akhlāq-i pizishkī i.e., Medical Ethics

ABSTRACT: This paper explores the significance of moral virtues in the conduct of healthcare providers towards patients. The key moral virtues of the medical professions if accompanied by apologetics, healthcare professionals can mitigate the likelihood of patient complaints resulting from medical or nursing errors.The concept of apology, comprising three steps -regret, cause and remedy -serves as a means to foster improved relations between healthcare providers and patients. In situations where mistakes occur, offering an apology is deemed the most appropriate course of action.

This article aims toَ draw the attention of researchers, educatorsand students to a form of self-deception known as "ethical fading".Ethical fading occurs when we unconsciously avoid or conceal the ethical consequences of a decision, allowing us to engage in unethical behaviors while maintaining the belief that we are good and ethical individuals. During the process of ethical fading, we often tend to justify our behaviors and believe that we have acted ethically, even if the reality is different. We rarely intend to do something wrong, but subtle and hidden cues lead us to disregard the ethical consequences of our decisions. This gradually leads to a weakening of adherence to ethics and ethical fading.

Background and Aim: Nursing as a growing profession is on the way to becoming a professional. Nursing ethics is a set of manifestations of the nurse's behavior during her professional activity that should be manifested in the form of personal communication with the patient, the patient's relatives, the community and colleagues. The purpose of this study is to investigate the application of professional ethics among nursing students of Ardabil University of Medical Sciences in the academic year 1398-99.

Methods: This research is cross-sectional descriptive-analytical in terms of purpose, including applied research and descriptive research. The study population in this study is all nursing students from the third to the eighth semester of Ardabil School of Nursing and Midwifery, Meshginshahr Health Institute and Garmi School of Nursing. According to the total statistical population (461 people) To obtain the level of professional ethics of students of Ardabil School of Nursing and Midwifery, Meshginshahr Health Institute and Garmi School of Nursing, the standard questionnaire of Ismailpour Zanjani et al. (2015) was used. To analyze data; Data were analyzed using SPSS20 software and appropriate statistical tests such as one-group t-test, Independent-Samples T Test, linear regression.

Ethical Considerations: In all stages of this study, the ethical principles and the confidentiality were respected and the questionnaires were completed by obtaining informed consent and explaining the research objectives to the participants.

Findings: The average application of professional ethics in the field of nursing and society is 4.292 with a standard deviation of 1.004; The average application of professional ethics in the field of nursing and professional commitment is equal to 4.253 with a standard deviation of 0.901; The average application of professional ethics in the field of nursing and providing clinical services is equal to 4.275 with a standard deviation of 0.949; The average application of professional ethics in the field of nursing and the cooperation of the medical services team is equal to 3.885 with a standard deviation of 1.256; The average application of professional ethics in the field of nursing and education and research is 4.296 with a standard deviation of 1.061 and in general, the average application status of professional ethics (overall score) among the studied sample is 4.201 with a standard deviation of / 968 0 was obtained.

Conclusion: The results show the observance of professional ethics among the study population. Ethical responsibilities do not belong to a specific group, but to all members of a profession. However, the development of nursing ethics is best done when it is institutionalized because ethical decision-making in real situations is possible only by knowing ethical concepts and values.

Background and Aim: Due to the nature of the nursing profession, confronting conflicting situations regarding values and facing moral dilemmas is inevitable. It can, in turn, interfere with cognitive function. Therefore, the current research was conducted with the purpose of determining the effectiveness of Acceptance and Commitment Therapy (ACT) in reducing moral distress and enhancing cognitive fusion in the nurses working at Imam Khomeini Hospital, Ilam.

Methods: The present study is a quasi-experimental research with a pre-test and post-test design and a comparison group. The statistical sample consisted of 40 nurses working at Imam Khomeini Hospital, Ilam in 2022, who were randomly assigned into intervention and comparison groups. Data collection was performed using the Moral Distress Scale Corley & et al (2001) and the Cognitive Fusion Questionnaire Gillanders & et al (2010). Eight 90-minute acceptance and commitment therapy training sessions were held weekly; however, the comparison group did not receive any intervention. The data were analyzed by SPSS 16 software using descriptive (frequency, percentage mean, standard deviation) and inferential (Chi-square, Independent T-test, Analysis of covariance) statistical tests.

Ethical Considerations: The principles of research ethics were observed: explaining the research objectives to the participants, obtaining informed consent, maintaining privacy, data confidentiality and providing the participants with the right to withdraw from the study at any stage of implementation.

Results: The findings indicated that Acceptance and Commitment Treatment has a significant effect on reducing moral distress and enhancing cognitive fusion in the nurses belonging to the intervention group compared to the comparison group in the post-test phase (P<0.001).

Conclusion: Based on the findings of the present research, eight weeks’ acceptance and commitment group therapy turned out to be effective in reducing moral distress and enhancing cognitive fusion in nurses.

Please cite this article as:

Basereh F, Amirpour B. The Effectiveness of Acceptance and Commitment Therapy in Reducing Moral Distress and Enhancing Cognitive Fusion in Nurses. Faṣlnāmah-i akhlāq-i pizishkī, i.e., Quarterly Journal of Medical Ethics. 2023; 17(48): e4.

