akhlāq-i pizishkī i.e., Medical Ethics

With the increasing elderly population and the complexity of health needs in this group, the use of new technologies, especially artificial intelligence (AI), has become an inevitable necessity in health systems. Artificial intelligence, the use of innovative technologies, especially artificial intelligence (AI), has become an inevitable necessity in health care. AI, with its capability to analyze complex data and facilitate clinical decisions, can improve the quality of life of the elderly and reduce the burden of care. Applications of AI include remote health monitoring, assistive robots, virtual reality-based cognitive games and smart diagnostic systems, to name just a few. Despite these benefits, challenges such as the lack of active participation of older adults in system design, complex user interfaces, language and content mismatch with digital literacy and physical and cognitive limitations are issues that need to be considered. In addition, ethical concerns including age discrimination, privacy protection, transparency of algorithm performance and the possibility of reproducing social inequalities and data biases are also of great importance. This manuscript, in the form of a letter to the editor, emphasizes the importance of integrating technology with human values, engaging active participation from end users and establishing effective scientific and legal oversight in the development of artificial intelligence in elder care and provides suggestions for enhancing the effectiveness and acceptability of these technologies.

Given the accelerating advancements in health technologies and the increasing ethical complexity of medical research, revising foundational guidance documents is imperative. The Declaration of Helsinki, as the cornerstone of human research ethics, has responded to these needs with the publication of its eighth revision in 2024 . This letter aims to provide a comparative content analysis of the 2013 and 2024 versions and explore their implications for the future of research ethics. The present analysis reveals that a key evolution is the paradigm shift from "research subject" to "participant", centering human agency and dignity. This shift underpins new emphases on structural justice, the necessity for meaningful and sustained engagement with local communities and the integration of environmental sustainability considerations into research design. Furthermore, for the first time, the Declaration explicitly addresses the ethical challenges of artificial intelligence and big data research, emphasizing transparency, accountability and the avoidance of algorithmic bias. The unprecedented strengthening of the oversight role and authority of ethics committees, along with clearer regulations on conflict of interest and dynamic informed consent, are other strengths of this revision. Overall, the 2024 Declaration has evolved from an individual-centric protective framework into a dynamic, socially-conscious and forward-looking document capable of guiding research in an era of technological complexity and global inequity. The success of this new framework depends on the continuous education of researchers, the strengthening of oversight institutions and a commitment to equitable international collaboration.

Background and Aim: In educational systems, fostering moral competence is of fundamental importance. Within this context, personality traits can be considered as self-regulatory mechanisms, while social perspective-taking represents a crucial prerequisite for moral behavior. Accordingly, within the framework of contemporary educational psychology, the present study aimed to compare academic moral resilience and social perspective-taking among high school students based on their level of prosocial personality.

Methods: This descriptive-analytical study was conducted on all secondary school students in Kermanshah during the 2023-24 academic year. Using the Morgan-Krejcie (1970) sampling table, 358 students were selected through multistage cluster sampling. Participants were classified into high and low prosocial personality groups according to the cut-off score obtained from the Prosocial Personality Scale. Data were collected using the Rahpeyma Academic Moral Resilience Questionnaire (2019), the Mohagheghi et al. Social Perspective-Taking Questionnaire (2016) and the Penner Prosocial Personality Scale (2002). Data analysis was performed in SPSS 27 using multivariate analysis of variance (MANOVA) at a significance level of less than 0.05.

Ethical Considerations: Ethical principles such as informed consent, voluntary participation, the right to withdraw, absence of financial burden, avoidance of labeling, confidentiality of personal data and the use of findings solely for research purposes were carefully observed.

Results: The findings indicated significant differences between the high and low prosocial personality groups in both academic moral resilience (F=15.21, p<0.003) and social perspective-taking (F=18.73, p<0.001). The test's statistical power was high (1–β>0.997), confirming the adequacy of the sample size. Moreover, prosocial personality accounted for 38.1% of the variance in academic moral resilience (η²=0.381) and 42.5% of the variance in social perspective-taking (η²=0.425).

