Vol 5 (2012)
In the last two decades, there have been numerous calls for a culturally sensitive bioethics. At the same time, bioethicists have become increasingly involved in empirical research, which is a sign of dissatisfaction with the analytic methods of traditional bioethics. In this article, I will argue that although these developments have broadened and enriched the field of bioethics, they can easily be construed to be an endorsement of ethical relativism, especially by those not well grounded in academic moral philosophy. I maintain that bioethicists must resist the temptation of moving too quickly from cultural relativism to ethical relativism and from empirical findings to normative conclusions. Indeed, anyone who reasons in this way is guilty of the naturalistic fallacy. I conclude by saying that properly conceptualized, empirical research and sensitivity to cultural diversity should give rise to objective rational discourse and criticism and not indiscriminate tolerance of every possible moral practice. Bioethics must remain a normative discipline that is characterized by rigorous argumentation.
Necessity of observing patient’s rights: a survey on the attitudes of patients, nurses and physicians
Studying the situation of observance of patients’ rights and interaction of those individuals who provide and/or receive health services are regarded as the most significant and salient parameters of qualitative evaluation of health services.
The main aim of this study is to compare the attitudes of patients as recipients of healthcare services with those of physicians and nurses as representatives of healthcare providers regarding the necessity of observance of various aspects of patients’ rights in three hospitals selected as representing the three models of providing medical service (teaching, private and public).
This was a cross-sectional descriptive analytical study and the data were gathered using a questionnaire. Researchers helped the patients to fill in the questionnaire through interviewing and the physicians and nurses filled in their own questionnaires.
The field consisted of three hospitals (a teaching general hospital, a private hospital and a public general one) all located in Tehran. The questionnaires included a set of general questions regarding demographic information and 21 questions about the necessity of observance of patients’ rights. They were filled in by the interviewer for 143 patients and, after being sent to other groups, 143 nurses (response rate = 61.3%) and 82 physicians (response rate = 27.5%) filled them in. The criterion for necessity of each right was measured according to the Likert Scale [from 0 (not necessary) to 10 (absolutely necessary]. The data were analyzed using SPSS 11.5 software. Given the abnormal distribution of the data, non-parametrical tests were used.
The results of this study showed that all of the study groups agreed with the necessity of almost all aspects of patients’ rights and the highest level of disagreement between groups was related to patients’ right of access to information and right of choosing provision provider and deciding on treatment plan. However, these disagreements were not significant altogether.
According to the results, it seems that healthcare providers, especially physicians, should be better familiarized with patients’ right of access to information and right of choosing and deciding. Based on the disagreement between the attitudes of the patients and physicians in this study, it seems that the patients had a higher level of expectations concerning their rights compared to physicians.
Gout, a medical condition of acute inflammatory joint disorders, has been recognized from the antiquity. However, the name of Rhazes, a Persian historic physician who has described the etiology, signs, symptoms, epidemiology, treatment and prevention of this malady more than a thousand year ago, hasn't been taken into consideration appropriately. In this article, we studied and reported several chapters of Alhawi which is considered the most important Rhazes's medical textbook, focussing on his hypotheses because he has described this disease more manifestly. His original manuscripts are originally written in Arabic and they hadn't been translated to Persian until 1998. We intend to compare Rhazes opinions about gout with those of the literature in the area of rheumatology. According to our findings, Rhazes documented the symptoms of gout and categorized them scientifically. His insights about the treatment of gout, side effects of pharmacotherapy and management of the patients are so interesting and wonderful. Generally most of Rhazes viewpoints about gout are correct and compatible with recent findings. More investigation on Rhazes' viewpoints can guide us to propose more reliable hypothesis and schematize cost effective studies by delving into past medical records.
Neglecting patients' rights in a health care system can give rise to a challenging situation between health care providers and patients. The purpose of this study was to compare the views of patients as recipients of healthcare services and physicians and nurses, as healthcare providers, regarding the unsatisfied demands of different aspects of patients' rights in 3 hospitals representing three types of settings (teaching, private, and public).
This was a cross-sectional descriptive analytical study. Data were gathered using a questionnaire which was filled out by an interviewer for the patients and self administered for nurses and physicians. The research venues were one general teaching hospital, one first class private hospital, and one non-teaching public hospital, and all 3 were in Tehran. The questionnaire consisted of some general questions about respondents' demographics, and 21 questions concerning the importance of patients' rights, and how well patients' rights were observed. Overall, 143 patients, 143 nurses (response rate: 61%) and 82 physicians (response rate: 27.5%) completed the questionnaire.
The degrees of unsatisfied demands were different depending on the various views within each group regarding the degree of importance and observance of each right, which was measured by the Likert's scale ranging from 0.0 (no importance, no observance) to 10.0 (absolutely important, full observance). Concerning the non-normal distribution, the collected data were analyzed by non-parametric tests using the SPSS software (ver. 11.5).
Results showed that the studied groups had significantly different views. The most prominent issue concerned patients' to make an informed decision, which was particularly unsatisfactory in the teaching hospital. The results of this research indicate that healthcare providers, especially physicians, need to be informed to show more respect for patients' rights in terms of access to clinical information and making decisions. The results demonstrated that there was a significant difference between the opinions of patients and health care providers regarding the extent of unsatisfied demands of patients' rights. According to the patients, the level of unsatisfied demands of these rights is far higher than that expressed by physicians.
Assessment of patients' views about the observance of patients' rights in the health system is of great importance for evaluation of such systems. Comparing views of patients (recipients of health services) and physicians and nurses (health care providers) regarding the observance of various aspects of patients' rights at three hospitals representing three models of medical service provision (teaching, private, and public) is the main objective of this study.
