities that new media provide to health educators in future planning. More to be done.

Cite this article as: Arabi S. Social Stigma COVID-19 More Dangerous COVID-19 Pandemic. Faṣlnāmah-i akhlāq-i pizishkī i.e., Quarterly Journal of Medical Ethics. 2021; 15(46): e8.

The epidemy of Covid 19 disease is a real danger of seriously endangering the safety and rights of women and infants. The true and correct diagnosis of the disease Covid 19 is still one of the concerns and challenges facing this pandemic. Over estimation or over-diagnosis of the disease may be associated with risks to the quality and quantity of sexual and reproductive health services. The four principles of medical ethics in the provision of health services are important. Regarding the principle of justice, over diagnosis of Covid 19 disease imposes additional financial burden on diagnostic and therapeutic tests. Beneficiary principle can be referred to the effectiveness of diagnostic tests in the provision of services, which due to unnecessary and unrelated diagnostic tests not only does not benefit the health of the individual, but also in terms of harm may lead to the use of unnecessary drugs, hospitalization and other consequences. Anxiety about the disease for the individual and family, fear of spreading the disease to other family members, impact on marital relationships, fear of pregnancy, fear of childbirth, stigma due to the diagnosis of Covid 19 disease, infant deprivation of breast feeding, lack of  enough care and treatment protocols are the challenges in providing sexual and reproductive health services. The need to separate mother and baby in the hospital in cases of suspected disease, the impossibility of attending and not receiving family support when receiving sexual and reproductive health services over shadows the moral principle of the right to autonomy. Women and their children need safe care following the Covid epidemic in clinical, emotional, psychological, and social dimensions. It seems that in this critical situation, the emphasis on the sensitivity of correct diagnosis and attention to the adverse consequences of misdiagnosis is considerable importance.

Cite this article as: Farajkhoda T. Sexual and Reproductive Health Rights and Challenges of Covid 19 Diagnosis. Faṣlnāmah-i akhlāq-i pizishkī i.e., Quarterly Journal of Medical Ethics. 2021; 15(46): e17.

Background and Aim: Safe operation of staff, especially nurses and the work environment have a decisive role in the quality and safety of patient care. The outbreak of the corona pandemic has led to a high degree of uncertainty and has filled health systems with a variety of challenges. Therefore, the present study aimed to investigate the relationship between patient safety friendly hospital standards and nurses' safety performance during the corona pandemic in Tehran in 2020.

Materials and Methods: The present study is a cross-sectional descriptive-correlational study that was performed on 266 nurses of Imam Khomeini Hospital in Tehran who met the inclusion criteria by stratified random sampling. The data collection tool was a questionnaire consisting of three parts including nurses' demographic information, patient safety friendly standards of Parvizi et al. And Parviz et al. Frequency distribution tables, central indices (mean and median) and dispersion indices (variance and standard deviation) were used to describe the data. Pearson correlation test was used to evaluate the correlation between patient safety friendly standards and nurses' safety performance using SPSS 16 software.

Findings: The mean and standard deviation of all patient safety friendly hospital standards from the perspective of the nurses was 97.35±16.59. The mean and standard deviation of nurses' safety performance was 59.36±10.37. Both variables were in the middle level. In addition, there was a positive and significant correlation between patient safety friendly hospital standards and all its dimensions with safety performance (r=0.843, P<0.001).

Ethical Considerations: This article is the result of a master of sciences nursing dissertation at Tehran University of Medical Sciences. During the research process, the ethical principles in research with human subjects were observed based on the guidelines of the Islamic Republic of Iran/ including obtaining informed consent to participate in the research.

Conclusion: Therefore, according to the results of this study, it seems that the review of strategies including purposeful and evidence-based management of organizational resources with a comprehensive approach including barriers to achieving safety dimensions, institutionalizing patient culture, safety and promoting safety atmosphere, focus on the index Patient safety measures are needed in hospitals.

Cite this article as: Hajibabaee F, Esmaeili M, Ashrafizadeh H, Farahani M, Haghani SH, Ariyamloo P. The Relationship between Patient Safety Friendly Hospital Standards and Nurses' Safety Performance during Corona Pandemic. Faṣlnāmah-i akhlāq-i pizishkī, i.e., Quarterly Journal of Medical Ethics. 2021; 15(46): e1.

Background and Aim: Professional ethics can be an effective indicator and an important motivational tool in the success of organizations to create excellence, sustainable development, good and healthy competition, reduce conflicts, increase job motivation, create commitment and social responsibility. The aim of this study was to investigate the effect of professional ethics on organizational accountability of employees by testing the mediating role of job enthusiasm and team work among employees of Ardabil University of Medical Sciences

Materials and Methods: The present study is applied based on the purpose and based on the type of method, it is descriptive-correlational and in terms of data collection is a survey. The statistical population of this study included all the staff of Ardabil University of Medical Sciences, 290 people. Based on Cochran's formula and using simple random sampling method (without placement), 170 people were selected as the statistical sample of the research to collect data. To collect the data, questionnaires of variables were used, respectively, independent, mediator, which includes professional ethics (Cadozier), job enthusiasm questionnaire (Salonava and Shuffle), team work (Linchoni) and organizational accountability (Bovens). The validity of the questionnaires was confirmed through apparent validity based on the views of experts and specialists and the construct validity was confirmed through factor analysis; The reliability of the questionnaires was also calculated based on Cronbach's alpha coefficient. Data were analyzed using SPSS 24 and Amos 22 statistical software.

Findings: The results showed that professional ethics has a positive and significant direct effect on Staff team work (0.67), their accountability (0.59) and on their enthusiasm (0.46) (p <0.01). The direct effect of team work on employee accountability (0.52) is positive and significant. The direct effect of job enthusiasm on employee accountability (0.37) is positive and significant. Team work has an indirect effect on the impact of professional ethics on employee accountability (0.34). Also, job enthusiasm has an indirect effect on the effect of professional ethics on employee accountability (0.17).

Ethical Considerations: After explaining the objectives of the study and reassuring the participants about the confidentiality of information and their verbal satisfaction, questionnaires were distributed among the participants.

Conclusion: The evidence showed that paying attention to the principles and standards of professional ethics by university staff can affect organizational variables and items such as carte blanche, job enthusiasm and organizational responsiveness of employees and improve the quality of service and improve their position in the eyes of the client to be.

Cite this article as: Ghasemzadeh Alishahi A, Zahed Babalan A, Moeini Kia M, Kazemi S, Mokalaf KH, Divband A. The Effect of Professional Ethics on Organizational Responsibility of Employees by Testing the Mediating Role of Job Enthusiasm and Team Work. Faṣlnāmah-i akhlāq-i pizishkī i.e., Quarterly Journal of Medical Ethics. 2021; 15(46): e3.

Background and Aim: Nurses in intensive care units has stressful situation, therefore it is essential to identify effective approaches to decrease stress and increase psychological health for them. Self-compassion can play a role in balancing the mental health of nurses. The aim of this study was to determine the relationship between self-compassion and Job stress of nurses in intensive care units of hospitals affiliated to Zanjan University of Medical Sciences in 2020.

Materials and Methods: This study was descriptive correlational cross-sectional study. It conducted on 367 nursing staff in intensive care units hospitals affiliated to Zanjan University of Medical Sciences in 2020. The data collection tool was a questioner consisted of: demographic characteristics; Neff’s Compassion Scale and Gray-Toft and Anderson’s job stress. Data were analyzed by using SPSS 21 software and descriptive and inferential statistical tests.