Conclusion: The findings suggest that prosocial personality, by enhancing individuals’ ability to understand others’ perspectives and improving communication and conflict-resolution skills in moral contexts, can be effectively integrated into the design of school educational programs

Background and Aim: Moral intelligence, as a fundamental competency in healthcare professions, has substantial potential to influence clinical decision-making and professional behavior. This concept is particularly critical in high-stress and crisis-driven environments such as prehospital emergency care, where effective time management is an undeniable necessity. The present study aimed to determine the relationship between moral intelligence and time management among emergency medical technicians in Arak, Iran.

Methods: This descriptive correlational study was conducted in 2024 among 200 emergency medical technicians working in prehospital emergency bases affiliated with Arak University of Medical Sciences. Participants were selected using convenience sampling. Data were collected using standardized questionnaires, including a demographic information form, the Moral Intelligence Questionnaire and the Time Management Questionnaire. Data analysis was performed using SPSS 22 Pearson correlation tests, one-way analysis of variance and independent t-test.

Ethical Considerations: Ethical principles were strictly observed throughout all stages of the study. Confidentiality was maintained and questionnaires were completed after obtaining informed consent from participants and providing a clear explanation of the study objectives.

Results: The findings indicated that the mean total score of moral intelligence was 147.63±21.18, while the mean score of time management was 75.9±9.91. Results showed that 181 participants (89.6%) demonstrated a strong level of time management. A positive and statistically significant correlation was observed between total moral intelligence and time management scores (r=0.608, p<0.001). Additionally, all dimensions of moral intelligence - including integrity, responsibility, compassion and forgiveness - were significantly and positively correlated with time management and its subdimensions (p<0.05).

Conclusion: The findings suggest that higher levels of moral intelligence are associated with more effective time management among emergency medical technicians. Accordingly, the design and implementation of educational programs aimed at enhancing moral intelligence may serve as an effective strategy for improving time management skills and, ultimately, for enhancing the quality of prehospital emergency care services.

Background and Aim: Patient satisfaction is a key indicator of the quality of hospital services. Awareness of patient rights may contribute to increased satisfaction; however, unmet expectations arising from such awareness may conversely lead to dissatisfaction. This study aimed to examine the effect of education on the Patient Rights Charter on awareness and satisfaction among hospitalized patients.

Methods: This quasi-experimental, two-group study was conducted among 28 hospitalized patients admitted to the internal medicine and surgical wards of Allameh Bohlool Hospital in Gonabad, Iran. A two-stage cluster sampling method was used, and participants were randomly assigned to either the intervention or control group. At baseline, all participants completed questionnaires assessing awareness of the Patient Rights Charter and satisfaction with medical and non-medical services. The intervention group received face-to-face education on the Patient Rights Charter over three sessions. At discharge, both questionnaires were re-administered in the two groups. Data were analyzed using SPSS 19, employing independent and paired t-tests, with the level of statistical significance set at p<0.05.

Ethical Considerations: Informed consent was obtained from all participants. Confidentiality of data, safety of the intervention, voluntary participation, and the right to withdraw from the study at any time were ensured.

Results: Before the intervention, no statistically significant difference was observed between the two groups regarding satisfaction with medical and non-medical services (p=0.16). After the intervention, patient satisfaction in the intervention group was significantly lower compared with the control group (p<0.001). Awareness of the Patient Rights Charter did not differ significantly between the two groups at baseline (p=0.265); however, a significant increase in awareness was observed in the intervention group following the educational program (p<0.001).

Conclusion: Education on the Patient Rights Charter increases patients’ awareness of their rights and subsequently raises their expectations of healthcare services. When these expectations are not adequately met by the healthcare team, patient satisfaction may decline. Therefore, strengthening adherence to patient rights and improving service quality through managerial and staff-level interventions are essential for enhancing patient satisfaction.

