Background: One of the main concerns in critical care units is the development of humanistic approaches. In this regard, recognizing the factors affecting humanistic nursing can contribute to humanizing nursing care in these units. Objective: The objective was to recognize the influential factors of humanistic nursing in critical care units. Research design: This qualitative study was carried out using a phenomenology method. Thirty-nine in-depth unstructured interviews were performed. The data were analyzed using the phenomenological nursology approach. To guarantee trustworthiness, prolonged (...) engagement, member check, triangulation of resources, and maximum variation sampling were used. Participants and research context: Purposeful sampling was employed to select 10 nurses, 8 patients, and 4 patient’s relatives from the intensive care unit and critical care unit departments. Ethical consideration: This study was approved by the ethics committee of Lorestan University of Medical Sciences with the code of LUMS.REC.1395.121. Finding: The participants’ experiences were reflected in the following three main concepts: moral, educational, and existential nature of the two humans involved in the interaction; maintenance of the nurses’ dignity; and interactions in the cultural and social context. Discussion: The nurse and patient, organizational environment, and society give rise to a set of intertwined characteristics which influence the realization of humanistic nursing. By affecting the nurses’ educational background and maintaining their dignity, the atmosphere of the hospital and cultural readiness of the society pave the way for delivering the humanistic care. (shrink)

This qualitative study describes ethical challenges faced by Iranian nurses in the process of pain management in surgical units. To address this issue, semistructured interviews were conducted with 26 nurses working in surgery units in three large university hospitals in Tehran. An analysis of the transcripts revealed three main categories: institutional limitations; nurses' proximity to and involvement with pain and suffering; and nurses' fallibility. Specific themes identified within the categories were: insufficient resources, medical hierarchy; difficulties with believing patients' complaints regarding (...) pain and suffering; and experiencing the consequences of poor judgments. Our findings lead us to conclude that, as nurses are much closer to patients' pain and suffering than other health professionals, being aware of their ethical problems, and being able to reflect on them and discuss and learn from them, will reduce the burden of the ethical challenges faced. The findings will help nurses in other countries to devise suitable ways to reduce the ethical burdens they bear in their daily practice. (shrink)

Commercial advertisements are considered informative discourse, whereas the manipulative effects of their verbal and visual strategies have been ignored. According to van Dijk (2006), manipulation in mass media is performed by drawing the audience’s attention to information A rather than to B, by providing irrelevant or incomplete information, and by playing emotional games. Since the analysis of manipulative effects of semiotic features used in advertisements is scarce, the present research project investigates the potential manipulative effects of semiotic aspects used in (...) Persian printed advertisements, and the influence of the Iranian sociocultural context on designing these visual messages. A corpus of 160 Persian printed advertisements was analyzed; the results revealed that their semiotic features, especially those which are meaningful based on the sociocultural context of Iran, tend to inculcate relevant information and meaning in consumers, in order to control their minds and subsequently their purchases. The findings of this study include six theme-based categories of semiotic manipulation strategies: Celebrity images, Creative images, Punctuation marks, Natural images, Seasonal images, and Cultural images. The results are discussed along the lines of research methodology in discourse and semiotic analysis. (shrink)

Scott Soames argues that consideration of the practice of legal judgement gives us good reason to favor the partial-definition/context-sensitive theory of vagueness against epistemicism. Despite the fact that the value of power-delegation through vagueness is evidenced in practice, Soames says, epistemicism cannot account for it theoretically, while the partial-definition/context-sensitive theory is capable of it. In this paper, I examine the two possible arguments against epistemicism that can be extracted from Soames’s account: (i) an argument based on unknown obligations, and (ii) (...) an argument based on power-delegation through vagueness. The first argument tries to convince us that, as based on epistemicism, the law has already decided the borderline cases, so that judges have obligatory decisions even in such cases: therefore epistemicism is inconsistent with the discretion of judges in borderline cases. I show that even if we sympathize with Soames’s intuitions concerning the legal practice, the argument he offers is not conclusive since it is either invalid, unsound, or paradoxical. The second argument holds that only the gaps which the partial-definition/context-sensitive theory predicts give judges the possibility of lawmaking in borderline cases. However, by categorizing the vague laws as imperfect laws, the judges can claim the right of lawmaking without any need to refer to gaps in the law. By neutralizing these arguments, I argue that epistemicism is able to explain the phenomena just as well as the partial-definition/context-sensitive theory. (shrink)