This was a cross-sectional descriptive and analytical study, and the information needed was gathered through questionnaires. They were filled out by an interviewer for patients, but self administered by physicians and nurses. The field of study consisted of three hospitals including a general teaching hospital, a private hospital, and a public hospital, all located in Tehran. The questionnaires contained some general questions regarding demographic information and 21 questions concerning the necessity of observing patient's rights. The questionnaires were initially filled out by a total of 143 patients, and then consigned to 143 nurses (response rate = 61.3%) and 82 physicians (response rate = 27.5%) to be completed. The rate of observance of each right was measured on a Likert scale ranging from zero (non-observance) to 10 (full observance). Considering abnormal distribution of the information, it was analyzed with non-parametrical tests using SPSS 11.5 software package.
The results of this study showed that the study groups had different views about how well different aspects of patients' rights were observed. The highest level of disagreement was related to the right of choosing and deciding by the patients, which was not satisfactory in the teaching hospital.
According to the results, it seems that healthcare providers, especially physicians, should be better informed of patients' right of access to information and right of choosing and deciding. Based on the observed disagreement between the views of the patients and those of the physicians in the present study, it can be asserted that the patients thought that the level of observance of these rights was lower in comparison with what the physicians thought.
The high turnover of nurses has become a universal issue. The manner in which nurses view their organization's ethical climate has direct bearing on their job satisfaction. There is little empirical evidence confirming a relationship between different sorts of ethical climate within organizations and job satisfaction in Iran.
The aim of this study was to determine the correlation between nurses' perception of ethical climate and job satisfaction in the Teaching Hospital of Kerman University of Medical Sciences.
A descriptive analytical design was used in this study. The sample consisted of 275 nurses working in 4 hospitals affiliated with the Kerman University of Medical Sciences. The instruments used in this study included a demographic questionnaire, Ethical Climate Questionnaire (ECQ), and Job Satisfaction Scale (JS). Data analysis was carried out using Pearson's correlation, one-way ANOVA, T-test and descriptive statistic through Statistical Package for Social Science (SPSS), version 16.
Across the five dimensions of ECQ the highest mean score pertained to professionalism (mean = 13.45±3.68), followed by rules climate (mean = 13.41±4.01), caring climate (mean = 12.92±3.95), independence climate (mean = 11.35±3.88), and instrumental climate (mean = 8.93±2.95). The results showed a positive correlation among ethical climate type of: professionalism (p=0.001), rules (p=0.045), caring (p=0.000), independence (p=0.000) with job satisfaction, and no correlation was found between instrumental climate and job satisfaction.
The result of this research indicated a positive correlation among professionalism, caring, rules, independence climate and job satisfaction. Therefore managers of hospitals can promote nurses' job satisfaction by providing ethics training programs that establish a working team and a culture that strengthens team spirit among nurses.
Organizational behaviors are commonly acknowledged as fundamentals of organizational life that strongly influence both formal and informal organizational processes, interpersonal relationships, work environments, and pay and promotion policies. The current study aims to investigate political behavior tendencies among employees of Tehran University of Medical Sciences (TUMS).
This cross-sectional, descriptive and analytical study was conducted on 810 TUMS employees at the headquarters of the Tehran University of Medical Sciences, Iran during 2010-2011. The research tool for data collection was a researcher-tailored questionnaire on political behaviors. The validity of the questionnaire was confirmed by seven management professors, and its reliability was tested by a pilot study using test-retest method which yielded a Cronbach's alpha coefficient of 0.71. The respondents were asked to fill the questionnaire and express their perceptions and tendencies to engage in organizational behaviors. The collected data was read to and analyzed by IBM SPSS environment and correlation analytical methods.
Overall, 729 respondents filled and returned the questionnaire yielding a response rate of 90%. Most of the respondents indicated that they had no tendency to engage in political behavior. Moreover, we found that there was a significant correlation between sex, higher education degrees, tenure and the employees' tendency to engage in political behavior.
The participants were not overtly political because of their personal belief, ethical values, and personal characters. Non-political and overtly political employees are both prejudicial for all organizations. Therefore, it seems that the medium rate of good political behavior is vital and prevalent in Iranian organizations.
Previous studies have traced a relationship between the attachment styles of nurses working as in healthcare teams and their empathy which is an essential characteristic required of people concerned with managing relationships, supporting social events, and improving the of nurse-patient relationships. Since determining the effective variables in the quality of nurse-patient relationships in clinical settings is of paramount importance, current investigation is an effort to examine the relationship between attachment styles and empathy in nursing students.
260 university students (male = 130 and female = 130) were chosen as the sample of the study based upon specific inclusion criteria. All participants completed the Attachment Style Questionnaire (ASQ) and the Interpersonal Reactivity Index (IRI). Data was collected and analyzed using Pearson correlation coefficient and regression analysis with SPSS (v.18).
The results showed that secure and insecure attachment styles have significant positive and negative correlation with empathy respectively. Based on the results of regression analysis, it was shown that secure attachment style is predicting 53% of the variance empathy variable, whereas insecure attachment styles are explaining up to 76% of the variance empathy variable collectively.
The increase of attention to instructions that focus on empathetic relationships with patients and that are based upon the secure attachment style can result in positive changes in the area of nurse-patient relations and in increasing attention to medical ethics. Findings are consistent with prediction derived from attachment theory and add to our understanding of relationship between attachment styles with empathy in nursing students. The meaning and limitations of this study and suggestions for further research are also discussed.