Background and Aim: Nowadays, when social environments are changing rapidly, it seems that the importance of moral reasoning and emotional maturity among all age groups, especially young people, is greatly reduced. The aim of the present study is to investigate the mediating role of moral reasoning in the relationship between emotional intelligence and the bystander behavior of bullying. The target population was male and female secondary school students of Khorram Abad city in the academic year of 1402-1401.

Method: This study is a model of structural equation. The sample of the present study consisted of 310 students selected by cluster sampling. The participants responded to the scales of the Defining Issues Test (Rest et al.), Emotional Intelligence (Bar-On), and the role of participants (Salmivalli et al.). Data analysis was done using a structural equation model by SmartPLS software.

Ethical considerations: Ethical considerations, such as explaining the purpose of the research, keeping the identity of the questioners, ensuring that the answers were confidential. Participants were free to respond to the free questionnaire.

Results: The results of the present study showed that all T-value coefficients were more than 1.96, R2 values for intra-research components of 0.53 to 0.93 as well as Q2 values for all model structures It is 0.27 to 0.61, which shows the meaning of all the relationships between the components at 95 % confidence, so the structural sector of the model is confirmed.

According to the results, emotional intelligence has a positive and significant effect on the bystander behavior of bullying and moral reasoning. The results of the structural equation model also showed that the meaningful number and indirect coefficient, respectively, equal to 8.26 and 0.45, meaning that moral reasoning plays a mediating role in the relationship between emotional intelligence and the bystander behavior of bullying.

Conclusion: The findings of the study showed that there is a significant relationship between emotional intelligence and bystander behavior of bullying. The results of the equation model showed that students' moral reasoning was able to play a significant mediating role in the relationship between the variables of emotional intelligence and bystander behavior of bullying.

Background and Aim: Empathy is a broad concept that refers to the emotional and cognitive reactions of an individual to the observed experiences of another. It has the most positive effect on the health outcomes of patients. This study aimed to investigate the effect of empathy training on employee motivation, moral sensitivity, and alexithymia among nurses working in Bahonar hospital in Kerman.

Methods: This quasi-experimental study was conducted on 80 nurses working in Shahid Bahonar hospital in Kerman in 2020, who were selected by census method. Eight 90-minute sessions were held to train empathy to the participants with a focus on the four-factor psychotherapy developed by Vaziri et al. (2011). Then, employee motivation questionnaire, moral sensitivity questionnaire, and Toronto alexithymia scale were used to collect data, and they were analyzed with SPSS23.

Results: The results showed the effect of empathy training on employee motivation (P <0.001), moral sensitivity (P <0.001), and alexithymia (P <0.001) among nurses working in Shahid Bahonar hospital in Kerman.

Conclusion: The study results showed that empathy training was effective in employee motivation, moral sensitivity, and alexithymia among nurses; therefore, it can be used to empower nurses.

Keywords: Empathy, Employee Motivation, Moral Sensitivity, Alexithymia, Nurses.

Background:  Moral sensitivity enables nurses to interpret the needs of their clients and respond to them according to ethical principles, which can play an important role in preventing situations that cause moral distress. Moral distress is a well-known phenomenon in the nursing profession that can cause a lot of physical and mental stress on nurses and cause them to be dissatisfied, reducing the efficiency and quality of care. Therefore, the present study was conducted with the aim of determining moral sensitivity and moral distress in nurses caring for patients with COVID-19 in medical training centers affiliated to Hamedan University of Medical Sciences in 2019.

Materials and methods: The current research is a descriptive-analytical study that was conducted on 180 nurses of Hamadan University of Medical Sciences in 2019 by stratified random sampling method. The data collection tools included a three-part demographic information questionnaire, MMSQ moral sensitivity and Corelli's moral distress. The data were analyzed by statistical software and using independent t-test, Mann-Whitney, ANOVA, Spearman's correlation coefficient, chi-score.

Results: The average moral sensitivity score of nurses was reported as 57.78 ± 13.53. The mean frequency of moral distress was 17.99 ± 37.01 and the intensity of moral distress was 52.83 ± 23.51. According to the classification, the frequency of moral distress is in the medium range and the intensity of moral distress is in the high range. In the examination of the relationship between sensitivity and repetition of moral distress among the subgroups of experiencing problems, the manner of interpersonal communication, independence and job sensitivity, a significant relationship was seen with repetition of moral distress. With the increase of these subgroups, the repetition of job distress also increases significantly.

Ethical Considerations: This  research  has  been  approved  by  the  ethics  committee  of Hamadan University of Medical Sciences (IR.UMSHA.REC.1399.090). After obtaining informed consent from the participants, the researcher assured them that all their information would be confidential.

Conclusion: Considering the average level of ethical sensitivity of nurses, efforts should be made to improve and promote ethical issues in nursing. Various factors are involved in the level of moral sensitivity and moral distress of nurses in caring for patients. In this research, it was in a situation where the nurses were facing the peak of the Covid-19 pandemic and were under high organizational and psychological pressures. Therefore, for a better conclusion, it is suggested that this research be conducted with more samples and in the inpatient wards of affected patients and other departments.

