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Background: Many children with cancer are hospitalised before the end of life and need special care. To improve the delivery of care for children, it is necessary to understand the insights, emotions and feelings of nurses. Aim: This study aimed to explore the lived experiences of nurses providing end-of-life care for children with cancer. Methods: A phenomenological hermeneutic approach was used to analyse the experience of 14 oncology nurses working in a children's hospital who were caring for children with cancer. Findings: Three themes and seven subthemes emerged from the analysis. The three main themes were: pain management (relieving physical pain and reducing the mental pain of the child and family); respect-based care (for the values and beliefs of the child and family and honesty in providing information to them); and negative reflections of care (psychological trauma, cultural challenges and futile care). Conclusion: The results of the present study showed that, despite the problems experienced by the nurses, they were still trying to provide life-sustaining care for children with cancer.

This study introduces an innovative design for a palliative care program by nursing students in an internship in a neonatal intensive care unit. An embedded mixed-method approach simultaneously collected quantitative and qualitative data. Themes identified were supporting and encouraging palliative care, changing the nursing culture, and promoting quality of care. Teaching palliative care during this internship rotation helped promote quality care by the students, with positive results for infants and their families, and empowerment of the students through increased knowledge and awareness of human needs for high-quality nursing care.

Background & Aims: Epidemiological changes have made chronic diseases increasingly important. Hypertension is also known as a chronic disease. The high prevalence of hypertension has made the disease a significant health problem in communities. Spiritual health has been proposed as one of the health indicators and predictors of self-care in chronic diseases. This study aimed to determine the relationship between spiritual health and adherence to the treatment regimen in patients with hypertension. Materials & Methods: In this descriptive correlational study, 121 patients with hypertension were selected by continuous sampling method from cardiac clinics affiliated with Iran University of Medical Sciences, Iran, in 2020. The study data were collected through demographic information form and validated Ellison and Paloutzian spiritual health and Hil-Bone diet adherence questionnaires. For data analysis, we performed the statistical tests of the Spearman, independent t test, Chi-square, and analysis of variance in SPSS version 16. Results: This study shows a significant and negative relationship between spiritual health and adherence to the treatment regimen in patients with hypertension (P=0.001, r=-0.05). Conclusion: As spiritual health increases, adherence to the treatment regimen in patients with hypertension decreases. Spiritual health in this group of patients leads to less adherence to the treatment regimen.

Background:: Women with breast cancer in Iran face challenges requiring support. Yet the provision of support may have changed during the coronavirus disease 2019 (COVID-19) pandemic Objective:: The aim of the present study was to explore the perceptions of women with breast cancer about the support they received during the COVID-19 pandemic Methods:: This study was qualitative in nature. Semi-structured interviews were conducted with Iranian women with breast cancer. The interviews were transcribed verbatim and analysed via conventional content analysis. Results:: Participants (n=33) were Iranian women aged 29-58 years. All women included were married and were working in the role of a housewife. Women's perceptions of breast cancer during the COVID-19 pandemic of support were identified under two main categories; Constructive support and Lack of support. Sub-categories related to constructive support included receiving support from family, peers, and nurses. Sub-categories related to lack of support included a perceived lack of spousal and sociocultural support. Conclusion:: Anti-stigma interventions (AS interventions) are suggested to increase both spousal and sociocultural support in this context. Further studies may usefully be conducted with the participation of Iranian women's family members in order to gain a deeper understanding of the support received and required by Iranian women with breast cancer during the COVID-19 pandemic and beyond.

