leila Afshar | Shahid Beheshti University of Medical Sciences (original) (raw)

Papers by leila Afshar

Developing World Bioethics, Jun 18, 2012

Iran is the only Muslim country that has legislation on embryo donation, adopted in 2003. With an... more Iran is the only Muslim country that has legislation on embryo donation, adopted in 2003. With an estimated 10-15% of couples in the country that are infertile, there are not any legal or religious barriers that prohibit an infertile couple from taking advantage of Assisted Reproductive Technologies (ARTs). Although all forms of ARTs available in Iran have been legitimized by religious authorities, there is a lack of legislation in all ARTs except embryo donation. By highlighting ethical issues in embryo donation, the paper presents a critical review of the Act of Embryo Donation in Iran. The paper argues that the Act does not provide enough safeguards for the future child and assurance for the safety of the donated embryos. It also does not restrict embryo donation to surplus embryos from infertile couples and is silent about the number of embryos that could be donated by each couple as well as the number of recipients for donated embryos by a couple. The Act is also silent about the issues of genetic linkage (nasab) and heritage which are challenging issues, especially in a conservative Islamic society. As a result, the future child may not inherit from their birth parents, as it is not required by the Act, or from the genetically related parents under the anonymity policy. Finally there is no standard national protocol or guidelines to evaluate the safety of the donated embryos. The paper concludes that despite its benefits, the Act lacks clarity, and it is subject to misunderstanding and confusion.

Medical journal of the Islamic Republic of Iran, Dec 30, 2022

Medical Ethics Journal, Mar 26, 2018

Over the past few decades, there is an increasing in studies on traumatic patients (violence, roa... more Over the past few decades, there is an increasing in studies on traumatic patients (violence, road accidents, natural disasters, terrorist attacks). In some trauma studies collecting the data from patients, especially mentally weak patients, may lead to remembering memories of bitter experience which can cause a feelings of discomfort, upset, anxiety, embarrassment and shame in narrowing the injury (1-2). Concerns and anxiety in patients during the study are related to their condition of injury. Injured patients with higher age or severe injury experience more worry during the study period than others (3). However, the findings of studies show that only a few trauma patients report their concerns and discomforts about research topics or methodology (4). On the other hand, only some patients are able to predict properly the inconvenience conditions of participating in the study. Consequently, this situation at the informed consent phase leads to a not informed decision. Therefore, inability to predict the research condition, accurately and completely, can lead to some challenge in informed consent process (5). There are different data collection methods such as; interviewing, focus group discussion, internet questionnaire, self-declaration questionnaire which can be used in non-experimental trauma studies. Nevertheless, using the questionnaire or interviewing methods are most used by the researcher in trauma studies. The discomforts effects of data collection methods which patients may experience vary in different studies. Some patients experience extreme emotions when they talk about the injury (6-7). In an interview, more information is provided by interviewees rather than the questionnaire method and these conditions may lead to having more experience embarrassment in patients. This is one of the potential risks in interviewing method and it is necessary to be considered by research ethics committee and researchers. Meanwhile, some studies show that the use of electronic questionnaire has greater discomfort effect on patients compared to paper-based questionnaires or face-to-face interviews (7). The Experience of emotions in patients is related to perceived helpfulness among them. The results of some studies have shown that patients in interview method feel more usefulness compared to the questionnaire method, so the experience of feeling anxiety in this group is far less. For example, in case of child abuse, parents feel that their experiences will be useful for the community and raise awareness of families about related issues (2, 8). In addition, addressing to the issues of trauma patients' including; discomfort and anxiety during the study and the data collection can have considerable significance in two aspects: 1-uncertainty of research ethics committees in approving this type of studies; 2-the effect of the patient's discomfort on the validity of the study (6, 9). While there are no uniform conditions for all participants in different types of studies, the same approach cannot be considered in different situations. Considering the principles of protecting human subjects in research ethical protocols including; respecting the participant's autonomy, beneficence and non-maleficence and justice, it is necessary to investigate suitable data collection method for each participant in informed consent process. In this circumstance, researchers can identify those who may be at risk of negative emotions during the study period and minimize the risk to them by using the most appropriate method of data collection. Based on the research conditions, the type of data collection method can vary. Nevertheless, it can be expected that using the appropriate data collection method according to mental health and psychological condition of each participant lead to more adherence to research ethics principals and best risk benefit ratio balance. Moreover, this strategy needs to consider the random and systematic errors and adopt effective methods to control them.

