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 qualitative research study with a content analysis approach aimed to explore families’ experiences of an organ donation request after brain death. Data were collected through 38 unstructured and in-depth interviews with 14 consenting families and 12 who declined to donate organs. A purposeful sampling process began in October 2009 and ended in October 2010. Data analysis reached 10 categories and two major themes were listed as: 1) serenity in eternal freedom; and 2) resentful grief. The central themes were peace (...) and honor versus doubt and regret. The findings indicated that the families faced with an organ donation request of a brain-dead loved one experienced a lasting effect long after the patient's demise regardless of their decision to donate or refusal to donate. In conclusion, this study highlights the importance of family support and follow-up in an efficient healthcare system aimed at developing trust with the families and providing comfort during and after the final decision. (shrink)

Nursing, a scientific and practical discipline, faces continuing challenges of finding new direction in order to decipher its core values and develop current ethical codes for nursing practice. In 2009–10, 28 nurses were purposely selected and interviewed using a semi-structured format in focus groups and individually. Thematic Content Analysis helped explore the perception of Iranian nurses on ethical values in patient care. Seven major themes emerged: respect for dignity, professional integrity, professional commitment, developing human relationships, justice, honesty, and promoting individuals (...) and the nursing profession. Iranian nurses revealed a unique and culture-based set of ethical values. This study found that Iranian nurses place a greater emphasis on preserving the dignity of those accompanying the patient and in showing regard for patients' religious beliefs in a gender appropriate environment. (shrink)

The formalist linguists are of the opinion that the literary language is formed by polishing and foregrounding the practiced slang. Many of this literary tricks used in foregrounding are categorized; but there exist some literary tricks that have not been dealt with and are not named or addressed in the available categories. The attempt is made in this study to find an answer to the questions that why has Mandanipour in his masterpiece, “Shargh-e Banafshe” achieved a superior language that is (...) outstanding among his colleagues of the same era and has become a model in advanced language for the writers to come based on adopting defamiliarization theory in the Leech foregrounding format? Assessing the language of this unique work indicates that in addition to introducing an innovation in the usual styles in contemporary writing and the themes he has allowed assimilation and metaphor and other obsolete styles in his language; and yet has used special literary tricks that have never been tried or tested before. This approach has pat language in story writing to a high position. (shrink)

The purpose of the present study was to compare differential functioning of Iranian English versus Persian teachers in responding to compliments and to investigate the possibility of sociolinguistic transmission of speech act of responding to compliments from English culture to native Iranian Persian speakers. Following Chen and Yang (2010), we hypothesized that exposure to English would affect the complimenting behavior of Persian speakers, leading to more acceptance of compliments compared to those with little or no exposure to English. Participants of (...) the study were 50 English teachers, regarded as “exposed-to-English” or E group, and 50 Persian teachers, considered as “unexposed-to-English” or U group. The participants’ age ranged from 20 to 35 and they were selected through non-randomized convenience sampling. A Discourse Completion Test (DCT) comprising eight complimenting situations was developed in two versions, i.e. English and Persian, in light of Mane’s (1983) taxonomy. The results revealed a significant difference in performance between groups and that Iranian English teachers’ Compliment Response (CR) behavior changed due to exposure to English and approached English culture. Further findings and implications are discussed in the paper. (shrink)

A many-valued modal logic, called linear abelian modal logic \(\rm {\mathbf{LK(A)}}\) is introduced as an extension of the abelian modal logic \(\rm \mathbf{K(A)}\). Abelian modal logic \(\rm \mathbf{K(A)}\) is the minimal modal extension of the logic of lattice-ordered abelian groups. The logic \(\rm \mathbf{LK(A)}\) is axiomatized by extending \(\rm \mathbf{K(A)}\) with the modal axiom schemas \(\Box(\varphi\vee\psi)\rightarrow(\Box\varphi\vee\Box\psi)\) and \((\Box\varphi\wedge\Box\psi)\rightarrow\Box(\varphi\wedge\psi)\). Completeness theorem with respect to algebraic semantics and a hypersequent calculus admitting cut-elimination are established. Finally, the correspondence between hypersequent calculi and axiomatization (...) is investigated. (shrink)