Introduction: Previous studies have confirmed the high prevalence of emotional eating in obese women and its relationship with weight gain. Given that eating behavior is formed since early childhood in interaction with parents, it is essential to study the parental role in obese women's emotional eating experiences. Accordingly, the present study aimed to describe and interpret the parental role in the emotional eating experiences of young obese Iranian women. Methods: The participants in this qualitative study that was conducted using a hermeneutic phenomenological approach were 17 young women with a body mass index (BMI) of 30 and above. The women were selected using purposive sampling with maximum variation. The data in this study were collected through semi-structured in-depth interviews that were conducted individually and face to face. Data analysis was performed using the seven-step analysis method proposed by Dickelman et al. Results: The main theme revealed from the data analysis was “parenting experiences”. This theme was further categorized into 6 subthemes including “the insecure attachment symbol”, “alleviation of psychological distress caused by parents”, “misunderstanding of food as a magic parenting wand”, “over-providing food security for the child”, “contradiction in fostering overeating behavior with destructive blaming”, and “child learning”. Conclusion: The subthemes that emerged in this study reflect various dimensions of the parental role in the emotional eating of young obese Iranian women. The results of this study provide deep insights into planning psychotherapy interventions for emotional eating and weight management, especially in women.

Compassion is a basic approach to medical practice and is the core component of health care. The purpose of the present study was to explore nurses' perceptions of compassion-based care (CBC) for COVID-19 patients. In this qualitative study, the participants were selected using purposeful sampling. Individual and semi-structured interviews were conducted with 25 nurses, and conventional content analysis was used to categorize the data. In the care of COVID-19 patients, CBC consisted of three categories including pro-social behaviors, paying attention to the beliefs and values ​​of patients, and concern for family members. The first category had three subcategories including empathy, altruism, and helping in critical situations. The second category included the subcategories of the spiritual approach to care and respect for cultural aspects. The third category, concern for family members, had one subcategory: the need to consider the patient's family. Our findings may help to develop a comprehensive model in COVID-19 care according to which, in addition to routine patient care, nurses will consider concepts such as empathy, altruism, helping in critical situations, spirituality, cultural values, ​​and the family’s needs at the end of the patient's life.

Cancer is a growing problem in the world, meanwhile, the issue of providing care for cancer patients has been associated with multiple ethical challenges (ECs). This study aimed to investigate and explain the nurses' perceptions of ECs in caring for cancer patients in Iran. In this qualitative study, the participants consisted of 25 nurses working in cancer wards. The typical EC that the nurses are faced with while caring for cancer patients included categories such as “creating moral distresses” and “threat to patient's autonomy.” The category of creating moral distress consisted of two subcategories, including “faulty communication process” and “provision of futile care.” Also, the category of “threat to patient's autonomy” included subcategories of “individual factors” and “organizational factors.” Since disregarding ethical principles in caring for patients with cancer will result in greater ECs in this respect, the healthcare administrators should make more effort to help establish transparent rules, and develop protocols needed to identify and eliminate these ECs.

This study was conducted with the aim to determine the effect of a stress management program on the response to stress by nurses working in neonatal intensive care units. This quasi-experimental study was conducted on 70 nurses in Iran. The nurses were assigned to the 2 groups: experimental and control groups, with each group comprising 35 participants. The McNamara education program was used for nurses in the experimental group. The response to stress in both groups was reviewed pre- and postintervention and 8 weeks after the intervention using the Stress Response Inventory. The 2 groups had no significant differences in terms of stress response preintervention (t = 0.668, P = .506). The mean scores in the experimental group were higher preintervention than those obtained postintervention, and the difference between them was significant. These findings indicate that the program has led to stress reduction in the experimental group.

PROBLEM Mothers of children with autism spectrum disorders (ASD) experience higher levels of stress compared to mothers of typically developing children. This study identified mothers' perceptions of the stress caused by lifelong caregiving to a child with ASD. METHODS The current study was conducted in Iran using qualitative methods. In-depth, semi-structured interviews were conducted with twenty-seven mothers. Content analysis was used to analyze and categorize the data. FINDINGS The main categories included (1) psychological concerns and suffering and (2) sociocultural challenges. The first category consisted of two subcategories, including disruption in mother-child relationships and fears and worries. Also, the second category included subcategories of cultural constraints and lack of social support. CONCLUSIONS In this study, the mothers of autistic children experienced psychosocial pain. Identifying the stressors for these mothers could lead to appropriate planning to provide psychological, social, and cultural support for them in Iranian society.