نشریه پرستاری ایران, Oct 1, 2020

Background & Aims: Professionalism is the underlying factor in strengthening the social contract ... more Background & Aims: Professionalism is the underlying factor in strengthening the social contract between professions and the society. Failure to adhere to this principle in healthcare providers (including nurses) reduces the quality of patient care and endangers community health, while also diminishing public trust and weakening the social image of healthcare professions. In recent decades, researchers of health science education have focused on the nature of professionalism and planning for training in this regard in order to achieve this important outcome in health science graduates. Despite the applications of the study results and the efforts to train students on the basic concepts of professional ethics, the expected outcomes have not yet been realized in terms of the performance of graduates. Today, numerous researchers believe that achieving professionalism is not possible merely through education and the evaluation of its principles, and the required competencies should also be cultivated to facilitate the process of professional socialization, so that a proper professional identity could be attained in medical science graduates. However, further studies should be focused on the top of Miller's pyramid (Does) pertains to the process of developing competencies and their components and has reached the stages of developing a competency-based curriculum, along with the formation of a professional identity, which is equivalent to the "Is" part added to the Miller's model by Cruess et al. (2016). In a study in this regard, the concept of professional socialization was analyzed, and professional identity was introduced as the main outcome of this process. The present study aimed to critically review the current literature regarding socialization and the development of professional identity in health science students. Materials & Methods: This critical review was conducted based on the Carnwell and Daly structure, which consists of six steps, including determining the objectives of the critical literature review, defining the scope of the review, identifying the sources of relevant information, literature review, writing the review, and applying the literature to the proposed study. At the stage of review writing, we followed the three steps proposed by Schutz. Initially, a systematic search was performed to obtain the available conceptual models and frameworks of socialization and professional identity formation in primary scientific databases, such as EBSCO CINAHL, Web of Science, Eric, PubMed, Scopus, and Google Scholar, using relevant keywords with "OR" and "AND" to combine the main concepts. The article search had no time limit until 2019. The eligibility criteria for article selection were proposing a model/conceptual framework, medical sciences, free access, and publication in English language. The exclusion criteria were duplicates and the experimental studies aimed at the measurement, comparison or production of tools. In the second phase of the search and to obtain citations and criticisms for each selected conceptual model/framework, the key concepts of each was systematically searched in the aforementioned databases using "AND" in combination with concepts such as "Criticism, Problems, Challenges, Advantages, Disadvantages". To ensure access to all the possibly relevant reviews, all the citations to each model were tracked through Google Scholar. Results: In total, 2,112 articles were retrieved in the first stage of the search in terms of the title, followed by the abstract. After reviewing the full texts of the selected articles, nine articles were selected based on the research criteria in the fields of nursing, social work, medicine, paramedicine, and student affairs. These articles were categorized in terms of the study design, model type, model focus, and outcomes. Following that, the selected

Iranian Journal of Medical Ethics and History of Medicine, Oct 15, 2012

Narrative ethics is an approach that is well known for ethical education and moral development. I... more Narrative ethics is an approach that is well known for ethical education and moral development. In narrative ethics, by using a story, its components and characters, ethical knowledge and awareness can be achieved. This approach is very useful in medical ethics education and is helpful in dealing with ethical dilemmas. In fact, part of ethical development, in addition to moral judgment, is to reinforce the ethical sensitivity in which narrative ethics can play a significant role for this purpose. This approach has been widely used for teaching morality in Persian literature and history telling, such as Mathnavi. Narrative ethics can be applied by telling stories about patients' life and their experience of illness. It can also be used to criticize and analyze the clinical situation and explore ethical challenges that healthcare providers face in their daily practice. Thus, it can help to prevent ethical conflicts by establishing interaction between ethical principles and patients' values. This paper emphasizes the application of this method in medical ethics education and ethical decisionmaking.

Academic Medicine, 2015

Background and purpose: Medical professional behavior includes the characteristics of devotion, i... more Background and purpose: Medical professional behavior includes the characteristics of devotion, integrity, compassion, good communication skills, respect, responsibility, excellence and leadership. Evaluation plays an important role in identifying the professionalism of people and training. Thus, this study was conducted to evaluate the professional behavior of clinical residents. Methods: In this descriptive study, 50 clinical attending physicians were randomly selected as the study population. Each attending physician completed assessment forms for two residents with whom they had rounds for more than one month. P-MEX was used for data collection and data analysis was done through descriptive method using one-sample t-test. Results: Based on the results, the professional behaviors of residents were as follows: 8.9% under the expected level, 57.4% at the expected level, 32.7% over the expected level and no residents were at an unacceptable level. Conclusions: The present study was conducted for the first time considering the fact that no professionalism assessment tool was provided for clinical departments. The study had useful results and some important steps can be taken in the future by localization of the P-MEX tool, adding items accepted by professionals and doing a 360-degree assessment.