Background and Aim: Organizational effectiveness depends on variables such as organizational development and justice. Paying attention to the concept of work conscience in health organizations, like other organizations, is in fact an ethical and humane view of the concept of work, which itself is affected by various factors. The present study was conducted with the aim of investigating how organizational development and justice relate to the work conscience of health centers’ staff.

Methods: This research is a descriptive correlational study conducted on 197 health network staff members in Shahrekord, were selected and studied through convenience sampling method. Data collection was done using three standard questionnaires: The Organizational maturity (Spiders, 2007), the organizational justice scale (Niehoff and Moorman, 1993) and the work Conscientiousness scale (Costa & McCrae, 1992). Data analysis was done using descriptive and analytical statistics (Pearson Correlation Coefficient and regression testing) and SPSS 16.

Ethical Considerations: This study has been approved by the Ethics Committee. Ethical considerations such as filling out the informed consent form, voluntary participation, explaining the research objectives and ensuring data confidentiality were observed.

Results: The findings indicate that the mean score of organizational development and justice is significantly related to work conscience (P<0.001). There is a significant positive relationship between the mean score of organizational development and the staff’s work conscience (r=0.711, p>0.001). There is also a significant positive relationship between the mean score of organizational justice and the staff’s work conscience (r=0.701, p>0.001).

Conclusion: Reinforcing organizational justice, through applying laws and guidelines, leads to the enhancement of justice and the observance of fairness among the staff. Furthermore, improving organizational development will provide a stronger basis for the health staff’s bringing their conscience to work.

Background and purpose: In case of failure to obtain informed consent in pediatric surgery, the four principles of medical ethics have not been observed, so by considering the importance of this issue, the status of consenting person in pediatric surgery by considering the relationship between the consenting person and the patient's age, gender and type of operation in terms of emergency or non-emergency was measured in this article.

Methodology: in this analytical -descriptive- cross-sectional survey, the information of consent form in pediatric surgery at 17 Shahrivar Hospital in Rasht from April 2018 to September 2019, including the patient gender and age, the type of operation and the relationship with the consenting person and patient in the prepared checklist, was collected. The collected data has been entered into SPSS version 21 software and the significance level of p<0.05 was considered.

Findings: Based on the results obtained from 187 cases, they had emergency surgery (61.3 percent) and the rest had non-emergency surgery, 202 of those who gave consent were legal (66.2 percent) and the rest, respectively: a person without the legal position of mother (8 31.0 percent), guardian by letter (0.7 percent) and person without legal position (other than mother) (1.3 percent). According to the results of the present study, regarding the legal guardian, 199 people (98.5%) were fathers and 3 people (1.5%) were both parents. In the case of a person without legal status, 97 people (96 percent) were mothers, 2 people (2 percent) were nurses, 1 person (1 percent) was a foster mother, and 1 person (1 percent) was a grandmother. 1 person (50%) and 1 person (50%) were the guardians by letter. Based on the obtained results, it was found that gender (p=0.894) and age (p=0.336) had no significant relationship with the satisfactory group, but the type of surgery had a significant relationship with the satisfactory group (p<0.001). So that most of the satisfied people were sick in emergency but legal surgery.

Conclusion: The results of the present study show that the type of surgery in the terms of emergency has a significant relationship with the consenting group so that contrary to our assumption, the more consenting person in emergency surgery, were legal guardians of patients, according to the obtained results about two-thirds of the consenting person were the patient's legal guardians, that in 100% of cases, it was the father. Also, this research showed that the age and gender of children have no effect on obtaining legal consent.

Background and Aim: In recent years, tremendous progress has been made in organ transplantation; as a result, the legal issues associated with it have become more visible, too. Furthermore, transplant patients need more exact knowledge and observing patient rights is more crucial to them, considering their special condition. Therefore, the present study was conducted with the aim of investigating the level of observing Patient Rights Charter in Montaserieh Hospital, Mashhad in 2017 from the perspective of the transplant patients.

Methods: The current research is a descriptive cross-sectional study conducted on 99 liver and kidney transplant patients during the first 3 months of 2017 at Montaserieh Hospital, Mashhad. In order to investigate the level of observing Patient Rights Charter from the perspective of transplant patients, the researcher made a questionnaire consisting of 28 questions, based on the 5 dimensions of Patient Rights Charter in Iran. The data was analyzed using descriptive statistics in SPSS software version 16.

Ethical Considerations: Sufficient explanations regarding the objectives of the research were given to the subjects and data confidentiality was ensured.

Results: The mean score of observing Patient Rights Charter was 100.05±20.24. From the perspective of the transplant patients, the second dimension (the right to receive sufficient information in a desirable manner), with the mean of 36.53±7.88 and the fifth dimension (the right to access an efficient complaint-handling system), with the mean of 5±3.70 were, respectively, the rights observed the most and the least.