Introduction Violence against women occurs all over the world; it is a phenomenon that is considered an invasion of human rights. The most common form of this phenomenon is domestic violence (DV). Aim The purpose of this study was to explore the health-related perceptions of married women in Iran who have experienced DV. Method This qualitative study was carried out using conventional content analysis method. In total, a purposive sample of 27 women who had been subjected to violence by their spouses agreed to participate in this study. Individual, in-depth, and semistructured interviews were conducted. Findings Three main categories emerged from the data: (a) perceptions related to physical health (including non-sex-organ injuries and sex organ injuries), (b) perceptions related to psychological health (including fear, concern, and the creation of challenges), and (c) perceptions related to sociocultural health (specifically social health and cultural health). Conclusion In Iran, DV threatens women's health and is influenced by personal, familial, social, and cultural factors. Nurses should consider various aspects of physical, psychological, and sociocultural health when caring for women who have experienced DV. Social and cultural-based interventions are needed to address negative attitudes, stigma, and false beliefs that sanction DV in Iran.

Nurses face several challenges in providing care for patients with coronavirus disease in 2019 (COVID-19). The study aimed to explain the nurses' perception of ethical challenges in this regard. The qualitative study was carried out using a content analysis method. Individual and semi-structured interviews were conducted with 24 nurses. Inductive content analysis was used to categorize the data. Nurses' narratives indicated that ethical challenges in caring for patients with COVID-19 included threats to professional values ​​and the absence of a holistic COVID-19 care approach. The first category was subcategorized into the risk of declining quality of patient care and a stigmatized public image about COVID-19 care. The second category was divided into poor spiritual care, poor compassionate care, and lack of family-centered care. Health care managers must develop protocols for nurses that address these issues to alleviate the ethical challenges of COVID-19 care.

Patient experience and satisfaction are often used to evaluate the quality of care provided in emergency departments (EDs). Several studies have evaluated the experiences of patients and their family members in EDs internationally, but few studies have investigated the experiences of those attending EDs in Iran.To investigate patients and family members' experiences of care in one ED in Iran.Semi-structured interviews were conducted with 17 patients and ten family members in one ED in Tehran, Iran. A qualitative content analysis approach was used to analyse the data.Three themes emerged from the data: quality of nursing care; satisfaction with medical care and waiting times; and adequate diagnostic testing and equipment. Participants reported several issues in relation to the care provided in the ED, including a lack of attention from nursing staff, long waiting times, delays in symptom management, and family members' involvement in care to compensate for high staff workload and overcrowding.The findings of this study demonstrate that the most important determinants of patients and family members' experiences in EDs are the quality of nursing and medical care, the length of waiting times, and adequate diagnostic testing and equipment. While it may be beneficial to involve family members in patient care, regular communication with them is essential to explain challenging situations that may affect the quality of ED care, such as low staff levels.

BackgroundClinical field is an important part of nursing education. Insufficiency in providing opportunities for learning practically not only gives rise to adverse consequences for students, but also affects educational programs and nursing profession.ObjectivesThe aim of this study was to investigate nursing students’ attitudes toward and satisfaction with concept map (CM).MethodsThe present research is an embedded study. The qualitative stage included 18 nursing students of Shahrekord University of Medical Sciences in their 6th semester who were selected through purposive sampling. Content analysis was used for data analysis. Semi-structured individual interviews were conducted for data collection. The quantitative stage was implemented simultaneously with distribution of the researcher-made questionnaires among 48 students.ResultsBased on findings, four categories were obtained: competency of CM method, managing and organizing measures, promoting care services, and increasing critical thinking. In the quantitative stage, data were gathered by obtaining history from parents or children; 31.2% - 68.8% agree with the quality of CM. Required information about disease was collected from parents and patient; 39.6% - 58.3% agree and 2.1% disagree. Different data from various sources (such as parents and children) were related; 43.7% - 54.2% agree and 2.1% disagree.ConclusionsConsidering that nursing process is now widely used in Iran at B.Sc. and M.Sc. levels, integrating CM to nursing process can be useful in nursing education.