Keywords: Education; Patient Rights Charter; Patient Satisfaction; Hospitalized Patients

Background and Aim: Moral distress refers to the psychological discomfort that arises when nurses recognize the ethically appropriate course of action but are unable to act accordingly due to organizational or systemic constraints. It represents a substantial component of occupational stress in nursing practice. This study aimed to determine the frequency and intensity of moral distress and to examine its associated factors among nurses working in oncology units of teaching hospitals in Mashhad in 2025.

Methods: In this descriptive cross-sectional study, 100 nurses employed in oncology units of teaching hospitals in Mashhad were recruited using a two-stage cluster and convenience sampling approach. Data were collected using a demographic questionnaire and the Moral Distress Scale-Revised (MDS-R). Statistical analyses were conducted using SPSS 26. Descriptive statistics were calculated, and appropriate inferential tests were applied to examine associations between variables.

Ethical Considerations: Participation was voluntary, and principles of confidentiality and non-maleficence, as well as established ethical standards, were strictly maintained. The study protocol was approved by the Ethics Committee of Mashhad University of Medical Sciences, and the research was conducted in accordance with its oversight.

Results: Of the 100 participants, 65% (n=65) were female and 35% (n=35) were male. The mean age was 34.1±7.96 years. The mean score for the frequency of moral distress was 41.09±17.32, while the mean intensity score was 48.84±18.13. Notably, 59% of nurses reported an intention to leave the nursing profession. No statistically significant differences were found between male and female nurses regarding the frequency or intensity of moral distress (p>0.05). Furthermore, age and years of professional experience demonstrated weak and non-significant correlations with both frequency and intensity of moral distress (r <0.2, p>0.05).

Conclusion: The elevated levels of moral distress and the substantial proportion of oncology unit nurses in Mashhad expressing an intention to leave the profession underscore the urgent need for organizational-level interventions within these settings. Future research should further examine organizational and individual determinants of moral distress to inform targeted strategies aimed at sustaining the oncology-nursing workforce.

Background and Aim: Heart failure is a chronic and debilitating disease that, in addition to physical consequences, imposes considerable psychological and social burdens on patients. Spiritual health, as a holistic dimension of health, may influence patients’ coping strategies and their adaptation to illness. The present study aimed to determine the correlation between spiritual health and coping strategies in patients with heart failure.

Methods: This descriptive-correlational study was conducted in 2019 on 180 patients with heart failure who attended two cardiology clinics in Tehran. Data were collected using a researcher-developed demographic questionnaire, the Paloutzian and Ellison Spiritual Well-Being Scale, and the Brief COPE questionnaire developed by Charles S. Carver. Data analysis was performed using descriptive statistics, independent t-test, analysis of variance (ANOVA) and Pearson correlation coefficient in SPSS 16. A significance level of p≤0.05 was considered.

Ethical Considerations: This study was approved by the Ethics Committee of Shahid Beheshti University of Medical Sciences. Written informed consent was obtained from all participants and confidentiality of their information was maintained in accordance with the principles of the Declaration of Helsinki.

Results: The mean total score of spiritual health was 89.86±16.22. The mean scores for the religious health and existential health dimensions were 46.86±8.74 and 42.99±8.79, respectively, indicating slightly higher scores in the existential dimension. Patients predominantly used problem-focused coping strategies, with acceptance and religion being the most frequently used subscales. Emotion-focused coping strategies were used more frequently by women and decreased with increasing age and longer duration of illness. Correlation analysis showed that spiritual health had a significant positive relationship with overall coping strategies (p<0.001) and problem-focused coping (p<0.001), while no significant relationship was found with emotion-focused coping (p>0.05).

Conclusion: The findings suggest that spiritual health, particularly the religious dimension, plays an important role in strengthening problem-focused coping strategies among patients with heart failure. These results highlight the importance of addressing spiritual aspects in clinical care, nursing education and the development of evidence-based supportive and management interventions.