Conclusion: Surveying the patients, it was found that the dimensions of patients’ right to have freedom of choice and making decisions around receiving healthcare services and the right to have access to an effective complaint-handling system have been observed less frequently than others. Therefore, it is recommended that healthcare centers provide patients with sufficient explanations regarding the treatment plan so that they can participate in choosing their treatment methods. In addition, certain guidelines should be developed to ensure access to an efficient complaint-handling system

Background and Aim: Iranian society has a multi-ethnic, cultural, linguistic and religious structure. Due to the fact that cultural differences affect the perception of patient data and the quality of the care provided by nurses, it can be concluded that care provision of care by culturally qualified nurses improves the health conditions of patients with different cultures. Considering that no study has been conducted regarding the cultural competence of emergency nurses in Mashhad, the present study was conducted with the aim of investigating the level of nurse’s cultural competence in emergency department

Methods: The research is a descriptive cross-sectional study conducted in 2023 on 139 nurses working at the emergency departments of the hospitals affiliated to Mashhad University of Medical Sciences, selected through convenience sampling. The nurses meeting the inclusion criteria were selected and informed consents were obtained from them. Then they were asked to complete nurses' cultural competency questionnaires. After data collection, the data was entered into SPSS 16 and statistical analysis was performed through independent t-test and Pearson's correlation coefficient. P<0.05 was considered as the significant level

Ethical Considerations: This study was conducted after observing ethical principles of conducting and publishing research

Results: The mean score of nurses' cultural competence was reported to be high, 76.8±58.24. The mean score of cultural competence in the married nurses was significantly higher than that of the single ones (p=0.047). Furthermore, the relationships between nurses' cultural competence scores with age (r=0.322, p<0.001), general work experience (r=0.325, p<0.001) and Working experience in at the emergency department (r=0.189, p<0.05) were significant

Conclusion: Despite the high score of nurses' cultural competence in this study, it is possible to enhance the cultural competence of emergency nurses from the existing appropriate state to a desirable and ideal state through proper educational programs

Background and Aim: As a medical procedure, hymen examination is influenced by various cultural and social factors. This study was conducted with the aim of determining the reasons and consequences of girls' virginity examination from the perspective of midwives.

Methods: This descriptive cross-sectional study was conducted on 210 employed midwives in Tabriz in the year 2021. Sampling method was simple random sampling. Data on the reasons and consequences of virginity examination from the perspective of midwives were collected using a researcher-made questionnaire. Data analysis was performed using SPSS 21 software and descriptive statistics, Pearson correlation, independent t-test and one-way ANOVA tests, with p<0.05 considered significant.

Ethical Considerations: Ethical principles in the present study included: clarifying the research objectives to participants, obtaining written informed consent, maintaining privacy and data confidentiality, providing the opportunity to leave the research at any study satge.

Results: 56.2% of midwives believed that hymen examination has no therapeutic value and should not be performed. The majority (81.9%) agreed to perform virginity examination for the purpose of investigating sexual abuse and exploitation. 62% of individuals opposed virginity examination for issuing virginity certificates to girls before marriage. The majority (86.1%) believed that virginity examination is a violation of privacy and causes physical discomfort (74.7%), mental distress (86.1%), exacerbation of gender inequality (75.7%) and increase in physical and verbal violence (62.9%) and honor killings (55.8%). There were statistically significant associations between the causes for midwives' willingness to perform or not perform virginity examinations and ethnicity (P=0.018), personal history of virginity examination (P<0.001) and place of employment (P=0.003). Additionally, there were statistically significant associations between the consequences of virginity examinations and the level of education (P=0.038), ethnicity (P=0.037), place of residence (P<0.001), place of employment (P=0.013) and the number of virginity examinations performed by midwives (P=0.022).

Conclusion: The study reveals that most midwives view hymen examinations as significant violations of women's rights and sources of physical and mental stress. Consequently, midwives, as key members of health care providers, can be instrumental in raising awareness, providing education and promoting cultural change. They can help dispel false beliefs, respect human dignity and privacy and shift the focus from the issue of virginity to other human aspects

Background and Aim: Nurses, as the frontline individuals in the healthcare system, face various challenges in their work environment, including ethical challenges and in order to provide quality care, they must control their emotions in the workplace. This study was conducted to determine the relationship between ethical reasoning and emotional labor in nurses working in public hospitals in Borujerd in 2021.

Methods: The present study was conducted using a descriptive method with the participation of 160 nurses from public hospitals of Borujerd. Sampling was done using stratified random sampling after obtaining the ethical code and adhering to ethical standards. Data collection tools included a demographic information form and two questionnaires: The Grandey Emotional Labor Scale (α=0.88) and the Nursing Dilemma Test (α=0.82). Data analysis was performed using independent t-test, Chi-square test, One way ANOVA, Pearson correlation coefficient and linear regression model with SPSS 21 software. A significance level of less than 0.05 was considered.

Ethical Considerations: The principles of research ethics were observed: explaining the research objectives to the participants, obtaining informed consent, maintaining privacy, data confidentiality and providing the participants with the right to withdraw from the study at any stage of implementation.