Background: The main goal of nursing profession is to provide people’s health that cannot be achieved only through the use of scientific methods, and it is essential to pay special attention to spirituality and ethics for its attainment. The current study aimed at determining the effect of spirituality training on the moral sensitivity of nursing students. Methods: The current quasi-experimental study was conducted on 70 nursing students of the fourth and higher semesters (35 in each group) from Iran University of Medical Sciences selected by stratified sampling proportion to size method. Pre-test was administered to both groups; then the intervention group attended six training sessions, once a week each for one hour, and the post-test was administered to the two groups one month after the end of the intervention. Data were collected by demographic characteristics and the Korean Version of the Moral Sensitivity Questionnaire (K-MSQ), and analyzed by descriptive statistics including frequency distribution, mean and standard d deviation, and inferential statistics including Chi-square, Fisher test, t-test, paired t-test and analysis of covariance using SPSS V. 22. Results: The study results showed a significant difference between the moral sensitivity score of the intervention group before (4.07±0.53) and after (6.36±0.18) training (P

Cancer patients are confronted with different challenges. The purpose of current study was to explore Iranian cancer patients’ perceptions of these challenges. The study took a qualitative approach. Semi-structured interviews were held with 26 cancer patients in four university hospitals in Iran. Transcripts of the interviews underwent conventional content analysis, and categories emerged. The findings came under two major categories: psychological challenges and socio-cultural challenges. Psychological challenges had two subcategories: repressed wishes, and negative feelings. Socio-cultural challenges also had two subcategories: deteriorated relationships and work distress. Findings of the current study have potential to identify psychosocial challenges of cancer patients. These findings propose that psychological support is essential for them. Our results recommend that healthcare providers should work to remain sensitive to cancer patients’ challenges. There is a need for culture-based caring programs that are responsive to these patients.