Findings: The results of Spearman correlation test showed that there is a statistically inverse significant relationship between job stress and self-compassion (P<0.01, r=-0.260). The mean score of self-compassion was 3.36±0.51, which shows a moderate level of self-compassion.

Ethical Considerations: This study is approved by the Ethics Committee on Medical Research. Ethical considerations such as completing the informed consent form voluntary participation, explaining research goals, and assurance of confidentiality were observed.

Discussion and Conclusion: The results of this study revealed a reverse relationship between self-compassion and job stress of nurses; therefore, policymakers and nursing authorities can take strides in moderating nurses’ job stress and improving their professional performance by education and improvement of nurses’ self-compassion skill.

Cite this article as: Razaghpour H, Rejeh N, Heravi Karimooi M, Tadrisi SD. The Study of Relationship between Self-Compassion and Job Stress of Nurses in Intensive Care Units. Faṣlnāmah-i akhlāq-i pizishkī i.e., Quarterly Journal of Medical Ethics. 2021; 15(46): e4.

Background and Aim: Bullying is a behavioral phenomenon that has attracted the attention of many teachers and educators in different parts of the world in recent years. The purpose of this study is to explain the Bystander behavior in schools based on Moral Disengagement and moral sensitivity with the mediating role of moral identity. The target population was male and female high school students in Lorestan province in the 1397-98 academic year.

Materials and Methods: This is a cross-sectional study kind of correlation. The sample of the present study included 617 students who were selected by cluster sampling. Participants responded to the scales of Mechanisms of Moral Disengagement, Ethical Sensitivity, participant's role (and Self-Importance of Moral Identity. Data analysis was performed using structural equation modeling as well as path analysis by AMOS 24 software.

Findings: The results showed that conceptual model of research has a desirable and acceptable fit with the research data. Findings from the structural equation model show that moral disengagement and moral sensitivity are related to the bystander behavior in bullying. In other words, those with high moral disengagement and low moral sensitivity they behave more harmful. The results of the analysis also show that moral identity has a mediating role in the relationship between bystander behaviors in schools and moral disengagement and moral sensitivity.

Ethical Considerations: In this study, principles related to ethical considerations such as confidentiality of the respondents' identity, satisfaction of the participants in the research and the right to leave the research was taken into consideration.

Conclusion: The results show that moral disengagement and moral sensitivity are related to the type of students' reaction as a witness during bullying and this reaction can be different according to characteristics such as moral identity.

Cite this article as: Souri H, Kadivar P, Keramati H, Hassanabadi HR. Explaining the Bystander behavior of Bullying in Schools Based on Moral Disengagement and Moral Sensitivity with the Mediating Role of Moral Identity. Faṣlnāmah-i akhlāq-i pizishkī i.e., Quarterly Journal of Medical Ethics.2021; 15(46): e5.

Background and Aim: Nurses in the clinical setting are confronted with multiple ethical decision-making that need ethical sensitivity to manage, so the present study was conducted to determine the nurses' moral sensitivity at hospitals of Guilan University of Medical Sciences.

Materials and Methods: In this descriptive-cross-sectional study in 2017, 180 nurses were selected via multistage sampling from Hospital wards of Guilan University of Medical Sciences. Data were collected through a demographic and the Moral Sensitivity Questionnaire (MSQ). The data were analyzed by the SPSS software version 19 using descriptive and inferential statistics.

Findings: The mean and standard deviation score for nurses’ moral sensitivity was (60.88±11.30). Moral sensitivity was low in 20 people (11.2%), moderate in 143 people (79.4%) and high in 17 people (9.4%). The highest scores were related to the domains of “professional knowledge” (Mean Rank=5.73) and the lowest scores were related to the domains of "honesty and benevolence" (Mean Rank=1.27). There was a significant relationship between Participate in ethics workshops and moral sensitivity (p=0.04).

Ethical Considerations: Written permission and ethical approval were obtained from Guilan University of Medical Sciences Ethics Code IR.GUMS.REC.1395. The goals of the study were explained to the participants and then a written informed consent was received from them. Participants were reassured that their participation in the research was voluntary and the information was confidential and results as a group analyze and report.

Conclusion: In this study, nurses received a moderate score in moral sensitivity and a low score in honesty and compassion, which indicates the difficulty in communicating with empathy therefore, planning to provide emotional and social support and also reduce the workload of nurses seems necessary.

Cite this article as: Faeze Kobrai Abkenar F, Mansour Ghanaei R, Omidzahir S, Poureini M. Moral Sensitivity in Nurses of Guilan University of Medical Sciences Hospitals: A Descriptive Study. Faṣlnāmah-i akhlāq-i pizishkī i.e., Quarterly Journal of Medical Ethics. 2021; 15(46): e6.

Background and Aim: Organizational culture as an important and fundamental component in the body of an organization, on all aspects of the organization, including the development of goals, strategy, individual behavior, organizational performance, job motivation and satisfaction, creativity and innovation, employee participation in affairs and the like. Affects, so that successful organizations have a strong and effective organizational culture. Meanwhile, employees' cultural intelligence has a significant role in strengthening the organization's culture. And the relationship between these two variables has not been studied in the country's hospitals. In this regard, the present study aimed to investigate the relationship between cultural intelligence and its dimensions with organizational culture in Shahid Madani Hospital in Khorramabad was studied.

Materials and Methods: The present study is a cross-sectional descriptive-correlational descriptive-odor cross-sectional paradigm. The statistical population studied in this study is all employees of Shahid Madani Hospital in Khorramabad with medical, paramedical and administrative positions. Thus, using Morgan table, 160 employees were selected by random sampling. Standard Ang and Denison questionnaires were used to assess cultural intelligence and organizational culture, respectively. Finally, the collected data were analyzed using structural equation method and SPSS 26 and LISREL software.

Findings: The relationship between cultural intelligence and its dimensions with organizational culture is significant. Therefore, the research hypotheses are significant and among the dimensions of cultural intelligence, the metacognitive dimension with a coefficient of 0.65 has a stronger correlation with organizational culture.

Ethical Considerations: In the present study, all cases related to the informed satisfaction of individuals in filling out the questionnaire and the confidentiality of their answers was observed.

Conclusion: The results showed that the ability of cultural intelligence as a very important ability to understand the cultural factors outside the organization and identify internal strengths and weaknesses is significant. Therefore, due to the acquired nature of this ability, it is suggested to increase cultural intelligence among the staff of the hospital through formal trainings. This requires that individuals be aware of the characteristics of other cultures and by reviewing their cultural cognition; provide the basis for extensive interactions between other cultures.

Cite this article as: Bashokoh M, Beigi Firoozi A. The Effect of Staff Cultural Intelligence on Hospital Organizational Culture. Faṣlnāmah-i akhlāq-i pizishkī i.e., Quarterly Journal of Medical Ethics. 2021; 15(46): e7.

Background and Aim: Ethics and teaching are inherently intertwined, and researchers have stated that adherence to the principles and values of professional ethics in university faculty members, who play a key role in administering and directing education, is very important because the role They have an important role in improving students 'performance. This study was conducted with the aim of students' views on the dimensions of teaching ethics of students of Abadan University of Medical Sciences.

Materials and Methods: In this descriptive cross-sectional study, 302 students of Abadan University of Medical Sciences were selected by stratified random sampling method. Composed. Data were collected and analyzed using SPSS 25 statistical software using descriptive statistics.

Findings: Students less dimensions [personality traits (2.99±0.41), content mastery [(2.87±0.51), recognition of different aspects of learning (2.75±0.53), standard evaluation (2.64±0.60) and observance of educational rules (2.29±0.46)] They evaluated it as moderate and evaluated only the dimension of mastery of teaching method (3.03±0.54) as above average. Also, the inferential findings of this section indicated that except for the dimensions of personality traits (P=0.883) and mastery of method Teaching (P=0.336) Among other dimensions, the difference between the mean and the mean was significant (P=0.0005).