Results: According to the findings, the level of ethical reasoning among nurses was 39.63±5.58, which was below average and undesirable based on the scoring of the tool used. The emotional labor status of nurses was 41.58±6.19, which was average and desirable based on the scoring of the tool used. There was no significant correlation between the level of ethical reasoning with emotional labor and its dimensions among nurses (P=0.628).

Conclusion: In this study, the ethical reasoning of nurses was not related to their emotional labor, but the increase in clinical reasoning and nurses' placement in difficult ethical situations had an impact on managing emotions in the nurses' work environment. These results can help nursing managers and planners by providing appropriate educational programs to prepare nurses for difficult ethical situations so that they can provide quality care and improve patients' health outcomes.

Background and Aim: Given the varying sensitivities of ethical issues in different professions and recognizing that educational environments, particularly medical universities, bear the crucial responsibility of educating and training skilled and committed human resources to meet societal needs and contribute to the comprehensive development of healthcare system, this study aimed to propose a model for simulating factors influencing the professional ethics development (PED) among medical university professors.

Methods: This research was exploratory in terms of its purpose and adopted a mixed-method approach (qualitative-quantitative). The study population for the qualitative phase consisted of medical university lecturers, while for the quantitative phase, it included lecturers at Ardabil University of Medical Sciences. Snowball sampling was employed in the qualitative phase until theoretical saturation was achieved (13 participants), while in the quantitative section, it was done judgmentally (30 participants). The data collection instruments were interviews for the qualitative phase and Fuzzy Delphi questionnaires for the quantitative phase. Qualitative data was analyzed using content analysis to identify main themes and sub-themes for the development of professional ethics among medical university lecturers. Subsequently, in the quantitative phase, the identified influencing factors were prioritized using the Fuzzy Delphi method. Finally, the criteria obtained from the qualitative analysis were simulated using an agent-based modeling approach. Data analysis for the qualitative phase was conducted using MAXQDA 20 software, while for the quantitative phase, Excel 16 and AnyLogic 8.9 software were employed.

Ethical Considerations: Ethical principles and data confidentiality were strictly adhered to throughout the study. Questionnaires were completed with informed consent and a clear explanation of the research objectives was provided to participants. 

Results: Based on the research findings, 51 primary codes, 10 sub-themes and 3 main themes (individual, educational and research) were identified. The individual factor was recognized as the most influential factor in the development of professional ethics among medical university lecturers. Furthermore, the results indicated that the level of professional ethics development among medical university lecturers reached 90% at the end of the simulation period. All necessary validations regarding the simulation were conducted, confirming the results through 120 tests.

Conclusion: Considering the research findings, it is recommended that the heads of medical universities pay special attention to the identified influencing factors, particularly the individual factor, which plays a significant role in developing professional ethics among lecturers.

Background and Aim: Aesthetic leadership is a leadership style closely intertwined with ethical leadership. This style is values-based and focused on promoting ethical behaviors, with a strong ethical goal centered on values of justice and fairness. This study aimed to explore ethical aesthetics from the perspective of nursing managers at Tehran University of Medical Sciences.

Methods: This descriptive qualitative study used a customary content analysis with the approach of Graneheim and Lundman. The study population included the leadership and management team of hospitals affiliated with Tehran University of Medical Sciences. Data collection was done through semi-structured, face-to-face interviews. The sampling method was purposive snowball sampling and participants were selected until data saturation was reached. A total of 28 interviews were conducted with matrons, supervisors and head nurses.

Ethical Considerations: The study was approved by the ethics committee. Ethical considerations such as obtaining informed consent, voluntary participation, explaining the research objectives and ensuring confidentiality were adhered to.

Results: After analysis, three main categories and sub-categories were identified. The main categories included aesthetic ethical thinking (self-discipline, absence the sense of superiority, respect in work, empathy and understanding of others, altruism, having a clear conscience, attention to human dignity, adherence to professional ethics principles), aesthetic ethical behavior (efforts to uphold employee rights, ethical judgments, ethical disciplinary methods, appreciation and recognition of staff efforts, adherence to justice, patience, forgiveness, altruism in behavior) and aesthetic ethical speech (respectful communication, courage in speech, fairness in speech, preservation of human dignity in speech, honesty and truthfulness in speech, respecting individuals' privacy in speech).

Conclusion: The aesthetics of ethics is an internalized ethical inclination that leads to actions (speech and behavior) grounded in human aesthetic values, goodness, benefit and truth. This research can strengthen the theoretical foundation of aesthetic leadership and complement the model of aesthetic nursing leadership within the healthcare system. It also contributes to the objectification and clarification of the concept of beauty and the sublime beauty of ethics in organizational life and nursing leadership and management in the Iranian healthcare system.

Background and Aim: Using non-scientific, vague and wrong words to describe the reproductive cycle of women is a common thing in Iranian culture and this can lead to negative taboos, followed by an adverse effect on the quality of life and health of half of the population. Using a word that is phonetically, structurally and conceptually worthy of describing this natural part of women's life with dignity is considered one of their rights.

Methods: This research is descriptive-analytical (theoretical analysis) in which the words used in research, medical and daily literature for women's bleeding cycles and the effect of these words on the formation of taboos or false beliefs in this field.