PubMed, 2016

In any clinical encounter, an effective physician-patient relationship is necessary for achieving... more In any clinical encounter, an effective physician-patient relationship is necessary for achieving the desired outcome. This outcome is successful treatment, and therefore, the relationship should be a healing one. In addition, in the Islamic view, the physician is a manifestation of God's healing attribute, which is usually undermined in everyday therapeutic communications. Yet there are few empirical data about this experience and how it occurs in the clinical context. This study was conducted to develop a model of physician-patient relationship, with the healing process at its core. Our goal was to explain the nature and characteristics of this encounter. In Islamic teachings, healing is defined as "cure" when possible and if not, reducing pain and suffering and ultimately finding a meaning in the illness experience. This study was a qualitative inquiry. Data were collected through 17 open-ended, semi-structured interviews with physicians who had an effective relationship with their patients. The participants' experiences and their perception regarding the relationship were subjected to grounded theory content analysis. For establishing the trustworthiness of the data collection and analysis we used triangulation, peer review, and member checking. The findings showed that the components of the patient-physician healing relationship could be categorized in the four key processes of valuing the patient as a person, effective management of power imbalance, commitment, and the physician's competence and character. This leads to forming the three necessary relational elements of trust, peace and hope, and being acknowledged. Their importance has been better demonstrated in a relationship which incorporates the spiritual aspects of patient care and also physician's satisfaction. The physician-patient relationship has a central role in patient outcome. This relationship has an understandable structure and its components may have an effective impact on promoting the patient's experience of the health system.

Iranian Journal of Medical Education, Apr 10, 2020

Journal of complementary medicine research, 2020

Background: Capability and professional behavior of nurses play a significant role in promoting t... more Background: Capability and professional behavior of nurses play a significant role in promoting the quality of patients' care. The present study aimed to explain the experiences of nurses from the challenges of nurses' professional behavior. Method: This study is a qualitative study was conducting using conventional approach to content analysis. A total of 31 participants, including nurses, nursing faculty members and medical ethics specialists, participated in the study. The sampling method was selected purposefully. A semi-structured in-depth and individual interview method was used for data collection. Results: In data analysis, 4 main themes including individual prerequisites, professional prerequisites, structure failure and social factor were considered as factors influencing on professional behavior in nursing. Conclusion: The organizational and educational structure reform and changing the social image of nursing can help improve the professional behavior of nurses.

Medical History Journal, 2011

Background: Research is a step that researcher clear an obscure problem until find a detailed and... more Background: Research is a step that researcher clear an obscure problem until find a detailed and reasonable answer for it. Research ethics is a branch of professional ethics and it is concerned ethical principles that have guided the research from beginning to end. Since education has the fundamental ethical purpose of improving the lives of individuals, communities and society, ethical considerations must lie at the core of educational research. The aim of this review article is explained ethical considerations in educational research. Method: This article offers an overview of ethical issues in the field of educational research literature related to ethical considerations in educational research have been published during the period 1999 to 2013 using the keywords ethical considerations, research, educational, moral guide in library and databases such as Eric, Medline and Google Scholar search engines such searches and have been studied. Conclusions: After examining the ethics of educational research in three dimensions include participant, design, implementation and dissemination of the research results, according to our findings, Professional codes and guidelines and, if necessary circumstances necessary laws and regulations to prevent further possible deviations in the course of study are necessary. Doing research under the supervision of research ethics committees (which were established by the university, institutions, associations related to the field of educational research), Seems to be necessary And educational researchers to be bound by these associations and their codes and instructions. The development of such associations in order to give a boost to the moral status of research is suggested.

Medical Ethics Journal, 2010

Medical students and residents have to improve their practical skills by spending a major part of... more Medical students and residents have to improve their practical skills by spending a major part of their training time in hospitals and clinics and will be involved in the patient’s treatment process. Professional groups involved in medical education and health policy maker point that patients refer to university teaching hospitals, means that they have consent with this process. But if we do not consider necessary arrangements, cannot say that the patients act is informed and vulnerable. And patients' understanding of the skills, experience and qualifications of participants in treatment process will not be complete. It should be noted that, there are not any detailed and comprehensive guidelines and protocols on this issue in Iran. In contrast, the ethics of medical research on human subjects have been the subject of much policy development and there are many international and national codes of ethics in research. Although research and education have different goals, but there is an analogy between medical education and research. In both cases the medical team asks patients to participate in a process which may have both individual and social benefits. So there should be a balance between the goods for society and the benefits to individual patient in one hand, and potential harm and risks on the other hand, In addition to respect for patient’s autonomy. From the medical ethics point of view, patients should be fully aware of educational and skill level of medical team, understand the risks and benefits of hospitalization in a university teaching hospital and could access to alternative possibilities. But in current system of medical education, which the governmental health facilities and medical education are fully integrated and almost there is no non-teaching hospital except the private ones, this challenge is very important. It seems that national health system should seek systematic solutions for this problem in an organizational manner. To develop guidelines and standard protocols to assure patients best interests in university teaching hospitals and to clarify the clinical professors and hospital managers’ responsibilities as well as the duties of government and Ministry of Health and Medical education.

DOAJ (DOAJ: Directory of Open Access Journals), Jun 1, 2019

Background: The complexity of the current health system, the expansion of the range, and types of... more Background: The complexity of the current health system, the expansion of the range, and types of activities of the medical group members have caused the physicians to encounter daily with many ethical issues, and as a result, attention to the medical ethics curriculum in medical science universities ,in line with the increasing advances in science, has enhanced.The present study aimed to use the global experience through a comparative study of the medical ethics curriculum in a number of selected universities. Methods: This study compares the medical ethics curriculum in selected medical schools based on the Bereday model. .The top 10 Medical School, based on the Times Higher Education ranking system(THE),were selected , and the results presented in four levels of description, interpretation, juxtaposition , and simultaneous comparison. Results: This study showed that teaching medical ethics have various objectives in different medical schools and .A wide range of topics is taught in addition to using traditional teacher-centered strategies, such as lectures, new and active educational methods, such as discussion in small groups, independent student studies, and role play have been used. For assessing the student's knowledge, written exams were the most used methods as well as measuring the students moral skills by self assessment tools and objective structured exams. Most of the medical schools adopted a multidisciplinary approach in teaching medical ethics. Conclusion: this comparative study showed that the medical ethics curriculum should adopt a student centered strategy and multidisciplinary approach to strengthen medical student's ethical reasoning and decision making.

Biosciences, Biotechnology Research Asia, Mar 30, 2015

Concept analysis is the foundation of achieving a clear and explicit understanding of the concept... more Concept analysis is the foundation of achieving a clear and explicit understanding of the concept of value-based curriculum and modelling. The curriculums of the medical sciences education in Iran suffer some drawbacks. The lack of a domestic model of the curriculum based on values is one of the main issues of the curriculum. There was no common and clear definition for the concept of value-based curriculum, or occasionally the definitions were not uniform and compatible. The present study proposes a concept analysis method to reach a proper definition of the concept and its further development. Then, it compares different definitions of the concept of value-based curriculum, and clarifies confusing definitions. To model the value-based curriculum, we chose the concept qualitative analysis model of Hugh McKenna. Value-based curriculum is not just a tool for perception of the educational contents, but it is a movement beyond reasoning and analytical methods and contemplation that usually takes place during education.

DOAJ (DOAJ: Directory of Open Access Journals), Aug 1, 2017

Medical Ethics Journal, 2014

There are problems that lie ahead about Conflict between the priorities of medical education and ... more There are problems that lie ahead about Conflict between the priorities of medical education and patient care and dignity of patients in clinical teaching. Like other areas of ethics in clinical teaching respect for the individual, benefits, equity and no harm should be taken into consideration. Studies show that the three pillars of clinical training are doctors, patients and students have been formed. Meanwhile, according to the study, the challenges of clinical training about patients and students are discussed. In this regard, with the use of available resources, the related problems were declared and their solutions are also given. Considering that the training process, students and physician attendance are fully conscious, therefore the patient attendance should be fully consciously too. To reduce conflict between clinical training and patient rights, it seems that it is necessary to be taught professional ethics and communication skills for students. On arrival at the health center should be given sufficient information about the patient's rights to their.

Medical Ethics Journal, 2012

Most of the decisions in Medical Ethic, especially in ethical considerations in beginning and end... more Most of the decisions in Medical Ethic, especially in ethical considerations in beginning and end of life depend on our definition of embryo and his/her ethical status. There are various factors to recognize someone as he human species such as impregnation time, implantation in the uterus, evolution of nervous system and senses, the embryos movement in the uterus of the mother, birth and conscious. The time of transformation of a human being to a person is different in various points of views, in the beliefs of Abrahamic Religions; besides physical features humans had spiritual features and with citing on this matter his/her ethical status can be defined. In this point of view personalizing a human being will be defined with his/her ensoulment, but the spirit and the procedure of ensoulment is a spiritual matter. This does not mean to deny the effect and the relationship of this phenomenon or synchrony of it by some physical effects. So there is a chance that because of this close relationship of spirit and the body, one can be able to identify physical changes in the body, which by them one can be able to guess the time of ensoulment or be able to claim that for embryo to have a spirit, he needs a certain extent of physical evolution. In this regard it is possible to ask that although the Islamic juridical point of view about the ensoulment and to determine 120 day of pregnancy as the time of ensoulment is a practical view but can we consider the embryo ready for ensoulment after being improved physically and to consider him as a person and to take all of the ethical consequences in to effect?!

Medical Ethics Journal, Sep 22, 2015

Training ethical concepts has a crucial role in promotion of moral sensitivity in nurses. Debate ... more Training ethical concepts has a crucial role in promotion of moral sensitivity in nurses. Debate to select most effective method of teaching ethics in nursing continues. Present study was aimed to compare the effects of ethical training based on two methods: narrative ethics and lecturing on moral sensitivity of nurses. Fifty-six nurses from two educational hospitals in Birjand participated in this randomized control field trial research. The demographic characteristics questionnaire, and Lutzen's Moral Sensitivity Questionnaire were completed by nurses in the three Tims (before, after and three month after the intervention). Then four sessions (each 3 hours) of ethical training with one week interval for two groups of narration (28 participants) and lecture (28 participants) were conducted. Data were analyzed by SPSS-16 software.Two methods of narration and lecture significantly increased the nurses' moral sensitivity in each group (respectively p<0.001, p=0.01). Despite the higher mean score of moral sensitivity in narration group rather than the lecture group, moral sensitivity did not show a significant difference (p=0.70). The mean score of moral sensitivity 3 months after the intervention showed a statistically significant decrease than after it in both groups. (P=0.00) Concerning the results of this study, a combination of these two methods can lead to useful outcomes.

Frontiers of Nursing, Dec 1, 2021

Objective: In today's world with sweeping changes, nurses are responsible for providing high-qual... more Objective: In today's world with sweeping changes, nurses are responsible for providing high-quality and cost-benefit care, which would almost be impossible unless they achieve their high professional status. To date, no precise and comprehensive definition of professionalism in nursing has been evidently proposed. In fact, many of the previously proposed definitions are either complicated or ambiguous. Moreover, there is no consensus in the literature on an exhaustive definition for "a professional nurse." The present study aimed to illustrate the concept of professionalism in nursing and identify its defining characteristics. Methods: In this study, concept analysis was conducted using Whittemore et al.'s method for the integrated review. A comprehensive search of electronic, scientific databases including Eric, PubMed, Scopus, Web of Science, EBSCO, PsychoINFO, Embass, MagIran, IranDoc, SID, and IRANMEDEX was carried out using the keywords such as professionalism, professional behavior, nursing professionalism (NP), professional attribute, and nursing. Results: In the present study, a comprehensive search of 11 electronic databases retrieved 5738 articles. Then, 2837 duplicate articles were removed by endnote (version 8). Based on a preliminary examination of the titles and abstracts as well as the inclusion and exclusion criteria, 1517 articles were excluded. In addition, 137 articles were removed for scientific reasons. Finally, 52 articles in English and Persian were selected. Content analysis of the articles revealed four major themes, namely, individual prerequisite, professional prerequisite, appropriate structure, and socio-individual factors. Conclusions: Professionalism in nursing is a major, multidimensional concept according to the literature that included individual prerequisites, professional prerequisites, appropriate structures, and socio-individual factors. In fact, professionalism in nursing comprises a wide range of personal characteristics, self-regulation, professional values, striving to acquire and enhance professional expertise, professional interactions, social, professional, and legal responsibility, and creation of a sense of belonging, and professional development.