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)

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)

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)

Introduction: Maintaining dignity is one of patients is one of the main ethical responsibilities of caregivers. However, in many cases, the dignity of patients, especially autistic teenagers is not maintained. The extent to which dignity needs are met for this group within the Iranian care system is difficult to determine as dignity is an abstract concept, and there are few related research studies reported. Objectives: The objective of this study is to find out caregivers perspectives on dignity in teenagers with (...) autistic spectrum disorder. Research design: This study uses a qualitative research design. The data were collected through individual, semi-structured interviews and field notes developed during the interviews. In order to analyze the data, qualitative conventional content analysis was used. Participants and research context: In all, 16 professional caregivers for autistic teenagers working in public hospitals were recruited based on a targeted sampling method to reach data saturation from February 2016 to July 2017. Findings: The findings of this study were presented in three main themes, “privacy,” “respecting individual identity,” and “comprehensive support,” and 11 categories. Ethical consideration: This study’s protocol was approved by the Research Ethics Committee of medical universities located in Southeast of Iran and the required ethical principles were followed throughout. Discussion and conclusion: Based on the findings of this study from the perspective of caregivers, autistic teenagers need to be cared for and educated in a respectful environment where their privacy is maintained, their individual identities are respected, and they receive comprehensive familial, social, and financial support. These conditions would maintain the dignity of such teenagers and would result in appropriate behavioral outcomes. Therefore, it is suggested that a cultural, professional and institutional background in which all components of the autistic teenager’s dignity are protected and emphasized be provided. (shrink)

Introduction: Maintaining patient dignity in a caregiving environment is one of the most important moral responsibilities for caregivers. Nonetheless, there are vulnerable groups, specifically teenagers, who in their final stages of life are prone to their dignity being threatened. Moreover, dignity is an abstract concept and there is no studies done on teenagers’ dignity in the final stages of life available in Iran.Purpose: The purpose of this study is to describe the caregivers’ experiences regarding teenagers’ dignity in the final stages (...) of life.Research design: This study is a descriptive phenomenological qualitative research project. The data was collected using deep individual and semi-structured interviews as well as taking notes. The Colaizzi analysis method was used to analyze the data.Participants and research context: 22 caregivers working with teenagers in the final stages of life in a public health centers in Iran who had the criteria to enter the study were selected using a purposeful sampling method and invited to join the study from August 2018 to June 2019. The sampling continued until data saturation.Findings: The findings of the present study were presented in the form of three main themes including “private,” “respecting individual identity,” and “attention to teenagers’ needs” and an additional eight categories.Ethical Considerations: The study’s protocol was approved by the Research Ethics Committee of the Shiraz University of Medical Sciences and all ethical principles were followed throughout the study.Discussion and conclusion: Based on the present study from the caregivers’ point of view, teenagers in their final stages of life required to be cared for and taught in an environment that their privacy was maintained and their individual identity was respected as well as getting attention from the caregivers and companions. In such situations, the teenagers felt calm and their dignity was maintained; therefore, providing a cultural, professional, and organizational setting where all the components of maintaining dignity in teenagers are supported and prioritized is necessary. (shrink)

BackgroundBurn patients are among the most vulnerable groups of patients requiring principled ethical care. Caring for these patients often brings various ethical challenges for the members of the health care teams, especially nurses, which affect the clinical decisions made for these patients. A limited number of studies have addressed the ethical challenges of caring for burn patients for the responsible caregivers, so the present study attempted to identify these challenges. The present study aimed to explore the health professionals' experiences of (...) the ethical challenges during caring for burn patients.MethodsThis was a qualitative study with a descriptive, phenomenological design. 22 health professional practiced in public burn centers in Iran who met the inclusion criteria of the study were selected via purposeful sampling to participate in the study from June to August 2019. Data were collected using semi-structured, in-depth interviews with the individuals as well as field notes. Sampling was continued up to the data saturation. Thereafter, the collected data were analyzed using Colaizzi's method.ResultsThe findings of the study yielded 3 themes, including respect for the patient's privacy, respect for the patient's personal identity, and care challenges, as well as 9 categories.ConclusionThe findings of this study showed that the burn patients’ caregivers face some challenges in the domains of maintaining the patient's privacy, respecting the patient’s personal identity, and making the best clinical decision. Thus, providing the cultural, professional, and organizational requirements of meeting the challenges of caring for burn patients can consequently result in the caregivers’ inner peace and the improved performance. (shrink)