Background and Aim: Receiving bad news places the patient and family in the most critical psychological and emotional moments. Ethical and empathetic care requires that the medical staff recognize their needs in these situations and not be satisfied with simply transmitting information. The present study is an exploration of the needs of patients and their families upon receiving bad news, based on their lived experiences.

Methods: This qualitative study was conducted in 2023-25 by utilizing conventional content analysis approach. Participants were thirteen patients with formidable, incurable, or life-threatening diseases and fifteen family members with the history of receiving bad news. They were purposively selected from three leading hospitals in Tehran, Iran. Data were gathered via 28 face-to-face in-depth semi-structured interviews and For data analysis, the approach by Graneheim and Lundman was used.

Ethical Considerations: Informed consent was obtained from all participants before conducting interviews and participants were assured of the confidentiality of information and the right to withdraw from the study at any stage of the research.

Results: In this study, three main categories and eight subcategories related to the needs of patients and families were extracted, which included: need for freedom (need for hope, need for peace, need for spiritual support), Appropriate Relationships (Need for the protection of human dignity, need for emotional support), and Professional support (need for gradual preparation, Need for information about disease reality, need for counseling and support).

Conclusion: Following the reception of bad news, patients and their families often find themselves unable to adapt to the prevailing reality. Consequently, they anticipate the provision of comprehensive and honest information, prior preparation, respect for their human dignity, and the availability of social support. Therefore, understanding the needs of patients and families when receiving bad news can mitigate their distress and assist in informed decision-making and satisfaction with healthcare services. Furthermore, comprehending these needs can be instrumental in the development of clinical guidelines.

Background and Aim: Spiritual needs are highly prevalent among patients with cancer and are closely linked to psychological outcomes and quality of life. Despite international recommendations advocating the integration of spiritual care into oncology practice, systematic identification of these needs remains inconsistent. This study aimed to explore how spiritual needs are identified in patients with cancer from the perspective of interdisciplinary care team members.

Methods: This qualitative study employed a conventional content analysis approach. 18 participants, including oncology nurses, physicians, social workers and hospital chaplains, were purposively recruited. Data were collected through in-depth semi-structured interviews and analyzed using a constant comparative method. Trustworthiness was ensured by applying credibility, transferability, dependability and confirmability criteria.

Ethical Considerations: Prior to the initiation of the study, the objectives of the research were thoroughly explained to the participants and informed consent was obtained both verbally and in written form. Participants were assured that all personal information would remain confidential and that all research documents would be securely stored. The study protocol was approved by the Ethics Committee of Shahid Beheshti University of Medical Sciences and the research was conducted under the supervision of this committee.

Results: A total of 412 initial codes were extracted, which were refined into 28 subcategories and 5 main categories. The main categories were: 1- Progressive and layered identification of spiritual needs; 2- A holistic and time-sensitive approach; 3- Communication skills as facilitators or barriers; 4- Personal and social characteristics; 5- Decision-making for intervention and care planning. Findings indicated that identifying spiritual needs is a dynamic and relational process that begins with informal observation and may evolve into structured assessment and specialist referral.

Conclusion: Identifying the spiritual needs of patients with cancer requires a stepwise, relationship-centered and interdisciplinary approach. Integrating spiritual screening into routine oncology care and providing communication skills training for healthcare team members can contribute to improving the quality of holistic care.

Background and Aim: Occupational calling, as one of the most vital sources of motivation in the healthcare system, can be influenced by ethical tensions. This study aimed to investigate the relationship between moral injury and sense of occupational calling by explaining the mediating role of assertiveness and the moderating roles of ethical leadership and self-compassion among healthcare personnel at the Health Deputy of Fasa University of Medical Sciences.