Ethical Considerations: Participation in the research was optional and the participants were explained about the objectives of the research and the confidentiality of information.

Conclusion: According to the findings, these disparities may be due to differences in educational facilities (time and space and educational equipment) and the unique nature of some disciplines. Also, the atmosphere in educational spaces varies according to the rules and management of the place and more appreciation of specific values in each place may make a difference.

Cite this article as: MohammadMousaei F, Sanaei H, Mohammad Zadeh R, Abbasi H, Sayadi Moghadam D, Mohsenpour M. Students Views of Abadan University of Medical Sciences on the Dimensions of Teachers Teaching Ethics. Faṣlnāmah-i akhlāq-i pizishkī i.e., Quarterly Journal of Medical Ethics.2021; 15(46): e9.

Background and Aim: Being a student is an exciting and challenging time for students. During this period, all students, especially students of Medical Sciences, should be happier due to facing more stressors and the need for proper adaptation. The aim of this study was to predict happiness based on ethical climate, perceived stress and self-esteem in nursing and paramedical students of Jahrom University of Medical Sciences.

Materials and Methods: This study was a correlational study conducted in 2018-19. 316 nursing and paramedical students participated in the census method. In this study, Olson questionnaire to assess the ethical climate of Hospital, Oxford Happiness Scale, Rosenberg Self-Esteem Scale and Cohen's Perceived Stress Scale were used. Data were analyzed by using descriptive statistics, Pearson, Spearman and Eta tests and linear regression by SPSS 16 software.

Findings: In the study, a significant association was observed between the hospital ethical climate (p<0/05, r=0/151), the perceived stress (p<0/001, r=-0/354) and the students' self-esteem (p<0/001, r=0/431) with their happiness. So that these three variables were able to predict 22% of the variance of students' happiness (ADj.R²=0/227).

Ethical Considerations: This research was conducted according to the principles of Helsinki, obtaining permission from the participants and after the approval of the ethics committee.

Conclusion: According to the results of study and the fact that happiness forms the basis of an public well-being in societies and has positive consequences such as physical and mental health, favorable production performance and entrepreneurship, so planning for improving the ethical climate of hospitals, training in coping strategies with stress and increase the self-esteem of students must be done to increase the happiness of medical students.

Cite this article as: Shadfard Z, Badiyepeymaiejahromi Z, Taghizadeganzadeh M, Pournoroz N, Maarefi F. Predicting Students' Happiness Based on Ethical Climate, Perceived Stress and Self-Esteem. Faṣlnāmah-i akhlāq-i pizishkī i.e., Quarterly Journal of Medical Ethics. 2021; 15(46): e10.

Background and Aim: In order to ensure that the quality of health care improves, the observance of medical ethics and patients’ rights is inevitable. The present study was conducted to determine how much dentists practicing in Khorramabad, Iran, in 2020 complied with the Charter of Patients’ Rights.

Materials and Methods: This was a descriptive-analytical study that was performed on 70 general dentists in Khorramabad from March 2019 to March 2020. The participants were selected by the census sampling method. Data were collected using the Patients’ Rights Questionnaire designed based on ethical codes approved by the American Dental Association (ADA). Data were analyzed using SPSS 20 at a significance level of 0.05.

Findings: The mean age was 34.58±7.21 in women and 38.84±9.82 in men. The awareness level of the dentists regarding the Charter of Patients’ Rights was 47±0.12.The highest score was related to explaining and clarifying the charged expenses with 71.4%. The lowest scores were related to providing expert testimony about the illegal practices of a colleague with 22.9% and explaining the treatment method to patients with 25.7%. Work experience had a weak correlation with awareness levels (r=0.2, p=0.095). There was no significant difference between men and women in terms of awareness levels (p=0.139).

Ethical Considerations: This article is the result of a research project with the ethical code IR.LUMS.REC.1397.190. Adequate explanations about the objectives of the research were given to the subjects. They were assured that all information collected in this study was confidential.

Conclusion: The awareness level of general dentists who were examined, about the observance of the principles of professional ethics was below average. Therefore, it is necessary for medical universities to pay more attention to aspects of patients’ rights that are less observed by dentists. It is obvious that observing the principles of professional ethics will increasingly gain patients’ trust and as a result, will promote the health level of the society.

Cite this article as: Qaruni K, Yaghoubipour F, Qaruni B, Bakhtiar M, Bakhtiar K, Birjandi M, Bastami F. Evaluation of the Observance of the Charter of Patients’ Rights by General Dentists. Faṣlnāmah-i akhlāq-i pizishkī i.e., Quarterly Journal of Medical Ethics. 2021; 15(46): e11.

Background and Aim: Employees who feel that the ethical atmosphere prevails in the organization consider the relationships and interactions of their organization as fair and this increases their satisfaction and commitment. On the other hand, conscience has been involved in nursing activities and nurses have insight and care must be taken to prevent harm to humans. The aim of this study was to determine the relationship between ethical climate and work conscience of intensive care unit nurses.

Materials and Methods: This descriptive-analytical cross-sectional study was conducted in 2019-20 in the intensive care units of educational and medical centers of Golestan University of Medical Sciences (6 medical centers) using multi-stage sampling. Hospitals were selected randomly and in proportion to the number of nurses in hospitals, samples were selected in selected hospitals in a purposful and accessible manner. 184 nurses participated in this study. The data were collected using Olson’ ethical climate and Costa & McCrae’ work conscience quessionaires. Descriptive statistics including mean, median, standard deviation and Spearman correlation coefficient and regression analysis were used to examine the relationship between variables. Analyzes were performed using SPSS software 21 at a significance level of 0.05.

Findings: 75% of nurses (n=138) were female and 36.4% (n=67) had less than five years of work experience. The mean and standard deviation of ethical climate were 4.01±0.43 (desirable) and nurses' work conscience was 3.46±0.27 (desirable). Ethical climate was favorable in each of five domains (patients, colleagues, managers, physicians and hospitals) (P-value<0.001). Regarding work conscience; the mean scores of dutifulness (3.42±0.35) and achiwement striving (3.42±0.35) indicated that the nurses' opinions were favorable and positive. Spearman test showed a direct relationship between ethical climate and work conscience (r=0.19).

Ethical Considerations: In the process of conducting this research, all ethical considerations related to human studies, such as obtaining informed consent and explaining the confidentiality of the details of the participants in the research, were observed.

Conclusion: The ethical climate and work conscience of the nurses in the intensive care unit was positive and favorable. It is recommended that the managers and stakholders of medical centers create a favorable and positive moral atmosphere to increase and strengthen the work conscience of nurses.

Cite this article as: Ghorbangholi T, Sanagoo A, Pahlavanzadeh B, Jouybari L. The Relationship between Ethical Climate with Job Conscience in Nurses of Intensive Care Units of Medical Centers of Golestan University of Educational and Medical Sciences. Faṣlnāmah-i akhlāq-i pizishkī i.e., Quarterly Journal of Medical Ethics. 2021; 15(46): e12.

Background and Aim: Children, have the right to and should be provided with a more effective treatment to return to the natural path of their lives. Therefore, identifying and offering supportive solutions to the parents especially the primary care (the mother) are essential for balancing the child's condition. This research's goal is to identify and introduce the solutions used by the mothers of children with cancer to improve their consistency and resistance against the disease.