Games are among cultural manifestations of human communities which have continued to exist since the ancient times and developed during peaceful times; in the Qajar era, during the reign of Nasser-al-Din Shah, because relative peace and prosperity was brought about, the people, especially courtiers, showed great interest in games and spent some of their daily life on it. In this article we have attempted to present some of the angles and dimensions of a number of these games using the itineraries (...) of orientalists and histories and works of that period. In this regard, we have borne in mind time, venue, extensiveness, customs and the reflection of these games in literature and based on evidences demonstrated that Qajar era is one of the most prominent periods in Iranian history and culture regarding the diversity and colorfulness of these games. Skillfulness of game players, large bets, struggles and arguments between opponents, special formalities, etc., are all the criteria for the acceptability and popularity of games in this age, which have been put into consideration. (shrink)

Background Providing care to children with cancer is one of the most challenging areas of ethical care for nurses. Few studies have addressed nurses’ perception of the barriers to giving ethical care in oncology departments. Thus, it is essential that the ethical challenges in caregiving as perceived by oncology nurses be investigated. Objective The present study was conducted to investigate the ethical challenges as perceived by nurses in pediatric oncology units in the south of Iran. Research design The present study (...) is a qualitative work of research with a conventional content analysis design. Data were collected via individual semi-structured interviews. The collected data were analyzed using the qualitative content analysis method. Participants and research context The participants were 21 nurses from pediatric oncology units in state hospitals who were selected by purposeful sampling. Sampling continued until the data were saturated. The study lasted from April to October 2022. Findings Three main themes, promoting psychological safety in the children, respect for the dignity of the children, and expansion of support for families, and nine subthemes were extracted from the data. Ethical considerations The study’s protocol was approved by the Research Ethics Committee of the University of Medical Sciences and ethical principles were followed throughout the study. Discussion and conclusion From the nurses’ perspective, the major ethical challenges in providing ethical care in pediatric oncology units were reducing tension toward promoting the patients’ psychological safety, showing respect for the identity and dignity of the children with cancer, and expanding support of the patients’ families. By creating the right cultural and professional context and establishing proper protocols, healthcare policymakers and administrators can take effective steps toward eliminating the barriers to providing ethical care. (shrink)

This study examined the longitudinal associations among children’s direct aggression, prosocial behaviors, and peer group acceptance in middle childhood. Children’s co-occurring aggressive and prosocial behaviors were assessed in order to identify distinct trajectory subgroups. Subsequently, variations in the development in peer acceptance were examined for each of the identified subgroups. The sample consisted of 784 children who were ethnically and socioeconomically diverse who were followed longitudinally from Grades 1 to 4. Results revealed several distinct trajectory subgroups, including children who were (...) primarily aggressive or prosocial, as well as children who exhibited co-occurring aggression and prosocial behaviors. Comparing these subgroups, the use of co-occurring prosocial behaviors appeared to have some protective effect on aggressive children’s peer acceptance. However, aggression was nonetheless associated with lower peer acceptance. The findings provide insights pertaining to the heterogeneity among aggressive children, the protective effects of prosocial behaviors on peer acceptance, and the differential effects of moderate versus high aggression. (shrink)

Publication date: 26 January 2017 Source: Author: Abolfazl Mohammadi, Javad Momeni Angela Carter in her famous short story, The Bloody Chamber, depicts a protagonist whose identity seems to be a predetermined sign in a signifying loop from which she can make no escape. In the first part of our paper, we attempt to show how The protagonist’s ensuing psychological tension is aggravated by the conflict which she feels between her ideal ego and her ego-ideal and which leads her to (...) unrelenting introspection and interior dialogue with her existential states. Such interior dialogue provides the protagonist with an existential ground on which she empties all her life events of their presence by signifying them through Derridean Differance. Therefore, her interior dialogue results in non-identity in her subjectivization both in the realm of signs and of events. Then, we focus on the protaganist’s paradoxical urges spontaneously outflowed from within which, by resisting symbolization, provide her with the possibility of becoming what she thinks she has never been and allow for her moments of self-determination. Finally, we illustrate how such psychological odyssey takes shape in the Gothic setting which arouses, in Lacanian terminology, pre-symbolic tendencies and which involves the coincidence of Gothic horror with the horrors of social reality. (shrink)