Ethical Considerations: Throughout all the stages of writing this research, authenticity, honesty and integrity have been observed.

Results: The words that are used to describe "mahingi" in Persian culture and language mainly mean repetition and emphasis on being a rule or custom, which on the contrary does not emphasize the reproductive health needs of women in this era. Some words are reminiscent of cultural or social prohibitions or even have a negative literal meaning. The word "mahinegi" has unified the description of the life cycle of women in research, medical and social literature. In terms of phonetics and structure, it is suitable for contemporary culture, in terms of lexical meaning; it is normative and dignity-oriented for women's reproductive health rights.

Conclusion: In this article, the philosophy of replacing the word "mahinegi", which is derived from its connection with the moon, is discussed. Using the word "mahinegi" with a metaphor of the moon as a celestial body that has many structural similarities in its evolution cycle with egg development and also using the moon as a symbol of reproductive can be a dignified description of women's Menstruation. In addition to these cases, the use of this beautiful and magnificent symbolization can facilitate the start of families' conversations with their children in this field.

Background and Aim: Proponents of the school of neurodeterminism, based on new findings from neuroscience, believe in the illusion of free will in man and claim that all individuals are under the control and dictatorship of their brains. Do we really have free will? Is free will an illusory abstract concept or a real quality in man? What is the definition of human free will in light of the new findings of human knowledge? The answer to these questions is important because the denial of free will means the denial of any criminal responsibility and in general the denial of the existence of the rules of criminal law in the normative order of society. This perception can turn into anarchy. The present article seeks to provide a convincing answer to the rejection of the skepticism introduced by the school of neurodeterminism and to redefine free will by examining the interdisciplinary approach of law, ethics and cognitive neuroscience.

Methods: This research is of theoretical type and the research method is descriptive-analytical and the method of data collection is library and has been done by referring to documents, books and articles.

Ethical Considerations: In order to organize this research, while observing the authenticity of the texts, honesty and fidelity have been observed.

Results: Consciousness is central to the definition of free will; Consciousness is self-awareness, which awareness (in the narrow sense) and arousal are the necessary means for its realization.

Conclusion: Free will includes a range of substantive and necessary elements in a coherent and inextricably linked sequence: motivation includes intention and delibration (in the words of Islamic philosophers, imagination, acknowledgment and enthusiasm) and determination includes the potential for preparation, awareness of intention and action. With these words, free will can be defined as follows: An intrinsic ability to perform conscious behavior based on purpose and reflection, which is realized in a range of elements from motivation to action.

Background and Aim: The right to health is among the most important human rights. This right can be influenced by certain factors such as the data induced through advertising. Therefore, legal systems have always taken approaches towards prohibiting or restricting the advertisements that endanger health. Throughout history, tobacco companies have advertised tobacco using various strategies, some of which have been subject to debate in terms of "rights" and at times, "ethics". Therefore, recognizing the advertising strategies in this field is of great importance. The purpose of conducting this research is to investigate whether some methods of tobacco advertising, in different eras, have resulted in "the violation of rights", or tobacco advertising is only an ethical issue.

Methods: The present research is a narrative review. The data has been collected through library and internet sources, besides referring to legal documents, books and articles.

Ethical Considerations: Throughout all the stages of writing this research, authenticity, honesty and integrity have been observed.

Results: The analysis of tobacco companies' advertising strategies indicates that, with the aim of making more profit, these companies have managed to accumulate a significant portion of capital through quite known advertising strategies: targeting women and children; inducing the sense of freedom, power and independence and some other misleading methods.

Conclusion: Prohibiting and restricting tobacco advertising is a crucial issue in protecting public health. Therefore, managing public affairs in the domain of health implies considering restrictions or prohibitions where necessary. Since advertising is a means of conveying specific messages and persuading the audience to achieve certain goals, it is essential to recognize the advertising mechanisms used by major tobacco companies. This knowledge can be used in future public actions such as determining precise prohibitions or reconsidering advertising restrictions.

Background and Aim: Nurses’ clinical competence, as the basic component of nursing care, is a very important and vital issue. Nursing competence has always been a challenging issue. In order to maintain the standards of nursing care, it is necessary to know the methods of developing and promoting clinical competence. The present study aims to examine and review the challenges and the approaches to obtaining clinical competence in Iran, so that the obtained results can help nursing managers and lecturers with promoting nursing competence, whose ultimate goal is to provide quality care to the patient.

Methods: The present research is a review study. The articles written in Farsi or English were included in the study. They were extracted using Farsi databases including SID and Magiran and Latin databases including ProQuest, Science Direct, Google Scholar, Ovid, PubMed. The search was conducted with no time limit until March 2020 and using the keywords nursing competence, nursing clinical competence and competence. After the careful examination of the title, the abstract and the full text of each article, a large number of articles were excluded due to the languages in which they had been written, different titles and purposes and inappropriate abstracts or contents. In the next step, 71 articles (44 Farsi and 27 English) were studied and, finally, 23 articles were included in the study.

Ethical Considerations: In order to organize this research, while observing the authenticity of the texts, honesty and fidelity have been observed.