Methods: This study is applied research with a descriptive-correlational study design. The study population consisted of healthcare personnel working at the Health Deputy of Fasa University of Medical Sciences in 2025, of whom 217 were included through the convenience sampling method. Data were collected using questionnaires assessing moral injury (Mantri et al, 2020), sense of occupational calling (Pardelan et al, 2022), assertiveness (Gambrill & Richey, 1975), ethical leadership (Yang et al, 2016) and self-compassion (Raes et al, 2011). The psychometric properties of the instruments were presented in the Methods section. Data analysis and hypothesis testing were analyzed using Structural Equation Modeling (SEM) and the Partial Least Squares (PLS) method in Smart PLS 3 software.

Ethical Considerations: In this study, by citing the references used, the ethical principle of scientific confidentiality and the intellectual property of authors’ rights were adhered to. Other principles of scientific ethics, including confidentiality and privacy of participants, were also observed.

Results: The findings indicated that moral injury had a significant negative effect on sense of occupational calling (p<0.001). The mediating role of assertiveness was also confirmed (p<0.001), indicating that moral injury decreases the sense of occupational calling by weakening individuals’ ability to express themselves assertively. Findings related to the moderating role also showed that both ethical leadership (p<0.001) and self-compassion (p<0.001), as protective factors, significantly moderated the destructive effects of moral injury and sense of occupational calling. Specifically, higher levels of self-compassion were associated with a weaker negative effect of moral injury on sense of occupational calling. The research model explained 58.4% of the variance in the sense of occupational calling.

Conclusion: According to findings, the professional identity and sense of occupational calling of healthcare personnel in the health system require a comprehensive approach. Improving psychological skills such as self-expression and self-compassion, along with promoting ethical leadership styles, can act as a factor against moral injury and prevent occupational alienation of personnel in healthcare settings.

Background and Aim: Moral sensitivity is a key component of the nursing profession, playing a crucial role in determining the quality of care provided in intensive care units (ICUs). This narrative review aimed to explore the dimensions, influencing factors and outcomes of nurses’ moral sensitivity in critical care settings.

Methods: This narrative review was conducted through a comprehensive search of reputable Persian and English databases, including Magiran, SID, Web of Science, PubMed and Google Scholar. After applying inclusion and exclusion criteria, nine relevant articles were selected and analysed.

Ethical Considerations: To ensure the validity and reliability of the study, all inclusion and exclusion criteria were strictly followed and only studies published in credible scientific sources were included.

Results: Moral sensitivity among ICU nurses can be discussed across four main dimensions: education and development of moral sensitivity, its relationship with patient safety attitudes, the role of experience and mental workload and the impact of teamwork and interprofessional collaboration. Enhancing moral sensitivity contributes to improved care quality, reduced risky behaviours and greater patient safety.

Conclusion: Strengthening professional ethics education, providing organizational support and promoting effective teamwork play significant roles in enhancing nurses’ moral sensitivity. These factors can improve care quality and patient satisfaction. Considering moral sensitivity as a multidimensional construct and investing in its development may foster professional commitment among nurses and lead to more positive care outcomes.

Background and Aim: Nurses frequently face complex ethical dilemmas in the process of caring for clients in order to create a balance between the ethical principles of truth-telling and compassion. Given the lack of studies in this field, this study aimed to explain expedient lies and pragmatic ethics in nursing.

Method: This study was conducted as a narrative review from April to July 2025. Searches were conducted in PubMed, CINAHL, Scopus, Web of Science, Magiran, SID databases using keywords such as "white lies in nursing", "therapeutic deception", "ethics of compassion", "truth-telling in healthcare", "pragmatic ethics" and "beneficence vs. autonomy" and their Persian equivalents, individually or in combination with each other, without time limit. After retrieving articles and screening them based on inclusion and exclusion criteria, data analysis was performed based on the Narrative Synthesis method.

Ethical Considerations: Ethics are a fundamental principle in any research. The present study was approved by the university ethics committee.

Findings: Data analysis showed that there is a persistent and meaningful ethical tension between the principle of truthfulness and the principle of compassion in nurses' clinical practice. Nurses use expedient lies as a practical strategy when dealing with vulnerable patients to prevent psychological distress in patients; maintain hope in the treatment process; and strengthen the therapeutic bond. The data showed that the lack of standardized ethical guidance frameworks can lead to ethical doubts among nurses; overreliance on personal judgments, and inconsistency in clinical decision-making.