The metaparadigm concept of person as a core emphasis for nursing theorizing has attracted considerable attention in western literature, but has received less attention in the context of eastern philosophical contexts. In this philosophical inquiry, we sought to clarify the concept of what it is to be a human being according to ideas deriving from Islamic tradition, drawing on concept analysis as general approach to advance an understanding of how nursing within an Islamic context might operationalize metaparadigm conceptualization. Specifically, we (...) considered person as human being on the basis of its definition, attributes/characteristics and boundaries to explore the anatomy of the concept in this context. Our analysis revealed that Islamic thought is relevant to two distinct understandings of the holistic concept of human being. Reciprocal interaction worldview organizes the dimensions of being human (cognitive, emotion, social and spiritual) into a whole. Simultaneous action worldview emphasizes that the human is a coherent and unified creature in harmony with the universe. In Islamic thought, these two worldviews are integrated and operate concurrently. Nurse–patient interactions arising from an integrated perspective that aligns both of these worldviews will allow for informed applications of knowledge to practice and enhanced patient care. (shrink)

The sixteenth-century Cossacks became the favourite topic of Ukrainian authors of the nineteenth century who dealt with national and individual identity issues. Nikolai Gogol, the celebrated Russian author who had Ukrainian origin and was born in a Cossack village, wrote the epic romance of Taras Bulba, which narrated the story of Cossacks and their struggle for preserving their independence. While the work has been previously studied under the light of postcolonial theoretical framework, using the concepts developed by Homi Bhabha to (...) scrutinize the situation and the destiny of the two main hybrid characters, Taras Bulba’s sons, takes a step further and reveals the deeply ingrained anxiety and ambivalence in the Cossack mentality. The article focuses on the two main hybrid characters who choose divergent paths upon encountering the conflict brought to them by the imperial power. (shrink)

We present a rooted hypersequent calculus for modal propositional logic S5. We show that all rules of this calculus are invertible and that the rules of weakening, contraction, and cut are admissible. Soundness and completeness are established as well.

Has the theory of rationality as ‘openness to criticism’ solved the problem of ‘rational belief in reason’? This is the main question the present article intends to address. I respond to this question by arguing that the justified true belief account of knowledge has prevented Karl Popper’s critical and William Bartley’s pan-critical rationalism from solving the problem of rational belief in reason. To elaborate this response, the article presents its arguments in three stages: First, it argues that the idea of (...) objective knowledge as justified true belief leads to the equation of objective knowledge with justification. Hence, if we base the theory of critical rationalism, as openness to criticism, upon such a conception of knowledge, our theory of rationality involves in infinite regress of proofs. Second, it argues that Popper describes critical rationalism as an ‘irrational attitude’ of openness to criticism because the rationalist cannot justify his belief in reason by argument or experience. Thus, since Popper assumes that ‘a belief in reason’ must be justified in order to be ‘rational’ he cannot lead to a solution for the problem of rational belief in reason. Third, it argues that, like Popper’s critical rationalism, Bartley’s pan-critical rationalism originates in the justified true belief account of knowledge, however, not because Bartley defines critical rationalism as irrational faith in reason, but because his theory does not tell us how an ‘open’ belief in reason is to be refuted logically. The reason for this failure is that Bartley uses Popper’s epistemology of science to define the conception of criticism. While Popper and Bartley are recognized as the non-justificationist philosophers of science and rationality, this article tries to reveal that the idea of objective knowledge as justified true belief has prevented them from showing how ‘a rational belief in reason’ can be defended by argument. The article also briefly shows the consequence of this study for a notable change in the logical foundations of science. (shrink)

Defining the Perian word, ‘Fotowat’ or ‘Chivalry’ is not an easy task; in the rite of ‘Fotowat’, before entering any profession, one must set one’s soul free and pay attention to the moral teaching...