Dignity is a human right and a base for human health. This right must be observed in work environments as a moral obligation. This qualitative study aimed to understand nurses’ experiences of violation of their dignity at work and to explore its dimensions. The participants were 15 nurses working in two hospitals in Tehran. The data were collected through 26 unstructured interviews and analyzed using content analysis. The dimensions of violation were ‘irreverence’, including experiences of abuse and violence, humiliation, and (...) being ignored; ‘coercion and violation of autonomy’, consisting of the control of relationships, lack of privacy, rigidness, and imposition; ‘ignoring professional and scientific ability’, indicating impossibilities in applying nurses’ knowledge; and ‘denying the value of nurse/care’, being the theme that verified the dominance of treatment/cure and lack of recognition of care value. Health systems should take the promotion of the nurses’ dignity into account through providing a dignified work environment. (shrink)

This paper proposes to present a novel method of generating cryptographic dynamic substitution-boxes, which makes use of the combined effect of discrete hyperchaos mapping and algebraic group theory. Firstly, an improved 2D hyperchaotic map is proposed, which consists of better dynamical behaviour in terms of large Lyapunov exponents, excellent bifurcation, phase attractor, high entropy, and unpredictability. Secondly, a hyperchaotic key-dependent substitution-box generation process is designed, which is based on the bijectivity-preserving effect of multiplication with permutation matrix to obtain satisfactory configuration (...) of substitution-box matrix over the enormously large problem space of 256!. Lastly, the security strength of obtained S-box is further elevated through the action of proposed algebraic group structure. The standard set of performance parameters such as nonlinearity, strict avalanche criterion, bits independent criterion, differential uniformity, and linear approximation probability is quantified to assess the security and robustness of proposed S-box. The simulation and comparison results demonstrate the effectiveness of proposed method for the construction of cryptographically sound S-boxes. (shrink)

Journal of Applied Philosophy, EarlyView.

Dignity is the most fundamental right of every human being, patients in particular. Despite being a fairly disputed concept, dignity is a multidimensional issue, the interpretation of which is affected by a multitude of factors. Semistructured interviews and observation data from 35 patients, their companions, and nurses were performed to highlight their views with regard to patients? dignity in health care centers. Although findings reveal that nearly all patients felt that their dignity had been violated, there is a considerable difference (...) between participants? viewpoints of dignity. Interactions among participants can increase their awareness of dignity and may lead to its maintenance. (shrink)

Next SectionPurpose The importance of recognising patient dignity has been realised in recent years. Despite being a central phenomenon in medicine, dignity is a controversial concept, the definition of which in healthcare centres is influenced by a multitude of factors. The aim of this study was to explore the perspective of Iranian patients on respect for their dignity in healthcare centres. Methods With the use of purposeful sampling, 20 patients were interviewed over an 11-month period in three educational hospitals affiliated (...) with the government. They were questioned about experiences related to respect for their dignity during their hospital encounter. Data were processed by qualitative content analysis. Results Data analysis identified nine categories and four themes. Respondents expressed their expectations and attitudes about dignity by the following themes: seeking a haven; disrespecting privacy; communicating in a vacuum; and disregard for secondary caregivers. They described how respect for their privacy, effective communication, access to facilities, and a regard for the requirements of their companions made them feel that their dignity had been conserved. Conclusions The findings indicate that almost no patient is satisfied with the quality of services with respect to maintenance of their dignity. Regardless of their hospital location and state of health, most participants had common complaints. These findings agree with the literature and confirm that grounds should be provided for conserving dignity in the healthcare system. To reach this goal, healthcare professionals should be aware of the factors that violate or preserve dignity from the patient's perspective. (shrink)