Background and Aim: Human rights issues are based on human dignity. In this regard, Rights of the Child are considered by most of world's organizations and the scientific communities. Different types of child punishment are prohibited according to international conventions as well as national legislation. Historically, the first legal action to protect the rights of children was taken in 1924. Then rights of the child were briefly referred to in the Universal Declaration of Human Rights approved in 1948. Afterwards, United Nations General Assembly adopted, in a resolution, the draft prepared by the Human Rights Commission under the Declaration of the Rights of the Child in 1959. Iran is also among the states that signed and approved this declaration in 1993. However, child abuse has become a global problem and violence against children is one of the major challenges for health care providers that has endangered their physical and mental health and creates serious problems for them in the future. According to Islamic-Iranian culture, children counts as trust and the family is responsible to take care of them and strive for their excellence. This study aimed to analyze a case of child abuse in 2016 with an ethical approach. Materials and Methods: In this case study, a real case was referred to Tehran Children Medical Center in a monthly session of medical ethics, and the ethical analysis was later carried out based on ethical considerations raised by the medical staff and specialists in various fields. The case is a 5-year-old boy who was physically abused and was brought to the emergency department at Children's Medical Center in the morning due to the multiple fractures in different parts of the hands as well as cigarette burn caused by his parents in his hands and feet. According to his mother, she first noticed the swelling of the child's hands and referred to the physician. After exact examination and radiography of the child's body, physicians noticed old and new fractures in the arm, the elbow and wrist. The mother claimed that the child's fractures were caused by falling off the swings and slides. The physicians also saw scars of old wounds on the child's head, as the mother claimed, they were caused as a result of fractures associated with falls. The child's physical examination showed that part of the back and posterior side of the thigh of one of his legs was burned and traces of cigarette burns were seen on one of the child’s hands. Thus, physicians requested help from forensic experts. After examining the child's condition and examining him thoroughly, they, while acknowledging the child physical abuse, found that the victim underwent sexual harassment by some of the family boys. Ethical considerations : While observing honesty in the case report, attempts were made to respect the confidentiality of personal information of the case and his family. Findings : The mother has rejected the occurrence of physical child abuse in the form of for multiple fractures in areas of the hands and feet as well as multiple burn cases on the child's body and tried to mislead the medical staff. Investigations suggest that the child's father was responsible for the physical abuse, but the mother denied it. On the other hand, the mother tried to hide the child molestation by male relatives, and following this sexual abuse, the father also resorted to unethical manner and has punished the child rather than appeasing and supporting the child as well as denouncing the actions of those who commit this immoral act. Employees participating in the study, said that it is essential to examine all surfaces of the child's body in cases of child abuse. It is essential to monitor vital signs of the abused child, particularly his temperature because high temperature could be the reason for this accident and the fact that child abuse is committed through exposing him to high temperature. Physical examination must also include any examination of external genitalia and anal area. Considering that the sexual abuse is a hidden conduct, if there is suspicion of rape, the assessment is necessary. The child's privacy must be respected during a physical examination, and explanations should be provided regarding measures that are going to be taken. Considering the foregoing, obtaining thorough medical and social history, thorough examination of the naked body, lack of secrecy about sexual assault on children, respect for human dignity, honesty, privacy, confidentiality and privacy of information, respectful conduct, respect for the child's independence, neutrality and social protection are considered as the most important ethical considerations referred to in this analysis . Also, helping families adapt in order to prevent further incidents of child abuse is another finding of the present analysis. Conclusion: In this study, it was found that the families of abused children deny and distort the facts about the children instead of supporting them for some reasons. However, medical staffs are usually the first individuals who are informed about the child abuse, so it is logical to consider their views in order to find appropriate solutions to help these children. In this case, one can provide better education and adequate facilities to properly deal with this vulnerable group. The relevant authorities are also recommended to design a written programs based on the ethical considerations raised and submitted it to the medical centers of the country. Also, a group consisted of pediatrics and medical ethics, social workers, psychiatric nurse and psychiatrist should assess needs of abused children and their families and plan to solve their problems. The importance of this lies in the right to social protection and care of abused children and their families to improve their quality of life. Effective measures can be taken in this regard through awareness raising at different levels of society, training for child rearing free from any violence, amending the Child Protection Act, identifying vulnerable families and providing rehabilitation services for victims of child abuse and finally take steps to prevent this phenomenon. Please cite this article as: KadivarM, Mardani-Hamooleh M, MadaniM. Analysis of a case of child abuse with ethical approach. Med Ethics J 2017; 11(39): 27-35.

Background: Nursing education provides opportunities for students to create positive changes in a clinical setting. Thus, the use of modern teaching approaches such as concept mapping (CM) in nursing can be useful. The aim of this study is to explain nursing students’ perception of applying CM. Methods: This qualitative study reports CM in nursing students. Research areas were nursing colleges affiliated with the Iran and Tehran Universities of Medical Sciences. The participants comprised 25 nursing students who entered the research purposefully. Interviews were conducted face-to-face and semi-structured. All interviews were recorded, transcribed, reviewed, and the results were then extracted. Results: Two categories and four subcategories were identified. The categories included transcendence of meaningful learning and improvement clinical skills. Transcendence of meaningful learning had 2 subcategories: favorable perception and deliberative interpretation. Improvement of clinical skills also had 2 subcategories: reinforcing critical thinking and facilitating patient-centered care. Conclusion: Identifying nursing students’ perception of CM techniques can assist nursing education administrators in providing better education to students both theoretically and practically based on the use of the aforementioned technique.

Family-centered care (FCC) is one of the important elements of care in neonatal intensive care units (NICUs). The aim of this study was to understand the nurses' perception of FCC in NICUs. This qualitative study was performed using conventional content analysis. Participants in this study included 18 nurses who were selected by a purposeful method. Semistructured, in-depth and face-to-face interviews were conducted with the participants. All interviews were written down, reviewed, and analyzed. Two categories were identified after the data analysis: (1) prerequisite for providing FCC and (2) parents' participation. Prerequisite for providing FCC consisted of two subcategories namely suitable facilities and adequate personnel. Parents' participation included subcategories of parents: neonate's attachment and parents' training. Nurses' perception of FCC in NICUs can facilitate an appropriate condition for the participation of family members in the care of neonates.