Background: Nurses’ perceived organizational justice is one of the factors influencing their social responsibility and conscientiousness. Social responsibility and conscience are major requirements for providing high-quality and standardized care. Objective: The aim of the present study is to investigate the relationship of perceived organizational justice with work consciousness and the social responsibility of the nurses. Methods: The present cross-sectional study was performed on 380 nurses who had at least 1 year of job experience and willingness to participate in the study. (...) The study was conducted in Zanjan province, Iran, in 2018. The study subjects were selected via stratified random sampling. The data were collected using an organizational justice scale, corporate social responsibility scale, and consciousness scale. Questionnaires were completed through self-reporting. The data were analyzed using partial correlation coefficient and linear regression analysis. Ethical considerations: Research ethics approval (with the code of IR.ZUMS.REC.1397.47) was obtained from Zanjan University of Medical Sciences. Results: The results indicated that nurses felt injustice in all dimensions of organizational justice (2.66 ±.753). They feel the most sense of injustice in distributive justice (2.19 ±.798). In three dimensions, except the ethic dimension, the social responsibility was in a desirable range (2.79 ±.703). In two dimensions, work consciousness was in a desirable range. The results showed a significant and positive relationship between all dimensions of social responsibility and all dimensions of organizational justice (r =.072). However, no statistically significant relationship was observed between the dimensions of organizational justice and conscience (r = –.002). Conclusion: Based on the obtained results, social responsibility and the work consciousness of the nurses are affected by organizational justice. Therefore, nursing managers are suggested to change their management styles to reduce the sense of organizational injustice in nurses and have long-term productivity. (shrink)

The later Wittgenstein presents all kinds of knowledge in the form of language games based on forms of life. One of the implications of his later views is that certain language games and forms of life are incommensurable. Since each person can know the world only through his/her own form of life and language game, those who subscribe to entirely different language games cannot have a proper understanding of the forms of life of others. They are not able to critique (...) and evaluate their knowledge of reality unless they abandon their own customary forms of life and internalize other forms of life that they want to know about, that is, to become a member of a society based on those different forms of life. In contrast, Popper emphasizes the objective nature of knowledge by considering external reality as a major criterion of objectivity. Popper maintains that the growth of human knowledge takes place through a never-ending process of critical evaluation of previous knowledge claims and a continuous supply of new conjectures for capturing reality and their critical appraisal incessantly. In this article, following a brief description of the philosophical approaches of Wittgenstein and Popper (Sections 1 and 2), and a brief explanation of the anti-relativist attitude of critical rationalism (Section 3), we turn to a critical assessment of Wittgenstein's relativist approach through the prism of Critical Rationalism (Section 4). The last chapter of the article (Section 5) is dedicated to a brief recap of the topics discussed in the earlier sections. (shrink)

"Certainty" occupies an important place in Wittgenstein’s epistemology: it does not belong to the category of knowledge but constitutes its foundation. In his view, knowledge boils down to language games, and language games are based on indubitable certainties. According to Wittgenstein, scepticism is meaningless, and if there is no certainty, then even doubt would be meaningless. Wittgesntein maintains that [relative] doubt and knowledge are epistemic categories, whereas absolute doubt and certainty are non-epistemic categories. Epistemic categories are meaningful and when expressed (...) by means of statements could be either true or false. In contrast, non-epistemic categories are meaningless and when expressed by means of statements the properties of truth and falsehood do not apply to them. The aim of the present paper is two fold: 1- Providing an explanation of the status of certainty in comparison to categories such as doubt and knowledge in Wittgenstein’s thought; 2- Providing a critical assessment of Wittgenstein's approach to certainty through the prism of critical rationalism. The main arguments of the paper are as follows: 1. Although Wittgenstein considers certainty to be meaningless and therefore not on a par with epistemological categories, he regards it as an objective concept that functions as the foundation upon which all human knowledge is based; 2. Wittgenstein's efforts to show the objectivity of certainty have not been entirely successful, partly due to his reliance on a defective notion of ‘objectivity’ and partly as a result of the prominence he assigns to the category of ‘meaning’ at the expense of the category of ‘truth’. (shrink)