Results: The educational and clinical challenges were investigated, along with the relevant approaches. Unmotivated students and inexperienced nurses’ low level of competence are among the mentioned challenges. Taking both educational and clinical measures, as an effective approach to improving clinical competence, will help reduce the gap between education and clinical practice.

Conclusion: Through recognizing the aforementioned challenges and approaches to improving clinical competence in nurses, it will be possible to ensure quality care provision, which is an important step in developing the health system. The recommended approaches include modifying the curriculum, increasing critical thinking skills in students and professors, increasing professors’ clinical and communicational skills, professors’ using different teaching methods and holding workshops and in-service training courses for nursing personnel and instructors.

Background and Aim: Ethics is the core of care activities. In recent years, virtue ethics has been one of captivating approaches in the nursing profession. This article aims to explain the concept of virtue in the nursing profession and the role of ethical virtues in various nursing domains.

Methods: This research is a review study. The keywords care ethics, ethical theories and nursing and virtue ethics were searched without time limit in reliable Farsi and English databases including SID, Iran Medex, Google books, PubMed, Google Scholar and ProQuest. The relevant articles were selected, reviewed and analyzed based on the objectives of the study.

Ethical Considerations: In all the stages of the present study, ethical considerations including trustworthiness in citing documents and non-bias have been observed.

Results: The results were categorized under a general image of virtue, virtue ethics, virtue and care, transferring virtue from ethics to practice, the role of ethical virtues in the nursing profession, the strategies of virtue ethics theory in education, the role of virtue in nursing theories and the challenges of virtue theory. Virtue is a prerequisite for ethical care. In the clinical sense, care ethics is enriched by a theoretical model of virtue. The virtue-oriented ethical approach in nursing education is learner-oriented and is considered as an essential part of nursing ethics education programs. Incorporating a discourse on virtues into the nursing theory may focus on ethical competence while meeting discipline-specific knowledge and technical skills. To solve the challenges of the virtue-based approach, ethical theories such as the consequentialism can be used besides this theory.

Conclusion: Ethical virtues are considered as an acceptable operations guide for clinical care practice in nursing. The virtue theory is widely used owing to the closer communication between nurses and patients and the nursing profession can make the most of this theory.

Background and Aim: Social stigmatization is one of the major consequences of the Covid-19 pandemic. With the onset of the Covid-19 pandemic, the crimes caused by stigma and hate increased all over the world, which targeted the identity and the personality of the infected people and East Asian communities and intensified insecurity in societies. This article explains the factors and analyzes the impact of the Covid-19 pandemic on the increase in hate crimes with a criminological approach.

Methods: The present study is a review and narrative research with a descriptive-analytical approach, which has been conducted using the relevant authentic resources and articles as well as some criminological theories in order to analyze the issue.

Ethical Considerations: In this research, ethical study aspects including the authenticity of texts, honesty and trustworthiness have been observed.

Results: Hate crimes are the unlawful acts committed with the motive of hating the identity characteristics of the victim, such as ethnicity, race, nationality, religion and gender. Moreover, being violent, being committed in public places and causing extensive damage to victims are among the features of these crimes.  Factors such as stigmatization, moral panics, pre-judgment and hateful attitudes played important roles in the increase of hate crimes during the Covid-19 pandemic around the world. Furthermore, the process of social stigmatization of the people infected with coronavirus and some Asians is also rooted in these prejudgments, ultimately leading to hate crimes.

Conclusion: Besides intensifying the punishment for such crimes, if necessary; removing hatred through strengthening cohesion among different groups and communities; raising awareness and modifying dominant discourses, with the help of the media and the Internet, can be effective in reducing the hate crimes caused by the Covid-19 pandemic.

Background and Aim: In today's modern society, work-related stress has been accepted as a job threat which can reduce compassion satisfaction and cause compassion fatigue. Healthcare providers in critical care and emergency departments may experience high levels of compassion fatigue and job burnout, which will lead to an impaired quality of professional life. The nurses who experience higher levels of compassion satisfaction have more protective resources to deal with the negative consequences of job stress and will be able to use coping mechanisms to prevent compassion fatigue while dealing with traumatized individuals. Therefore, this study was conducted to investigate compassion fatigue, compassion satisfaction and job burnout in emergency nurses and the influential factors.

Methods: The present research is a systematic review which was conducted in Iran in 2023. Searching was performed without a time limit until October 2023 and using the keywords compassion fatigue, compassion satisfaction, job burnout and emergency nurse in the international databases PubMed, Scopus, Web of Science, Science Direct and EMBASE, as well as the national ones including Iranmedex, Magiran, SID and Irandoc. The articles which were in line with the aim of this research and written in Farsi or English were included in the study. JBI checklist was used to evaluate the quality of the articles.

Ethical Considerations: In all the stages of writing the present research, honesty and trustworthiness has been observed while respecting the originality of the texts.