Materials and Methods: This is a qualitative with a phenomenological approach and an emphasis on the lived experience of those mothers. For doing the research, 19 mothers of 1 to 15hl year old in-treatment children with cancer were chosen by purposive sampling and studied with in-depth semi-structured interviews.

Ethical Considerations: First, the purpose of the research and also to ensure the confidentiality of the results were explained to the participants. After obtaining the consent, they consciously participated in the research.

Findings: The supporting solutions after knowing about the disease included "hiding", "getting help and support from others" and "direct confrontation". The solutions for boosting the kid's morale during the treatment process were categorized into 9 main categories: "the prudent change of the condition", "facilitating the kid's catharsis", "resorting to spirituality and God", "increasing hope and encouragement", "using common activities", "family and social relationships", "expressing kindness", "having fun with family", "communicative changes between the mother and the kid".

Conclusion: The mothers studied in this research, according to the conditions of their children and themselves, used different solutions. However, it seems possible to manage their conditions and improve their quality of life by organizing and teaching the right coping solutions to them, thus facilitating a more effective treatment.

Cite this article as: Hajkarami P, Hejazi E, Moussavi F. Supportive Strategies of Mothers of Children with Cancer to Help their Child Adapt to the Disease. Faṣlnāmah-i akhlāq-i pizishkī i.e., Quarterly Journal of Medical Ethics.2021; 15(46): e13.

Background and Aim: Successful implementation of the accreditation program, as a regular evaluation of hospital centers with the aim of improving the quality of services and patient safety, largely depends on the familiarity of medical center managers with the knowledge of hospital management and the existence of scientific and committed manpower. The aim of this study was to investigate the relationship between nurses' perception of organizational justice and organizational commitment with their performance on decuple tests of accreditation of Shahid Rahimi Hospital in Khorramabad in 2020.

Materials and Methods: The research method was descriptive-correlation. The statistical population was the nurses of Shahid Rahimi Hospital in Khorramabad, from which 112 people were selected by random sampling. Data collection tools were Niehoff & Moorman's Organizational Justice Questionnaire, Meyer & Allen's Organizational Commitment Questionnaire and decuple tests of accreditation conducted by Shahid Rahimi Hospital in Khorramabad in 2020. Data were analyzed by SPSS 24 software using descriptive indicators (frequency, frequency percentage, means, standard deviation, minimum and maximum score) and statistical tests Pearson correlation coefficient and multiple Regression analysis.

Ethical Considerations: Verbal informed consent was obtained from participants and to they was assured about information confidentiality.

Findings: There was a significant positive relationship between nurses' perception of organizational justice (p<0.01, r_s=0.44) and organizational commitment (p<0.01, r_s=0.33) with their performance on decuple tests of accreditation. 19% of the total variance of nurses' performance on decuple tests of accreditation was explained by their perception of organizational justice and organizational commitment.

Conclusion: Nurses' perception of organizational justice as a powerful factor in organizational effectiveness can also affect their commitment to the organization and thus the effectiveness and quality of service delivery in the organization. Therefore, it is necessary for the managers of medical centers not only to increase their commitment to the organization but also provide sufficient motivation for their participation in the implementation of the accreditation program, through fair interaction and fair job behaviors in relation to nurses.

Cite this article as: Rahmati S, Seyfi R. The Relationship between Nurses' Perception of Organizational Justice and Organizational Commitment with Their Performance on Decuple Tests of Accreditation of Shahid Rahimi Hospital in Khorramabad in 2020. Faṣlnāmah-i akhlāq-i pizishkī i.e., Quarterly Journal of Medical Ethics. 2021; 15(46): e15.

Background and Aim: Resilience is one of the required characteristics of nursing professionals. Therefore, it seems necessary to study the nurses' resilience predictors in order to encourage them to engage in behaviors based on accepted ethical norms and attempt to internalize these behaviors so as to establish human relationships in health care systems. Hence, the objective of this study was to investigate the correlation between ethical behavior and nurses' resilience by explaining the mediating role of social desirability and organizational trust.

Materials and Methods: This was a descriptive-correlational study. A sample of 195 nurses in Borujerd teaching hospitals in 2020 was selected based on availability quota sampling method. They responded to the standard scales of moral behavior (Swanson & Hill), resilience (Connor and Davidson), organizational trust (Paine) and social desirability (Marlowe-Crowne). Content validity was measured qualitatively, construct validity was measured through convergent and discriminant validity; the internal consistency reliability was measured through Cronbach's alpha and composite reliability for instruments. Data analysis was performed through Smart Pls 3.5.

Ethical Considerations: In this study, principles related to ethical considerations such as confidentiality of participants' identities, informed consent of research participants and the possibility to leave the research process were observed.

Findings: Ethical behavior has a significant and direct correlation with social desirability (0.51), organizational trust (0.58) and resilience (0.69), respectively. Also, social desirability of 0.62 and organizational trusts of 0.66 have a significant and direct correlation with resilience. The mediating role of social desirability increases the correlation between ethical behavior and nurses' resilience by 0.32. Also, the mediating role of organizational trust increases the correlation between ethical behavior and nurses' resilience by 0.38.

Conclusion: According to the research findings, it is suggested that hospital managers pay attention to the components of ethical behavior and practice them, especially in the nursing department, to influence nurses’ social desirability and organizational trust, leading to the positive enhancement of their resilience.

Cite this article as: Mohsenpour M, Taheri Goodarzi H. Correlation between Ethical Behavior and Nurses' Resilience: The Mediating Role of Social Desirability and Organizational Trust. Faṣlnāmah-i akhlāq-i pizishkī i.e., Quarterly Journal of Medical Ethics. 2021; 15(46): e20.

Background and Aim: Innovative climate plays an important role in the development of health care organizations and the role of organizations' ethical leadership is undeniable. Given the ambiguity of many effective aspects of innovation in the organization and the related factors, this study explored the innovative organizational climate through the dimensions of ethical leadership in nurses.

Materials and Methods: This descriptive-correlational study was performed on 200 nurses working in the teaching hospitals in Shahrekord in Iran; they were selected through quota sampling method. Data were collected using the questionnaires of demographic information, Siegel and kaimer innovative organizational climate and Emadifar’s ethical leadership and were analyzed by means of SPSS 16.

Ethical Considerations: In order to participate in the study, informed written consent was obtained from the participants. The nurses were provided with necessary information about being free to participate and leave the study.

Findings: The mean of ethical leadership in nurses and the innovative organizational climate were obtained (134.8±6.13) and (89.85±5.02), respectively. There was a positive and significant relationship between ethical leadership in nurses and innovative organizational climate (r=0.63, p=0.04). Regression test also showed that 31% of innovative organizational climate change was predictable by the dimensions of ethical leadership in nurses (ADJ.R²=0.31). Also, among the dimensions of ethical leadership, effort to promote employees and the ability to express different opinions significantly predict the innovative organizational climate (R²=0.25).

Conclusion: The health system managers need to take into consideration ethical issues such as trying to promote employees and allowing them to express different opinions in order to promote innovation in the system. Continuous education and evaluation of health systems regarding the ethical issues by managers can play an important role in promoting ethical leadership and innovation in the organization.

Cite this article as: Roshanzadeh M, Nafar M, Tajabadi A, Mohammadi S. Predicting Innovative Organizational Climate Using the Ethical Leadership Dimensions. Faṣlnāmah-i akhlāq-i pizishkī i.e., Quarterly Journal of Medical Ethics. 2021; 15(46): e22.

Background and Aim: Employee`s loyalty is an important factor in achieving organizational goals and increasing the productivity of human resources in the organization. With this approach, the present study was conducted with the aim of developing a comprehensive model for nurses' loyalty during the Covid 19 pandemic period in Golestan Hospital, Ahvaz.