Conclusion: The use of pragmatism in nursing ethics, although beneficial in resolving clinical conflicts, is associated with the risk of moral relativism and a misunderstanding of professional flexibility. It is suggested that regulatory bodies create a balance between pragmatism and basic ethical principles by developing situation-based clinical guidelines.

Background and Aim: Ethics plays a vital role in ensuring human health, well-being and dignity, particularly within the nursing profession. One relatively underexplored domain is research ethics, which is fundamental to maintaining scientific integrity and safeguarding research participants. Therefore, the present narrative review was conducted to identify, describe and analyze the ethical principles and challenges associated with nursing research.

Methods: This study was conducted as a narrative review. A comprehensive literature search was performed across PubMed, Scopus, Web of Science, Magiran, SID and Google Scholar. Keywords were selected based on the MeSH system. They included the English terms "Ethics", "Moral", "Principle-Based Ethics" and "Nursing Research", along with their Persian equivalents. The search covered publications from 2005 to 2025. After removing duplicate records and screening titles, abstracts and full texts, 15 articles were ultimately selected for final analysis based on predefined inclusion and exclusion criteria.

Ethical Considerations: Throughout all stages of preparing this manuscript, principles of academic integrity, honesty and proper attribution were strictly observed.

Results: Content analysis of the 15 selected articles revealed that ethical principles, including autonomy and informed consent, beneficence, non-maleficence, justice, honesty and confidentiality, constitute the core foundations of nursing research, underscoring the necessity of ethics education for nurses. Nevertheless, several challenges remain, including conducting research with vulnerable populations, role conflict between nurse and researcher and research misconduct, all of which pose significant threats to scientific and ethical integrity. In addition, emerging ethical concerns-such as the use of artificial intelligence in research-have received comparatively limited attention.

Conclusion: Awareness and application of ethical principles and recognition of ethical challenges in nursing research not only enhance the scientific quality of research outcomes but also strengthen public trust in nursing research, ultimately contributing to improved quality of care and health services. The findings of this review may serve as a foundation for developing research ethics education programs in nursing schools, formulating national ethical guidelines and codes and providing practical guidance for early-career nursing researchers

Background & Aim: The global nurse shortage is a problem caused by an imbalance between the supply and demand of nurses. One issue exacerbating by this shortage is the ethical dilemmas in patient care. Nurses face ethical dilemmas when they are unable to deliver optimal care due to constraints. This study was conducted with the aim of reviewing solutions for ethical challenges in patient care caused by a shortage of nurses.

Methods: We conducted a comprehensive search across multiple databases including PubMed, Medline, Google Scholar, SID, Magiran, using Persian and English keywords related to the shortage of nurses, patient care, healthcare workforce, demand for health services, and ethical challenges. The search was limited to the years 2000-2024. After reviewing the titles and abstracts and carefully studying selected articles, 7 articles were selected.

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

Results: Ethical dilemmas in nursing practice encompass medication errors, adverse clinical events, balancing patient benefits and risks, communication limitations, neglecting ethical and human connections, transmitting negative emotions to patients and families, and personal sacrifices by nurses. Addressing these challenges involves modifying organizational policies and procedures and considering nurses' job experiences as effective strategies.

Conclusion: The articles highlighted key strategies including effective human resource management, accurate cost estimation and financial allocation, enhancing work environment structure and conditions, empowering nurses, ethics-focused training, strategic policy-making, and practical implementation of these strategies. Implementing these strategies can help alleviate nurse shortages and ethical dilemmas in patient care.

Background and Aim: Despite its vital role in health promotion, the nursing profession is confronted with substantial workload pressures and shortages of human resources, which have contributed to the emergence of challenges such as moral distress and compassion fatigue. If left unaddressed, these phenomena may lead to serious clinical and professional consequences. The present study adopts a narrative review approach to examine these consequences and to propose strategies for improving nurses’ work environments.