Results: In the initial search, 412 studies were obtained, which were reduced to 77 after the first screening, based on the title and the abstract of the articles. In the next step, screening the articles based on their full text, seven articles meeting the inclusion criteria were selected. Based on the results of the included studies, emergency nurses have moderate to high levels of compassion fatigue, job burnout and secondary traumatic stress, as well as moderate to high levels of compassion satisfaction. Furthermore, factors such as empathy, job satisfaction, self-compassion, as well as organizational and management support significantly predict compassion fatigue and compassion satisfaction in these nurses.

Conclusion: Providing strategies to improve knowledge and awareness of compassion satisfaction, compassion fatigue and job burnout can prevent emotional burnout in emergency nurses and help identify interventions to keep nurses empathetic and compassionate in their profession.

Background and Aim: Today, artificial intelligence technologies can provide incredible benefits to the health system. While artificial intelligence has a significant capacity to improve the performance of the health system, it is accompanied by challenges that sometimes lead to damages the health system. Therefore, the aim of the current research is to review the ethical and legal challenges associated with the use of artificial intelligence in the health system.

Methods: This research is a review study. To collect data, evidence was searched in Web of Science, PubMed, Scopus and Google Scholar databases using the keywords artificial intelligence, medical ethics, health rights, health care and human dignity.

Ethical Considerations: In all the stages of writing the present research, while respecting the originality of the texts, honesty and trustworthiness have been observed.

Results: Based on the findings of the present research, several items can be mentioned regarding ethical challenges: trust in artificial intelligence, violation of human dignity in artificial intelligence, observing the principle of individual independence and its rules, artificial intelligence in diagnosing the completion of treatment, and artificial intelligence and emotional functioning. The legal challenges include the standardization of artificial intelligence in medicine, artificial intelligence and civil liability, artificial intelligence and the physician’s warranty, artificial intelligence and the breach of data confidentiality, and artificial intelligence and cyber security.

Conclusion: While using artificial intelligence technologies to provide healthcare and medical services, decisions should be made based on respect for human dignity and observing ethical and legal principles, rules and regulations. Any AI-based technology which is considered for use in healthcare and the health system must be efficient, safe, standardized and regulated. Such technologies can only be efficient if they are implemented in healthcare and medical services along with monitoring and evaluation.

Background and Aim: Human dignity serves as the cornerstone of human rights and is fundamental in understanding patient rights. Given the delicate nature of pregnancy, preserving women's dignity during this period is crucial. This study aims to explore the various dimensions of women's dignity throughout pregnancy and childbirth.

Methods: This review-narrative study utilized a method of collecting information by searching for relevant books and articles published in the past two decades (2000-24) from reputable databases such as Magiran, SID, PubMed, Web of Science and Google Scholar.

Ethical Considerations: In this research, ethical aspects were observed in the literature review, including authenticity of texts, honesty and integrity.

Results: Based on the study's findings, the dignity of pregnant women should be addressed in three dimensions: 1- Clinical Environment, which encompasses ensuring the presence of specialized personnel in healthcare centers, pregnant women's comfort provision, comprehensive patient care, access to medications and facilities and an effective complaint handling system; 2- Service Providers, focusing on effective communication, avoiding verbal and physical violence, maintaining positive attitudes and appropriate behavior, safeguarding physical and psychological privacy, avoiding discrimination and labeling pregnant women and paying adequate attention to them; 3- Diagnostic and Treatment Processes, emphasizing the importance of providing information, involving pregnant women in decision-making, respecting their preferences and obtaining informed consent before interventions.

Conclusion: Creating a calm clinical environment, enhancing effective communication, respecting women's choices during diagnosis and treatment, accurate and transparent information dissemination and increasing awareness among pregnant women about treatment processes all contribute to improving maternal health. Human rights and human dignity must be upheld at all stages of healthcare. Continuous training for healthcare personnel, especially midwives as the first point of contact, plays a crucial role in raising awareness about the dimensions of human dignity, women's rights and commitment to improving care practices.

Background and Aim: Digital immigrants are individuals who have migrated from one generation to another, while digital natives are a new generation of individuals who have grown up in the digital world. The aim of present study is to scrutinize the characteristics, differences and effective interaction methods of digital natives and digital immigrants.

Methods: The study method involves a review of documents and articles from 2000 to 2023 using keywords extracted from Scopus, Web of Science and Science Direct databases. Out of 68 articles found, 10 relevant articles were studied and analyzed.

Ethical Considerations: Honesty and integrity in reporting texts, proper referencing of sources and avoidance of bias have been observed.

Results: Research findings led to classification into 7 categories including age and gender; worldview and values; learning process and information search; preferred technologies; skill acquisition; employment and work environment; and leisure time among digital natives and immigrants.

Conclusion: Results indicate gender differences between digital natives and immigrants affecting technology usage. In the category of values, digital immigrants act mostly based on collective values and digital natives act based on individual values. Learning and adaptation process to new technologies requires more support and training for digital immigrants. Additionally, digital natives exhibit different preferences in technology use. Moreover, the skills of digital immigrants are shaped by local experience and knowledge and the skills of digital natives are built upon new technologies.Concerning employment and work environments, digital immigrants typically encounter greater cultural and language challenges in new work settings. The leisure activities of digital immigrants often revolve around traditional pursuits and digital natives lean towards technology-related activities and digital entertainment.