Materials and Methods: The present study is a developmental-applied one in terms of purpose and the research method is (quantitative-qualitative) of data-based type. In the qualitative part, experts of human resource management and skilled nurses with at least 15 years of experience and a master's degree by a non-random purposive method and in the quantitative part method of research was descriptive which were selected 215 people among the nurses of Golestan Hospital in Ahvaz based on Cochran's formula by simple random method. Results of the interview using data-based method (Eshtruss Korbin 1998) and MaxQuda software and in the quantitative part with the structural equation model were analyzed.

Ethical Considerations: About the objectives of the research and the confidentiality of information were explained to the participants and their satisfaction was obtained in written form.

Findings: The results showed that the causation factors which affect the loyalty of nurses during the covid 19 pandemic period should be sought in the organizational factor. According to the fulfilled steps of open and pivotal and selective coding of the data, nurses' loyalty in this study can be considered as behavioral and attitudinal dimensions. According to the results of the open (43 concepts) and pivotal (7 categories) and selective coding stage, it can be said that causal conditions including (organizational factors, contextual conditions including job-related factors) and interferential factors (job motivation and extra-organizational) were identified. Also, the use of strategies such as reward and job motivation can be considered in building nurses' loyalty during the covid 19 outbreak. Also results of quantitative part showed that the provided model has a suitable fitness.

Conclusion: According to the results of this study, it is necessary for managers to master a set of skills and technologies to be able to gain a proper understanding of the situation and needs of their employees. Also, in order to reduce managers' misunderstanding of employees, human resources training courses should be organized with the aim of improving the relationship between managers and employees and managers should have a better and more realistic understanding of the situation of employees.

Cite this article as: Baledi Z, Rajabi Farjad H, Nasiripour A Formulation of a Comprehensive Model for Nurses' Loyalty during the Covid 19 Pandemic Period. Faṣlnāmah-i akhlāq-i pizishkī i.e., Quarterly Journal of Medical Ethics. 2021; 15(46): e18.

Background and Aim: Discrimination in caring is a challenging issue in the field of professional ethics that occurs consciously or unconsciously and some factors have an important role in this issue. This study planned to explain the underlying factors of discrimination in caring for patients from views of nursing students and teachers.

Materials and Methods: In this qualitative content analysis study, the participants were 8 teachers and 13 nursing students of Rafsanjan University of Medical Sciences who were selected by purposive sampling. The study was performed in nursing school, 2020. The data collection method was semi-structured interviews and group discussions and the data were analyzed by qualitative content analysis suggested by Graneheim and Lundman.

Ethical Considerations: In the process of conducting of this research, all ethical considerations such as receiving the code of ethics, obtaining informed consent and keeping confidential the information of the participants were observed.

Findings: Data analysis led to the emergence of four categories: "factors related to the patient" and "factors related to the nurse", "factors related to the organization", "factors related to culture" and 12 subcategories. Each of the categories was described with use of quotes.

Conclusion: The results of this study identified the underlying factors of discrimination from the perspective of nursing teachers and students that can guide nurses for better actions and their programs in this field. Also, the results can be used as a basis for future research in this field.

Cite this article as: Sadeghi R, Sadeghi T. Explaining the Underlying Factors of Discrimination in Caring for Patients from Views of Nursing Students and Teachers. Faṣlnāmah-i akhlāq-i pizishkī, i.e., Quarterly Journal of Medical Ethics. 2021; 15(46): e24.

Background and Aim: Ethical leadership provides the ground for nurses' citizenship behavior and loyalty. Moreover, since ethical leadership, coupled with high human values and support for nurses, can provide the ground for effective realization of nurses' organizational citizenship behavior, it can be argued that enhancement of nurses' intrinsic motivation can reduce turnover intentions among them.

Materials and Methods: The present study falls within the category of applied studies in terms of objective and descriptive studies in terms of method.  The study was conducted on a sample of 270 nurses of Rasht hospitals using nonprobability convenient sampling.  The sample size was determined using the Cochran's formula. The required data were collected using a standard questionnaire whose validity and reliability was confirmed. Data analysis was performed using descriptive and inferential statistics within the framework of Smart-PLS statistical software.

Ethical Considerations: Questionnaires were distributed among the subjects after they were provided with an account of the objectives of the study and were ensured about the confidentiality of information and their verbal consent was obtained.

Findings: The results suggest that ethical leadership has a significant direct effect on individual-level citizenship behavior (0.69) and organizational-level citizenship behavior (0.70) and turnover intention (-0.60) (<0.01). Intrinsic motivation can indirectly affect the impact of ethical leadership on individual-level citizenship behavior (0.25), organizational-level citizenship behavior (0.24) and turnover intention (-0.07).

Conclusion: According to the hypothesis testing results and the investigations of variables' effect, it can be concluded that managers should nurture the ethical leadership style by enhancing the significance of tasks, paying special attention to the position and status of nurses and emphasizing on the observance of ethics in the workplace. In addition, by involving nurses in formulation of the organizational and professional vision, attracting nurses' contribution to goal fulfilment processes, helping them develop a positive attitude towards the future and creating opportunities for their prosperity, managers can provide the ground for enhancement of nurses' motivation and realization of organizational citizenship behaviors.

Cite this article as: Moghadam A, Ranji Jafroudi N. The Effect of Ethical Leadership on Organizational Citizenship Behavior and Turnover Intention of Nurses with Mediation of Intrinsic Motivation. Faṣlnāmah-i akhlāq-i pizishkī, i.e., Quarterly Journal of Medical Ethics. 2021; 15(46): e25.

Background and Aim: Professional ethics can be an effective measure of the development and success of organizations, excellence creation, sustainable development, entrepreneurship and commitment. Therefore, the present study aimed to investigate the effect of professional ethics on organizational entrepreneurship and the social entrepreneurship of employees by examining the mediating role of organizational commitment.

Materials and Methods: The present research is of applied type in terms of purpose and descriptive-correlational in terms of the strategy used. Data was collected through the survey method. The statistical population of the study was made up of all 440 employees of Shiraz Namazi Hospital. Out of these employees, 205 people were selected as the sample size of the study using simple random sampling and Morgan's table. Questionnaires of professional ethics (Cadozier), organizational entrepreneurship (Margaret Hill), social entrepreneurship (Dees) and organizational commitment (Allen & Mayer) were used to collect data. Data were analyzed by Pearson correlation coefficient and Structural Equation Modeling using SPSS 24 and LISREL 8.8 software.

Ethical Considerations: The objectives of the research and the confidentiality of information were explained to the participants and their informed consent was obtained.

Findings: The results showed the direct, positive and significant effect of professional ethics on organizational entrepreneurship (P=0.56) and social entrepreneurship (P=0.41), professional ethics on organizational commitment (P=0.22), organizational commitment on organizational entrepreneurship (P=0.22) and Social entrepreneurship (P=0.25) of the staff of Shiraz Namazi Hospital. Results also manifested that professional ethics with the mediating role of organizational commitment impacts organizational entrepreneurship (P=0.05) and social entrepreneurship (P=0.06) of Namazi Hospital staff. Furthermore, it was found that the largest total effect is related to the effect of professional ethics on organizational entrepreneurship (P=0.58).

Conclusion: This study showed that professional ethics and organizational commitment have an effective role in organizational and social entrepreneurship and to promote organizational and social entrepreneurship of employees along with entrepreneurship training, these factors should also be considered.

Cite this article as: Mahmoodi M, Mohajeran B, Razzaghi M. The Effect of Professional Ethics on Organizational Entrepreneurship and Social Entrepreneurship of Employees by Testing the Mediating Role of Organizational Commitment. Faṣlnāmah-i akhlāq-i pizishkī, i.e., Quarterly Journal of Medical Ethics. 2021; 15(46): e26.

Background and Aim: Improving the perception of organizational justice in nurses can be a motivating factor for their quality of work life. Considering that organizational justice can be affected by various factors, so in the present study, the relationship between the perception of organizational justice with citizenship behavior and adaptive practice in nurses has been determined.

Materials and Methods: A descriptive cross-sectional study was performed on 400 nurses in quota sampling in Shahrekord University of Medical Sciences in 2019. Data were collected using the Demographic Information Questionnaire, Niehoff and Morman Perception of Organizational Justice, Lee and Allen Citizenship Behavior and the Adaptive Performance of Charbnier-Virin and Russell. Data were analyzed by SPSS software 16 and descriptive and inferential statistical tests.

Ethical Considerations: Gaining informed consent and freedom to participate in the study were considered.

Findings: Pearson correlation coefficient showed a positive and significant relationship between citizenship behavior and adaptive performance with the perception of organizational justice (P<0.05). Regression test showed that citizenship behavior (ADJ.R2=0.269) and adaptive performance (ADJ.R2=0.145) significantly predict the perception of organizational justice. Mean citizenship behavior (66.85±18.26) was moderate, adaptive performance (68.76±16.98) was moderate and perception of organizational justice (61.5±8.9) was high.

Conclusion: Developing creativity in the workplace and planning to control nurses' stress has an important role in improving the perception of organizational justice in nurses. Also, creating a healthy work environment by improving healthy working relationships and nurses' participation in functional decisions by increasing the adaptive performance of nurses can play a decisive role in the perception of organizational justice in health systems.

Cite this article as: Roshanzadeh M, Begie A, Tajabadi A, Mohammadi S. Predicting Nurses' Perceptions of Organizational Justice Using Citizenship Behavior and Adaptive Practice. Faṣlnāmah-i akhlāq-i pizishkī, i.e., Quarterly Journal of Medical Ethics. 2021; 15(46): e27.

Background and Aim: In previous studies, the relationship between ethical leadership as the most important factor in the survival and success of organizations, with job meaningfulness, group learning behaviour and organizational identity, with the mediating role of justice has not been studied much. Therefore, the present study aims to investigate the causal effect of ethical leadership on job meaningfulness, group learning behaviour and organizational identity in the presence of the mediating variable of justice.

Materials and Methods: This is a descriptive-correlation research. The samples included 186 staff members of Imam Reza Hospital in Urmia who were selected by stratified random sampling method. The data were collected through the questionnaires of ethical leadership, justice, job meaningfulness, group learning behaviour and organizational identity. Consequently, the data were analysed employing LISREL 18.8 software using structural equation modellin.

Ethical Considerations: In this study, ethical concerns such as explaining the research objectives, providing informed consent form, voluntary participation and ensuring the confidentiality of information were taken into consideration.

Findings: The findings indicate that the role of justice in mediating the relationship between ethical leadership and group learning behaviour, job meaningfulness and organizational identity in the structural equation model has been confirmed. In addition, there has been a significant relationship between ethical leadership and justice (coefficient=0.53). Job meaningfulness has had a positive impact on justice as well (coefficient=0.36). Furthermore, justice has had a significant positive impact on group learning behaviour (coefficient=0.82), job meaningfulness (coefficient=0.43) and organizational identity (coefficient=0.60).

Conclusion: The results showed that the mediating variable of justice has a significant role in explaining the influence of ethical leadership on job meaningfulness, group learning behaviour and organizational identity among the hospital staff. Therefore, we suggest that the organisation adopt appropriate strategies in selecting managers and improving their ethical leadership dimension.

Cite this article as: Vakili T, Hasani M, Ghasemzade A, Ebn Abbasi Z. Investigating the Causal Effect of Ethical Leadership on Job Meaningfulness, Group Learning Behavior and Organizational Identity by Examining the Mediating Role of Justice. Faslnamah-i akhlaq-i pizishki. 2021; 15(46): e28.

Background and Aim: Trust between patient and physician has been challenged by overt and covert factors such as eroding social capital and increasing the cost of medical services in the community. To understand such a challenging situation, scientific research needs to be done so that the results of which can be used for making social, education and health policies. This study aimed to identify the components of trust between patient and physician as well as understand how to strengthen "trust" in physicians.

Materials and Methods: A meta-synthesis was used to evaluate systematically the results of previous research regarding trust in physicians. This study has been designed, implemented and concluded from 2019 to 2021. Domestic and international scientific databases such as Normags, MagIran, SID, Scopus, Science Direct and open-access databases were the main sources for extracting text110 articles were selected based on the seven-step approach of Sandelowski and Barroso (2007) and focused search strategy. Key terms of "trust in patient", "trust between patient and physician", "physician-patient relationship", "trust between patient and physician" was used to obtain information about questionnaires. The criteria for selecting articles were methodological similarities and comprehensive coverage of the desired features affecting the results. By comparing the title, abstract, method and findings of the research, some articles were excluded from the study and finally, 54 articles were used as final sources for coding and analyzing.

Ethical Considerations: The research ethical principles such as fidelity to the text, reference to sources and observance of the principles of scientific writing have been adhered to by the researchers in different stages of the research design, data collection, analysis and conclusion.

Findings: The results of this study showed that the patients trust in the physician is a complex, two-way relationship and is affected by a variety of components. Based on the results, the confidence-building factors of the patient-physician relationship were classified into three levels of macro (socio-cultural), meso (legal-moral) and micro (professional-specialized, individual-psychological). In addition, the sub-components of this study include social trust, social satisfaction, cultural education, management and treatment environment, legal rights, ethical principles, treatment and health facilities, scientific ethics, legal rights, ethical principles, job commitment, confidentiality, clinical-specialized knowledge, verbal-communication skills, credibility, patient knowledge and therapeutic experience and demographic variables.

Conclusion: Based on the findings of this study, improving the trust-based relationship between the patient and physician requires the provision of various social conditions and circumstances, including treatment management (increasing equality in access to high-quality educational opportunities as well as building and equipping patient-centered treatment spaces), treatment learning (educating, informing and strengthening the perceptual and human skills of physicians and treatment staff) and treatment environment management (communication skills training, communicating with patients and distancing oneself from an authoritarian position for all medical staff and treatment based on the type of communication), considered as its infrastructural requirements.

Cite this article as: Safaei M, Farasatkhah M, Shamsi Gooshki E. The Social Context-Mining of Patients Trust in Physicians and Recommendations for Improvement and Promotion: A Meta-Synthesis Analysis. Faṣlnāmah-i akhlāq-i pizishkī, i.e., Quarterly Journal of Medical Ethics. 2021; 15(46): e29.

Background and Aim: Clinical ethics is an analytical activity in which one's thoughts, ideas, commitments, actions, emotions, arguments and discussions in the realm of clinical decision making are analyzed attentively and critically. Clinical professors are a significant part in students' moral and professional personalities and it is crucial to pay greater attention to this subject since clinical professors influence student conduct and instill moral values in them. The purpose of this research was to assess the degree of professional ethics in clinical education from the viewpoint of Abadan University of Medical Sciences students in 2020.

Materials and Methods: The research used a census technique to enroll 125 third- and fourth-year students at Abadan University of Medical Sciences in 2020 who were studying nursing and operating room. The data collection tools, which included demographic data and a clinical professional ethics questionnaire for professors, were adapted from previous studies and their validity and reliability were reaffirmed in this study, which included 23 questions about students' perceptions of professors' level of professional ethics in their field. In fact, SPSS 24 was used to gather data, which were then summarized and analyzed using descriptive statistics and the independent t-test.

Ethical Considerations: Participation in the study was voluntary and participants were informed of the study's aims and the importance of maintaining the confidentiality of their data. Participants provided written informed permission to participate in the study.

Results: Based on the average score received from the questionnaire, clinical teachers' adherence to professional ethics is rated as positive by students at 53.37±5.35 The mean score for clinical professors' adherence to professional ethics was not statistically significant (P=0.289) in terms of students' demographic information.

Conclusion: Professors maintained a high standard of professional ethics. This may be a strong point for medical students' clinical education; nevertheless, further measures to enhance professional ethics and elevate this sector need planning and policymaking.

Cite this article as: MohammadMousaei F, Abbasi H, Fakharzadeh L, Mohammad Zadeh R, Mahdavi N, Mohsenpour M. Students Views of Abadan University of Medical Sciences on the Dimensions of Teachers Teaching Ethics. Faṣlnāmah-i akhlāq-i pizishkī, i.e., Quarterly Journal of Medical Ethics. 2021; 15(46): e30.

Background and Aim: Ethical codes are used as a practical guide to show the ethical behaviors of the owners of each profession in specific situations. Every organizational set has ethical codes appropriate to its professional structure, which is called professional ethics. Higher education is also a professional system, and professors and students must be aware of and adhere to the principles of professional ethics in e-learning. Adherence to the ethics of virtual education ensures the health of the teaching-learning process in the university and increases the commitment of professors to respond to the needs of students.

Materials and Methods: This study was a developmental research that was conducted with the aim of extracting and compiling ethical codes in virtual education activities for professors and students by extracting the opinions of professors of Kermanshah University of Medical Sciences as a research community in four stages. The first stage in the research committee in medical school education was prepared with the presence of 20 professors of the initial draft of ethical codes, including 75 codes. In the second stage, the subject was categorized in 4 areas and 66 codes in the ethics committee of university education. Then, in the third stage, the proposed codes were sent to the faculties for the comments of all professors and officials in the field of education.

Ethical Considerations: The purpose of the study was explained to the participants and individuals participated in the study voluntarily. Next, it was approved by the ethics committee of Kermanshah University of Medical Sciences and received a code of ethics.

Findings: After conducting four stages of study and obtaining comprehensive opinions from professors, and officials in the field of education in different faculties and reviewing them in the work of the Department of Ethics in Virtual Education, codes in four general areas and 58 codes including: 25 Ethical codes of professors in virtual education, 11 ethical codes of electronic content production in virtual education, 10 ethical codes of students in virtual education and 12 ethical codes in electronic exam were compiled.

Conclusion: The result of this study was to explain the ethical codes in virtual education for professors and students of medical universities.

Cite this article as: Khazaei MR, Izadi B, Almasi A, Sorosh A, Parvizifard AA, Foroghi AA, K Soltani M Boniani, Salari F, Farzaei MH. Devising Ethical Codes in Virtual Education. Faṣlnāmah-i akhlāq-i pizishkī, i.e., Quarterly Journal of Medical Ethics. 2021; 15(46): e31.

Background and Aim: Organizational silence is a common phenomenon in organizations that is influenced by many organizational characteristics including organizational culture, perception of organizational policy and professional ethics. Accordingly, the present study aimed to investigate the impact of organizational culture and perception of organizational policy on organizational silence with emphasis on the mediating role of professional ethics among faculty members of the University of Gilan.

Materials and Methods: This research is a descriptive correlational study based on structural equation modeling. The statistical population of the study included all faculty members of the University of Gilan in 2019 to 545 people. The sample size was 220 according to the statistical population and using simple random sampling method and Morgan table. Questionnaires of Organizational Silence (Dain), organizational culture (Queen), Understanding of Organizational Policy (Kakmar & Carlson) and Professional Ethics (Haywood & et al) were used to collect data. Data were analyzed by Pearson correlation coefficient and Structural Equation Modeling using SPSS 24 and LISREL 8.8 software.

Ethical Considerations: The objectives of the research and the confidentiality of information were explained to the participants and their informed consent was obtained.

Results: The results showed the direct, positive, and significant effect of perception of organizational policy and organizational silence (ß=1.40) and professional ethics (ß=16.01). Organizational culture has a direct, negative and significant effect on organizational silence (ß=1.37). Perception of organizational politics with the mediating role of professional ethics on organizational silence (ß=0.08) and organizational culture with the mediating role of professional ethics on organizational silence (ß=0.07) of faculty members of the University of Gilan.

Conclusion: This study showed that organizational culture, perception of organizational policy and professional ethics affect the organizational silence of faculty members and in order to defeat the phenomenon of organizational silence along with teaching ways to overcome it, these factors should also be considered.

Cite this article as: Akbari M, Rafiei M, Yarmohammadzadeh P. The Effect of Organizational Culture and Perception of Organizational Policy on Organizational Silence with Emphasis on the Mediating Role of Professional Ethics in Faculty Members. Faṣlnāmah-i akhlāq-i pizishkī, i.e., Quarterly Journal of Medical Ethics. 2021; 15(46): e32.

Background and Aim: People with disabilities, as one of the largest minorities in the world, are exposed to various forms of discrimination and social deprivation. Benefit. The purpose of this article is to study the support provided to people with disabilities in international and domestic documents and to examine their legal guarantees based on the moral norms of society.

Materials and Methods: This scientific-research article is of review-analytical type and its information has been collected by library-documentary method.

Findings: What has been achieved after studying, evaluating and comparing is that the rules related to people with disabilities, both nationally and internationally, have numerous shortcomings. In fact, the Convention on the Rights of Persons with Disabilities is the only international document that specifically addresses the social rights of the disabled are addressed. In the internal documents, the comprehensive law for the protection of the disabled has tried in its sixteen articles to somehow lead this vulnerable group to achieve their fraudulent rights.

Ethical Considerations: Ethical considerations have been observed in all stages of research, including the study and collection of data, their documentation and analysis.

Conclusion: Because we are a value and ethics-oriented society, adhering to ethical norms can be very crucial in supporting the disabled. Revision of domestic law and their harmonization with the provisions of the Convention is a very effective step for the implementation of the rights of persons with disabilities.

Cite this article as: Jalalian A. Research from the Perspective of Ethical Norms on Guarantees for the Protection of Persons with Disabilities in the Convention on the Rights of Persons with Disabilities and the Law of Iran. Med Ethics J 2021; 15(46): e2.

Background and Aim: Medical errors are a significant burden on the health care system and considered as a fundamental challenge for physician, ethic and health care policymakers. Most of these errors in diagnosis are associated with defects in clinical reasoning. Currently, investigating and identifying cognitive factors involved in these errors are taken into consideration.

Materials and Methods: In this narrative review, the history of medical errors and cognitive biases in clinical diagnoses will be explained. For this purpose, 400 articles published between 1900 to 2018, were extracted from four databases PubMed, SCOPUS, Google Scholar and Oxford.

Ethical Considerations: In this narrative study, we tried to follow the principles of scientific writing, trusteeship and honesty in using resources.

Findings: Research literature in this field suggests three hypotheses triple processing models, system one and two of information processing, and intuitive-analytical thinking to explain medical errors and defects in clinical diagnoses, so that cognitive biases are considered one of the most basic origins of defects in the process of clinical reasoning. Accordingly, the findings are developed in three sections: Clinical reasoning and error in diagnosis, dual processing models and cognitive bias.