Today, health systems around the world are under pressure to create greater value for patients and society [81, p. 1, 119]; increasing access, improving client orientation and responsiveness, reducing medical errors and safety, restraining utilization via managed care, and implementing priority allocation of resources for high-burden health problems are examples of strategies towards this end. The quality paradigm by virtue of its strategic consumer focus and its methods for achieving operational excellence has proved an effective approach for creating higher value (...) in many sectors. If applied in a deliberate and holistic manner, the quality paradigm can bring about a more cost-effective organization of the health systems. In this article, we apply quality concepts to healthcare in a conceptual format; we characterize the health system’s customers and outputs with their quality dimensions. The product of this effort is a blueprint for a customer-driven health system which identifies six types of customers, nine types of outputs and the associated operations. As a preliminary step, a new analysis and definition of health and disease is provided. Rethinking the structure of health system in this manner and the related conceptual model can guide medical research, health sciences education, and health services policy, and help the practitioner to integrate all modern trends in healthcare delivery. (shrink)

Background: Certain factors may facilitate or inhibit the formation of moral sensitivity in nurses performing cardiopulmonary resuscitation (CPR). The identification of these factors in the context can help develop strategies to promote nurses’ moral sensitivity and offer new insights into the consequences of their moral decisions. Objective: Taking into account the possibly multi-factorial nature of moral sensitivity, this study aimed to identify the factors affecting the formation of nurses’ moral sensitivity in CPR settings. Research design and methods: This study performed (...) a conventional qualitative content analysis. Twenty-one participants were selected via purposive and theoretical sampling. The data were collected through in-depth semi-structured interviews and simultaneously analyzed via content analysis. Participants and research context: In total, twenty-one participants (fourteen clinical care nurses, three head nurses, two educational supervisors, and two faculty members) from different cities of Iran were interviewed. Ethical considerations: The research was approved by the Ethics Committee of Urmia University of Medical Sciences in Iran (IR.UMSU.REC.1399.337). Findings: Four categories (underlying factors, professional factors, organizational inhibitors of ethics, and professional limitations) and 13 sub-categories were extracted. Discussion: The formation of moral sensitivity requires a range of ethical standards and their maintenance, not only at the individual level but also at the profession, organization, and community levels. So eliminating inhibitors of ethics in these contexts can improve nurse’s ethical performance in CPR settings. Conclusion: Any measures taken or decisions made by nurses in CPR are driven by numerous ethical issues to which nurses must be morally sensitive. Some factors facilitate and some inhibit the formation of moral sensitivity in nurses. (shrink)

Flooding is one of the most damaging natural hazards globally. During the past three years, floods have claimed hundreds of lives and millions of dollars of damage in Iran. In this study, we detected flood locations and mapped areas susceptible to floods using time series satellite data analysis as well as a new model of bagging ensemble-based alternating decision trees, namely, bag-ADTree. We used Sentinel-1 data for flood detection and time series analysis. We employed twelve conditioning parameters of elevation, normalized (...) difference’s vegetation index, slope, topographic wetness index, aspect, curvature, stream power index, lithology, drainage density, proximities to river, soil type, and rainfall for mapping areas susceptible to floods. ADTree and bag-ADTree models were used for flood susceptibility mapping. We used software of Sentinel application platform, Waikato Environment for Knowledge Analysis, ArcGIS, and Statistical Package for the Social Sciences for preprocessing, processing, and postprocessing of the data. We extracted 199 locations as flooded areas, which were tested using a global positioning system to ensure that flooded areas were detected correctly. Root mean square error, accuracy, and the area under the ROC curve were used to validate the models. Findings showed that root mean square error was 0.31 and 0.3 for ADTree and bag-ADTree techniques, respectively. More findings illustrated that accuracy was obtained as 86.61 for bag-ADTree model, while it was 85.44 for ADTree method. Based on AUC, success and prediction rates were 0.736 and 0.786 for bag-ADTree algorithm, in order, while these proportions were 0.714 and 0.784 for ADTree. This study can be a good source of information for crisis management in the study area. (shrink)