Methods: This narrative review was conducted in 2025 with the aim of exploring the clinical and professional consequences associated with moral distress and compassion fatigue among nurses. To this end, a comprehensive literature search was performed using the keywords moral distress, compassion fatigue, ethical consequences, professional consequences and nurses, along with their Persian equivalents. International databases (PubMed and Web of Science), Iranian national databases (SID, Magiran and Irandoc) and the Google Scholar search engine were searched without time restrictions from inception to October 2025. Relevant articles published in Persian and English and aligned with the study objectives were selected and analyzed.

Ethical Considerations: Throughout all stages of manuscript preparation, principles of academic integrity, honesty and fidelity to original sources were strictly observed.

Results: The findings of the reviewed studies were organized into three main themes. First, moral distress and compassion fatigue, which nurses experience to varying degrees, were found to be associated with individual factors such as age, gender, level of education and work experience, as well as organizational factors including workplace conditions. Second, the clinical and professional consequences of moral distress and compassion fatigue were identified as adverse outcomes that significantly affect nurses’ mental health, reduce job satisfaction, increase intentions to leave the profession and compromise the quality of nursing care. Third, evidence-based strategies aimed at improving these conditions were highlighted, including educational interventions (such as ethics education and coping skills training), the creation of supportive work environments and the implementation of spirituality-based approaches. These strategies have been shown to be effective in reducing moral distress and compassion fatigue and in enhancing nurses’ resilience.

Conclusion: Moral distress and compassion fatigue are among the most critical professional challenges faced by nurses, posing threats to their mental health and diminishing the quality of patient care. This review demonstrates that although these conditions may be inevitable in high-stress clinical settings, their severity and consequences can be mitigated through targeted interventions. Training in ethical and psychological strategies, enhancement of communication skills and the development of a supportive workplace culture provide a foundation for strengthening nurses’ resilience and restoring their professional capacity. Moreover, attention to spiritual values and the reinforcement of a team-oriented perspective play a significant role in alleviating ethical pressures and fostering professional solidarity. Accordingly, the findings of this study underscore the need to design comprehensive and sustainable programs to support nurses and to improve the quality and safety of clinical care

Background and Aim: Sports physiological research that simultaneously involves human participants and animal models plays a critical role in elucidating metabolic, cardiovascular and neural adaptations to physical activity. Due to their inherently interventional nature - particularly when employing high-intensity or prolonged training protocols - such studies face distinctive ethical and legal challenges that extend beyond general bioethical considerations. The aim of the present study was to conduct a narrative review and ethical - legal analysis of these challenges within the field of sports sciences, emphasizing the necessity of adopting a sport-specific (sports-oriented) approach to research ethics - one that contextualizes ethical requirements in light of the unique characteristics of the sporting environment, performance-driven pressures and its professional structures.

Methods: This study employed a narrative review design. Relevant Persian and English-language sources were identified through systematic searches of international databases including PubMed, Scopus, Web of Science and ScienceDirect, as well as Persian databases (SID and Magiran). In addition, Google Scholar was used as a scientific search engine to supplement the search. The search covered publications from 2015 to 2024. Study selection followed the general stages outlined in the PRISMA flow diagram.

Ethical Considerations: To ensure the validity and credibility of the review, only studies meeting predefined inclusion criteria and published in reputable scientific sources were considered.

Results: Of the 212 records initially identified, 12 studies met the inclusion criteria and were ultimately included in the narrative analysis. The findings indicate that in human-based sports research, informed consent, athlete vulnerability and the assessment of scientific benefits relative to potential risks constitute the primary ethical challenges. In animal-based research, the practical implementation of the 3Rs principles, animal welfare and the quality of reporting emerged as central ethical concerns. Furthermore, international policy documents and ethical guidelines - such as the Declaration of Helsinki and the European Union Directive 2010/63/EU - provide general ethical frameworks but do not adequately address the specific complexities inherent in human - animal sports research.