Conclusion: This narrative review revealed that it is necessary to address the cognitive aspects of clinical errors as long as the common and well-known causes of medical errors in health care.

Cite this article as: Saeedi MT, Arbabi M. The Role of Cognitive Biases in Medical Errors: A Review of the Literature, Concepts and Definitions. Faṣlnāmah-i akhlāq-i pizishkī i.e., Quarterly Journal of Medical Ethics. 2021; 15(46): e14.

Background and Aim: Professional ethics is of great value in all majors especially medicine, but unfortunately it is not paid enough attention during studying, also the behavior of students and workers in clinical settings shows multiple cases of disrespecting professional ethics. Regarding the importance of professional ethics in medicine and paramedics, the present article addresses the teaching methods of professional ethics in Iran.

Materials and Methods: The present review has been done using three-phase search strategy with the following keywords: "medical ethics", "nursing ethics", "professional ethics", "ethical codes", education in Magiran, Iranmedex, Sid, Googlescholar databases. Published articles by Iranians which address the outcome of a special method to teach professional ethics to students or workers in medicine or paramedic majors were included in the study.

Ethical Considerations: Ethics were considered in all phases of the present study including data gathering and analysis, documentation, and publication.

Findings: Acquired articles in this review were rare but involved different methods to teach professional ethics including lecture, narrative ethics, case based, Jurisprudential inquiry, role playing, … the findings indicate the effectiveness of those methods in teaching professional ethics. Among those methods, lecture was the most common one, multiple researches used lecture method, others compare lecture to other methods and other ones used newer methods and advised using new and creative methods in teaching ethics.

Conclusion: Teaching professional ethics is of great value in medicine and paramedics regardless to the special teaching method, according to the current conditions in hospitals and medical centers in Iran, it is advised to apply suitable teaching methods regarding the learning environment, available equipment, and learners’ properties.

Cite this article as: Houshmand M, Laeli M. Investigating Teaching Methods of Professional Ethics in Iran: A Review Study. Faṣlnāmah-i akhlāq-i pizishkī i.e., Quarterly Journal of Medical Ethics. 2021; 15(46): e16.

Background and Aim: In order to sustain the world^’s growing population, the production of food must be more than 70% of what it is produced today. A remarkable and stable solution for the eradication of hunger is using genetically modified organisms (GMOs). Genetic modifications have contributed to larger yields in agriculture and livestock as well as the development of new biopharmaceuticals, vaccines and proteins. Despite the large benefits that genetic engineering and GMOs can bring for us, they may produce some hazards and concerns in certain areas. Moreover, considering the products to be new and also vast changes that they can make in economical, social, health, and safety matters, ethical issues plays an important role in the application of these technologies.

Materials and Methods: This is a review study. Research data were collected by searching databases of Web of science, PubMed, Scopus, google scholar, Magiran (Bank of Iran's Magazines Information), SID (Jahad-e Daneshgahi Scientific Information Center) with keywords of Ethic, Genetic engineering, genetically modified organisms and transgenic.

Ethical Considerations: The findings of these articles are stated in all stages of the research without bias and with respect to ethical aspects.

Findings: In this study, first some of the beneficial effects of such products on humanity and their contribution to the conservation of available resources are pointed out and then possible concerns about mass production and consumption of transgenic products as well as safety issues are discussed. Finally, the need to observe ethical considerations, the importance of respecting the rights of customers and product labeling are mentioned.

Conclusion: Adopting rational and prospective policies by observing ethical aspects, enacting integrated laws to avoid consumer's confusion, observing ethical aspects and providing correct and unbiased informing can prevent the possible dangers of this technology and people will profit its benefits.

Cite this article as: Zahedipour F, Hosseini SA, Jalili A. Genetic Engineering in Food and Pharmaceutical Products: Benefits, Concerns and Ethical Considerations. Faslnamah-i akhlaq-i pizishki. 2021; 15(46): e19.

Background and Aim: Patient respect is based on human dignity. Any variation in definition and aspects of human dignity caused to change in aspects of patient respect. The goal of this study is comparison between patient dignity in Islamic and nursing texts.

Materials and Methods: A review study with a comparative approach was conducted in three stages; the first Definition of patient respect based on Islamic texts, then definition based on nursing texts, Finally, compares the two definitions in terms of structure, foundation and philosophy. Compare finding in terms of structure, fundamentals and philosophy.

Ethical Considerations: All ethical considerations regarding the citation of texts have been respected.

Findings: Findings show patient respect was acceptable in both ideas. In Islamic texts spirituality and patient transcendence is important than nursing view because during of illness patient is under God’s attention and have the best opportunity for transcendences. In Islam patient must be respected because the God created human being. In Kantian view that is dominant philosophy in nursing ethics, patient must be respect due to human authority. In this view spirituality will important if the patient wants it.

Conclusion: In both view patient respect is related to human dignity. But in Islamic view caring interaction between patient and nurses have spiritual aspects. Both of them have potential situation for getting transcendences and God’s satisfaction.

Cite this article as: Khosropanahi AH, Sadat Hoseini AS, Dehghan Nayeri N. Comparison of the Patient Respect in Islamic and Nursing Text. Faṣlnāmah-i akhlāq-i pizishkī, i.e., Quarterly Journal of Medical Ethics. 2021; 15(46): e23.

Background and Aim: The co-citation analysis represents similarity, conceptual connection, and recognition between two authors, two magazines, or two documents. The purpose of this study is to map the co-citation network in the field of ethics and Covid 19 in order to better understand this field based on co-citation networks.

Materials and Methods: The present study is applied with the practical purpose, with narraive approach, and is done by the use of scientometrics and co-citation analysis method. In this study, all scientific productions in the field of ethics and Covid 19 (42 documents) without considering shortage of time (up to the date December 6th, 2020) in the Web of Science database is studied. VOS Viewer and Excel software are used to analyze and draw co-citation maps.

Ethical Considerations: Ethics were considered in all phases of the present study including data gathering and analysis, and publication.

Findings: Cited documents in the field of ethics and Covid 19, 5 co-citation clusters and the first cluster with the principle of ethical principles, and practical duty of care in epidemic diseases is the largest cluster. Emanuel's article ranked first in 2020 with eight citations and topics on how to allocate medical resources to patients during the Covid 19 epidemic based on ethical principles. The American Journal of Bioethics (AM J Bioethics) won the first rank with the topic about the bioethics and interpretations of clinical care and ethics as well as special topics such as day-to-day ethical challenges and reception of 14 citations. Highly cited journals in the field of ethics and Covid 19, 7 co-citation clusters and the first cluster with the thematic scope of publishing the latest news in various fields of medicine is the largest cluster. Michael L. Gross, an expert in bioethics, medical ethics, and military ethics is the top cited author in this field. Authors in the field of ethics and Covid 19, 7 thematic clusters and the first cluster with the thematic domain of cardiac arrest and cardiopulmonary resuscitation is the largest cluster.

Conclusion: By identifying the highly cited scientific products in the field of ethics and Covid 19, an attempt is made to provide a comprehensive view of the top documents, top journals, and top authors so that it can be a decision-making tool in the shortest possible time. Also, considering the existing scientific capacities, the role of Iran and medical universities to produce science in the mentioned field should be increased.   

Cite this article as: Daniali S, Mazloum Rahni AR. Drawing and Analyzing Co-Citation Networks of Ethics in Covid 19. Faṣlnāmah-i akhlāq-i pizishkī i.e., Quarterly Journal of Medical Ethics. 2021; 15(46): e21.