BackgroundDiscrimination in health care is an international challenge and a serious obstacle to justice and equality in health.Research objectiveThe purpose of this study was to design a grounded theory of discrimination in health care based on the experiences and perceptions of Iranian healthcare providers and patients.Research designThis qualitative study was conducted using by the grounded theory method.Participants and research contextData were collected through semi-structured interviews with 18 healthcare providers including 11 nurses, two physicians, two nurse’s assistants, and three patients in (...) two general hospitals in Tehran, Iran. Participants were selected through purposeful sampling and analyzed simultaneously using the Corbin and Strauss (2015) approach.Ethical considerationsThe study was approved by the Research Ethics Committee of the University of Social Welfare and Rehabilitation Sciences (Ethics code: IR.USWR.REC.1398.023). Also, after explaining the objectives of the study, all the participants completed and signed the written consent form.FindingsThe “culture of discrimination” was the study’s core category, reflecting the nature of discrimination in health care. The theory of “culture of discrimination in health care” is the result of five main categories: “individual social stimuli,” “culture of discrimination,” “unintentional discrimination,” “conflict with discrimination,” and “dissatisfaction with discriminatory behavior.” These categories cover the underlying factors, strategies, and outcomes of the discrimination process in health care.DiscussionThe results of the study showed that nurses and other health care providers experience unintentional discrimination. Unintentional discrimination refers to discriminatory behaviors and practices of health care providers.ConclusionThe theory of culture of discrimination in health care can be used as a practical guide to describe and understand the role of health care providers, especially nurses. Further studies with a quantitative approach to applying this theory in medical settings are recommended. (shrink)

Background:Despite the growing importance of spiritual care, the delivery of spiritual care is still an area of disagreement among healthcare providers.Objective:To develop a grounded theory about spiritual care delivery based on Iranian nurses’ perceptions and experiences.A grounded theory approach:A qualitative study using the grounded theory approach.Participants and research context:Data were collected through holding 27 interviews with 25 participants. The study setting was the Imam Khomeini Hospital Complex. Sampling was started purposively and continued theoretically. Data analysis was performed by the method (...) proposed by Strauss and Corbin.Ethical consideration:The study was approved by the Ethics Committee of Tarbiat Modares University and the agreement of the administrators of the study setting was got before starting the study.Results:The core category of the study was “Trust building” which reflected the nature of spiritual care delivery by nurses. Trust building was the result of eight main categories or strategies including creating a positive mentality at hospital admission, understanding patients in care circumstances, having a caring presence, adhering to care ethics, developing meaningful relationships, promoting positive thinking and energy, establishing effective communication with patients, and attempting to create a safe therapeutic environment. Poor interprofessional coordination negatively affected this process while living toward developing greater cognizance of divinity and adhering to the principles of professional ethics facilitated it. The outcome of the process was to gain a sense of partial psychological security.Conclusion:The “Trust building” theory can be used as a guide for describing and expanding nurses’ roles in spiritual care delivery, developing care documentation systems and clinical guidelines, and planning educational programs for nursing students and staff nurses. (shrink)

The autonomy of chronic patients in Iranian hospitals is challenged by impaired functioning resulting from chronic illness, a negative image in society, and effects related to hospitalization. Comprehensive interviews and observations of 34 patients, nurses, and physicians were performed to assess the autonomy of chronic patients in Iran. Conceptualization, constant comparison, and the combination of data resulted in the identification of 5 main categories related to autonomy: welcoming paternalism, self-expression, self-proof, shared decision making, and self-determination. Authority scrambling was a central (...) category describing chronic patients’ perceptions of their autonomy during hospitalization. These patients sought to maintain their independence despite serious threats to their autonomy. (shrink)