Sexual health is one of element of general health that has great impact on the health of people with cancer. It has been expressed as a strategy to achieve the millennium development goals. In a review of literature, it was found that there are not qualitative researches on sexual health of individuals with cancer in the background of Iranian culture. The purpose of this study was to explore the perceptions of Iranian patients with cancer regarding sexual health. The study took a qualitative approach. Semi-structured interviews were held with 27 patients with cancer in Iran. Transcripts of the interviews underwent conventional content analysis, and categories emerged. The findings came under 4 major categories: physical health, psychological health, informational health, and socio-cultural health. The major categories also included several subcategories that were explained with the statements of patients. Findings of the current study have the potential to identify sexual health of individuals with cancer in the context of Iranian culture. Our results recommend that all health care providers should work to remain sensitive to sexual health of people with cancer.

Objective: Violence against women is a serious public health issue with negative effects, and it is a widespread problem. It affects the stability of the family. The purpose of this study was to explore the lived experiences of Iranian married women on violence against women. Study design: This qualitative research was carried out using a hermeneutic phenomenological approach. Participants and methods: We interviewed 11 married women to understand their experiences with regard to domestic violence against women. The seven-stage process of data analysis was used. Results: One constitutive pattern ‘violence against women as a cultural taboo’ and one associated theme, ‘Living in pain and torment’, were identified. Living in pain and torment also had two subcategories: living with fear and worry and living with sex inequality. Conclusion: The findings present a better understanding of the lived experiences of married women in Iran as regards violence against women. Nurses and other healthcare providers should be astute in identifying abused married women. They should evaluate the urgent physical, emotional, and sexual needs of these women.

Objective (s): Birth of a premature infant can create emotional crisis for the mothers and encounter them with a variety of problems. The purpose of this study was to identify the perception of mothers with premature infants hospitalized in the neonatal intensive care units (NICU). Methods: This was a qualitative study. In all 25 mothers were selected through purposive sampling, and a face-to-face semi structured interview was conducted with each participant. For the analysis of the data, the content analysis was applied containing verbatim transcription, reading interviews several times to obtain a sense of the whole, division of the text into meaning units and coding them, categorization of the codes into sub- categories and categories, and finally formulation of the latent content into categories. Results: In general, 2 categories and 5 sub-categories were identified. Categories encompass the followings: ‘living with tension, and ‘empowerment’. Living with tension has 2 sub-categories consisting of ‘fear of future’ and ‘damage to family’. Empowerment has 3 sub-categories consisting of ‘seeking for learning of unknowns’, ‘participation in treatment’ and ‘preparation for discharge’. Conclusion: Understanding of mothers’ premature infant’s perceptions can help health care team to provide better services.

Background and Objectives: Respecting privacy means respecting individuals, their dignity and independence. It is mandatory to observe privacy in health-care systems. Therefore, this study was carried out with the aim of expressing nursing students’ experience of privacy in pediatrics ward. Methods: This qualitative study was done inductively using content analysis method. The participants included 10 nursing students studying at 6th semester. The samples were selected purposefully. The semi-structured interview with each participant lasted for 30 minutes. Results: Based on data analysis obtained from students’ experiences three following major categories were obtained: The need to change pediatrics ward, lack of attention to observance of patient’s privacy and the necessity of paying attention to patient’s rights. Conclusion: The results of our study revealed that inappropriateness of ward atmosphere, ward crowdedness, training state of hospital are among factors which give rise to failure in observing privacy. Considering that maintaining privacy is one of fundamental human rights, it is also necessary to change attitudes of students and personnel and to train them in order to observe privacy. The academic staff and instructors should provide nursing and medical students with required trainings in observing privacy.