Health, Spirituality and Medical Ethics
Volume:7 Issue: 2, Jun 2020

Medical education, beyond the acquisition of a set of knowledge and skills, is a quite complicated process of cultivation, formation, and development of health professionals (1) in the educational context which in turn, is deeply associated and intertwined with health delivery system. This is an output of close relationship and long-term interaction of the learner with the educational environment. The optimum output of this system, will be a graduate, possessing the required competencies and capable of performance with a holistic approach, a part of which are spiritual competencies (2). Regarding the significance of spirituality in holistic approach to health, medical education institutes and their accrediting agencies all over the world have seriously addressed the issue as an inseparable part of instructional goals and programs (3). Although this, by nature, is based on an old and original need, it is a relatively new phenomenon in formal medical education and thus undergoing a process of trial and error. Considering the multiple teaching and learning strategies and methods in medical education (4), the question arises about the best way for spirituality to be taught in medical schools.Determining the appropriate educational strategies in this field depends on a clear explanation of the aims and purposes of addressing spirituality in medical education. These aims could be classified in different levels, the minimum level being an overall perception of non-physical dimensions of human being. Nevertheless, the ultimate goal of incorporating spirituality in medical education according to the authors can be stated as a shift from the narrow biomedical paradigm to a deepened and strengthened holistic view among the health care potential workers, with special attention to Spirit as a truth composing a main part of his existence. It is believed that this recognition, followed by a comprehensive understanding of man and his diverse needs, leads to improvement in healthcare system and transcendence of health in human communities. In this way, addressing spirituality in medical education should be regarded paradigmatically, influencing many fundamentals of knowledge, attitude, and behavior. In other words, spirituality should be covered in medical curricula to convey a thorough knowledge of human being (5). It should be noted that during medical education, apart from technical knowledge and skills, a set of character traits and a kind of professional identity are formed, not only as a result of textbooks and educational materials, but through implicit and indirect messages conveyed within the atmosphere of education. These messages mainly focus on cultural customs, values, norms, social and behavioral expectations and tendencies, encompassing the concept of hidden curriculum in which, in addition to the content of the message, the sender, the environment and the way the message is exchanged are of particular importance (6). