Background:Experiencing moral distress is traumatic for nurses. Ignoring moral distress can lead to job dissatisfaction, improper handling in the care of patients, or even leaving the job. Thus, it is crucial to use valid and reliable instruments to measure moral distress.Objective:The purpose of this study was to determine the reliability and the validity of the Persian version of the Moral Distress Scale–Revised among a sample of Iranian nurses.Research design:In this methodological study, 310 nurses were recruited from all hospitals affiliated with (...) the Qazvin University of Medical Sciences from February 2014 to April 2015. Data were collected using a demographic questionnaire and the Moral Distress Scale–Revised. The construct validity of the Moral Distress Scale–Revised was evaluated using principal component analysis and confirmatory factor analysis. Internal consistency reliability was assessed with Cronbach’s alpha.Ethical considerations:This study was approved by the Regional Committee of Medical Research Ethics. The ethical principles of voluntary participation, anonymity, and confidentiality were considered.Findings:The construct validity of the scale showed four factors with eigenvalues greater than one. The model had a good fit ( χ2(162) = 307.561, χ2/ df = 1.899, goodness-of-fit index =.904, comparative fit index =.927, incremental fit index =.929, and root mean square error of approximation (90% confidence interval) =.049 (.040–.057)) with all factor loadings greater than.5 and statistically significant. Cronbach’s alpha coefficients were.853,.686,.685, and.711for the four factors. Moreover, the model structure was invariant across different income groups.Discussion and conclusion:The Persian version of the Moral Distress Scale–Revised demonstrated suitable validity and reliability among nurses. The factor analysis also revealed that the Moral Distress Scale–Revised has a multidimensional structure. Regarding the proper psychometric characteristics, the validated scale can be used to further research about moral distress in this population. (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)

The aim of this study is to introduce a novel method to solve a class of two-dimensional fractional optimal control problems. Since there are some difficulties solving these problems using analytical methods, thus finding numerical methods to approximate their solution is a challenging topic. In this study, we use transcendental Bernstein series. In fact, for solving the problem, we generalize the Bernstein polynomials to a larger class of functions which can provide more accurate approximate solutions. The convergence theorem is proved. (...) Some examples are solved to demonstrate the validity and applicability of this technique. Comparing the results with other methods, we can find the efficiency and applicability of the scheme. (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)

Background Maintaining the dignity of patients who attempted suicide is one of the caregivers’ main ethical duties. Yet, in many cases, these patients are not treated with dignity. The concept of dignity is abstract, and there is no research on the dignity of suicidal patients. So, the present study is done to investigate psychiatric nurses’ perception of dignity in patients who attempted suicide. Objective The present study explores the concept of dignity in patients who attempted suicide from the perspective of (...) psychiatric nurses. Research design The present study is a qualitative, descriptive work of research Participants and research context A total of 20 psychiatric nurses from 2 hospitals affiliated with a university of medical sciences in the southeast of Iran were selected via purposeful sampling. Ethical considerations The Research Ethics Committee of the Hamadan University of Medical Sciences approved the study’s protocol, and ethical principles were followed in general. Findings From the findings of the study, three main themes, namely “ respect for personal; identity,” “management of psychological tension,” and “compassion-focused therapy,” with 12 sub-themes were extracted. Discussion and conclusion In the perspective of caregivers, patients who attempted suicide need to be cared for in supportive environments with compassionate and respectful behaviors to control their psychological tensions. These conditions would maintain such patients’ dignity and result in appropriate behavioral outcomes. Policy-makers and administrators can use the present study’s findings to create an appropriate clinical environment in which the dignity of patients who attempted suicide is properly maintained. (shrink)

By studying history, we understand that religion in different ages is influenced by the culture of people. This reality signals the probability of that religion is made by people and it is the product of man in history. This probability indeed ignores the divinity of religion and presents it only as a human product. But is there only one probability for human influence? We should survey the relation between the human and divine in religion to clarify this question. By surveying (...) this relation, we understand that there is a fundamental discontinuity between the divine and human realms. Different objects could cause this discontinuity, but the most fundamental object is the power that causes the excellence and mastery of divine and fundamental discontinuity. If the power only is regarded, the probability ofhumanity of religion increases. But other objects may be regarded. If wisdom has an important place in the discontinuity, there is a probability for the influence of the human. It is wise divine variation of religion that correlates the eternal variation of the human. (shrink)

The purpose of the current study was to investigate the effect of two types of repeated reading on incidental vocabulary learning of Iranian English as a Foreign Language learners. In so doing, a sample of 45 intermediate EFL students from two intact classes of a language institute were selected as the participants. The two classes were randomly assigned to an unassisted group who were required to just read and an assisted group who were asked to read and listen to 24 (...) short texts several times. The assisted group employed their smartphones to listen to the audio files of the short stories. The data were gathered via a researcher-made vocabulary test and vocabulary learning self-efficacy scale. The results of ANCOVA revealed that although both types of repeated reading contributed to enhancing vocabulary learning of the participants, assisted repeated reading led to significantly greater EFL vocabulary gains. Additionally, the findings revealed that both assisted and unassisted repeated reading improved vocabulary learning self-efficacy of the participants and there was not a significant difference between the two types of interventions. The findings of the present study have implications for EFL researchers and practitioners. (shrink)

The human in continuous century envisage the skepticism. When the human envisage the deficiency of his knowledge, will be in trouble of skepticism, when the knowledge of human fundamentally is doubted, all internal or external impressions will be doubted, so the man envisage the unlimited skepticism. But is it possible and logical? The possibility of it is a psychological question too, but my effort is the epistemological surveying of it. We can survey this question in two ways. One way is (...) justifier reasons of skepticism. Are there sufficient for unlimited skepticism? Every deduction is based on preludes and if they’re uncertain the result will be uncertain too. There any deduction can’t justify unlimited skepticism. The other way is the surveying results of this skepticism. We have beliefs thatnever can doubt them like our existence. This inability express that the unlimited skepticism doesn’t agree the logic of our subject. Moreover the unlimited skepticism brings the mixed continuums. If we doubt anything, doubt this doubting too and this involving haven’t extremity, the demoniac hang that can’t be accepted by our. (shrink)

The Augustinian theologian's unusual assertion that understanding rests on the faith, seems to be confronted with various objections. Through analyzing, criticizing, and refuting these objections, we will clarify epistemological status of this assertion. This essay consists of two sections. In the first section, by distinguishing two different approaches to epistemic justification, that is, internalism and externalism, it will be argued that these objections are all due to epistemic obligations which are imposed by internalist approach. The said objections, thus, will be (...) resolved if these obligations are eliminated; externalist approach undertakes to do this. Then, we will show that although the latter one can appropriately satisfy the requisites which are necessary to representing a general epistemology but its foundations rest on a condition which will merely be provided through a faith-based explanation. In the second section, we will argue that the Augustinian theologian's viewpoint is the only one which can appropriately pave the way for this condition. (shrink)

The past 15 years of exceptionally severe water scarcity in the Islamic Republic of Iran have resulted in the desertification and salinity of formerly arable lands, drying out of Iranian lakes and rivers, and quickly shrinking groundwater resources, while water demand has risen, along with the size of the Iranian population, of which over 70% lives in urban areas now. We have aimed to discover the causes of water scarcity in the IR Iran and evaluated its social and economic impacts. (...) First, we computed the Weighted Anomaly Standardized Precipitation (WASP) Index for the period of 1979-2014. To illustrate the social impact of water scarcity, we analyzed the current water risk for the twenty most populous Iranian cities, by employing the composite index approach to translate hydrological data into comprehensible indicators of water related risks, and made a projection for 2020-2030, by modeling potential changes in the future demand and supply of water. To demonstrate the economic impact of water scarcity, we evaluated the overall agricultural contribution to the IR Iran GDP. We have found that the 1999 severe drought in the IR Iran commenced a period of unusually dry conditions that is still ongoing. The rapidly growing Iranian urban populations presently experience a medium to extremely high overall water risk, with extremely high baseline water stress that, in part, is due to the lack of upstream protected lands. The relationship between baseline water stress and drought severity has been determined as weak, confirming that other factors than drought are equally or more important contributors to the existing water risk. Our projection calculations indicate that Iranian urban populations will continue to experience an extremely high water stress for the coming decade. Due to the fast growth of these populations as well as considerable rise of value added to the IR Iran GDP by other sectors of the national economy, the contribution of agricultural production to the national GDP has declined from about 25% to under 10% (although its total yield has risen considerably) during the past 30 years. This decrease has been directly proportional to the increased foreign food imports, dependency on the IR Iran oil exports and reduction in the non-oil exports. The main causes of water scarcity in the IR Iran appear to be due to climatic factors, insufficient environmental protection, and over-exploitation and mismanagement of water resources, especially by the agricultural sector. In conclusion, our study proposes anti-wasting water management action plan that recommends shifting the IR Iran government response to water scarcity from reactive survival strategies to proactive crisis prevention, with emphasis on safeguarding, monitoring, early warning, and effective step-by-step preparedness and readiness, and by laterally integrating water management between all levels of the IR Iran government, including local, regional and national, for a sustainable, resilient and prosperous economy of the Islamic Republic of Iran now and in the future. (shrink)

Patient advocacy has been a topic of much discussion in the nursing literature for a number of decades. Ambiguities remain, however, concerning definitions of advocacy in nursing. This qualitative grounded theory-type study aimed to inquire into the meaning of patient advocacy from Iranian nurses' perspective. A purposive sample of 24 nurses (staff nurses, head nurses and supervisors) working in a large university hospital in Tehran was used. Data were collected using in-depth semistructured interviews and reflective diaries kept by the participants. (...) The data were analyzed using elements of Strauss and Corbin's' approach. Advocacy was defined by the participants as: informing and educating; valuing and respecting; supporting; protecting; and promoting continuity of care for patients. The participants also believed that advocacy could take place only if there was respect for patients' individuality and their inherent human dignity. Many of the descriptions given by the participants are consistent with previous research in this area and represent a comprehensive account of their perceptions of patient advocacy. (shrink)

Background Moral distress is a complex and challenging issue in the nursing profession that can negatively affect the nurses’ job satisfaction and retention and the quality of patient care. This study focused on describing the resources and constraints, consequences, and interventions of moral distress in nurses. Methods In a literature review, an extensive electronic search was conducted in databases including PubMed, ISI, Scopus as well as Google Scholar search engine using the keywords including “moral distress” and “nurses” to identify resources, (...) constraints, consequences, and interventions about moral distress in nurses, from the earliest records up to 26 December 2020. The required data were extracted from 61 relevant studies by two independent reviewers. Results Resources and constraints in the occurrence of moral distress among nurses can be divided into three general categories including internal factors, clinical factors, and external factors. The consequences of moral distress on nurses and the medical system reduced moral sensitivity, development of psychological and physical health problems, and the intention to leave the profession. The potential effective interventions were the implementation of integrated communication programs, strengthening physician–nurse collaboration, nursing involvement in clinical decision-making and end-of-life issues, social support, using a resiliency bundle, interdisciplinary discussion, and promoting nurses’ ethical and communication skills. Conclusion There are a wide range of resources and constraints impacting moral distress in nurses that could lead to negative consequences. Further studies are necessary to identify, evaluate, and implement a range of potential effective interventions for the management of moral distress in nurses. (shrink)

The home learning environment includes what parents do to stimulate children’s literacy and numeracy skills at home and their overall beliefs and attitudes about children’s learning. The home literacy and numeracy environments are two of the most widely discussed aspects of the home learning environment, and past studies have identified how socioeconomic status and parents’ own abilities and interest in these domains also play a part in shaping children’s learning experiences. However, these studies are mostly from the West, and there (...) has been little focus on the situation of homes in Asia, which captures a large geographical area and a wide diversity of social, ethnic, and linguistic groups. Therefore, this paper aims to review extant studies on the home literacy and numeracy environments that have been conducted in different parts of Asia, such as China, the Philippines, India, Iran, Turkey, and the United Arab Emirates. Specifically, we explore how parents in these places perceive their roles in children’s early literacy and numeracy development, the methods they regard as effective for promoting young children’s literacy and numeracy learning, and the frequency with which they engage their young children in different types of home literacy and numeracy activities. We also examine studies on the relationship of the home literacy and numeracy environment with young children’s developmental outcomes, and the effectiveness of parent training programs to improve the home literacy and numeracy environments in these contexts. By examining potential trends in findings obtained in different geographical areas, we can initially determine whether there are characteristics that are potentially unique to contexts in Asia. We propose future research directions that acknowledge the role of cultural values and social factors in shaping the home learning environment, and, by extension, in facilitating children’s early literacy and numeracy development. (shrink)

The problem which is both created and tackled by this article is that although it advocates the Iranian progressive reformism as the most preferable political force in Iran, it simply does not find reformists’ own formulation of their “competitive advantage” convincing enough. Thus, to provide an argument for Iranian progressive reformism this article not only strives to explain one of the latest Iranian reformists’ mistakes through the Lacanian concept of imaginary identification as elaborated upon by Slavoj Zizek, but also to (...) illuminate precisely at formulation of what that mistake was an attempt. In doing so, it conducts a comparative analysis of the funeral processions for General Qassem Soleimani in 2020 and for Ayatollah Khomeini in 1989, and then proceeds to draw some perhaps neglected points from the moment of the Islamic revolution of 1979 as well as from the period of Khomeini’s leadership. However, far from being just a more elaborated explanation of Iranian reformism, an attempted reformulation like this of Iranian progressive reformism hopes to pave the way for creating new spaces for political act in Iran. Key Words: Iranian progressive reformism, Slavoj Zizek, Ayatollah Khomeini, Qassem Soleimani, imaginary identification, political act. (shrink)

Limited strikes are arguably different from war insofar as they are more circumscribed, less destructive, and cost less in blood and treasure to employ. However, what they can achieve is also considerably more circumscribed than what is set out by the goals of war. How do we morally evaluate limited strikes? As part of the roundtable, “The Ethics of Limited Strikes,” this essay argues that we need to turn to the ethics of limited of force, orjus ad vim, to do (...) so. Two moral assumptions that are the keystone tojus ad vimcan shed light on the moral imperatives and ethical dilemmas of undertaking limited strikes. First, such strikes should be seen as an alternative to war, and not part of thejus ad bellumlast resort process. What I call the “Rubicon assessment” determines at what level force should be used: at the level of war, with all its costs and unpredictability, or at that of the more predictable and less costly limited force. Second, limited strikes should adhere to a “presumption against escalation”; that is, a moral commitment not to escalate to war. This essay highlights these moral principles in five different limited strike scenarios: “hot pursuit,” “red line,” “the last straw,” “the point of no return,” and “the right of retaliation.” The conclusion explores the notion of justice after limited strikes, or what I calljus post vim, to show that while what can be accomplished by limited strikes is inherently constrained, they can, if used morally and in tune with diplomacy, be of service in the quest for peace. (shrink)