Conclusion: This narrative review demonstrates that research ethics in sports science requires a dedicated, sport-specific ethical framework. Strengthening ethical oversight by research ethics committees, enhancing researcher education regarding the 3Rs principles and redefining informed consent within the sporting context are essential measures for improving both the ethical integrity and scientific quality of human - animal sports physiology research.

Background and Aim: Ethical decision-making is one of the fundamental components of the nursing profession and is influenced by nurses’ individual perspectives. Idealism, as a core dimension of ethical ideology, affects the way individuals judge and respond to complex ethical situations. However, the role of idealism in nurses’ ethical decision-making has received limited attention as an independent subject of review. Therefore, the present study aimed to examine the role of idealism in nurses’ ethical decision-making through a narrative review.

Methods: This study was conducted as a narrative review without language or time restrictions up to 2025. All original studies were searched using the keywords idealism, decision-making, and nurse, as well as their Persian equivalents. The search was carried out in international databases, including PubMed, Scopus, and Web of Science, as well as Persian-language databases such as SID and Magiran. After completing the screening process, 17 articles were included in the final analysis.

Ethical Considerations: In the preparation of this study, principles of academic integrity, proper citation, and fidelity to original sources were fully observed.

Results: Five main findings regarding nurses’ ethical decision-making and the role of idealism were identified, based on the frequency of recurrence in the included articles. These findings included: the conflict between idealistic thinking and clinical realities; strong adherence to professional nursing ethical principles; efforts to integrate theoretical knowledge with clinical practice; a tendency to enhance knowledge regarding idealism; and emotional consequences associated with idealistic thinking.

Conclusion: The findings indicate that nurses’ ethical decision-making inspired by an idealistic approach may be influenced by professional ethical principles, clinical realities, theoretical knowledge, and nurses’ ability to apply professional ethical standards in practice. Practical ethics education and the localization of instruments used to assess ethical ideology may contribute to the improvement of ethical decision-making in nursing.

Background and Aim: Spiritual therapy, as a value-based approach, appears to help war-affected populations to facilitate the experience of psychological trauma. This study aims to narratively review the evidence on the role of spiritual therapy in managing post-war psychological trauma within an ethical framework, particularly in communities with a strong religious-cultural background.

Methods: This narrative review was conducted based on a comprehensive literature review in PubMed/ Medline, Google Scholar and national Persian-language databases, including SID, Magiran, Irandoc and Noormagz. English and Persian articles that addressed the role of spiritual therapy in war-affected populations were assessed. The analysis was conducted thematically and EndNote X20 software was used for reference management.

Ethical Considerations: In the present study, the ethical aspects of review studies, including the authenticity, honesty and integrity, were adhered to.

Results: The literature on spirituality therapy in war-affected populations included eight studies that could be classified into five themes: 1. Reduction of post-traumatic stress symptoms; 2. Psychological resilience; 3. post-traumatic growth; 4. Contradictory findings among refugees; 5. Positive and negative religious coping. Socio-religious activities, group meetings and creative workshops could reduce anxiety and increase resilience. However, the effectiveness of spiritual therapy depends on supportive, culturally sensitive and professionally guided frameworks. Positive religious coping is associated with post-traumatic growth, while negative coping is associated with increased psychological distress. The lack of professional support or social structure can limit or even harm the impact of spirituality.

Conclusion: The results showed that spiritual therapy should not be viewed as a substitute for psychotherapy, but rather should be offered in a structured, voluntary and integrative manner with psychotherapy interventions. Adhering to the principles of care ethics, respecting religious diversity and providing a safe environment for expressing negative emotions are essential for these interventions. Spirituality can be a source of meaning, hope and resilience and by integrating it with psychotherapy, it can improve the mental health of war-affected populations. Future research should focus on longitudinal evaluation and the development of culturally-psychological integrated guidelines.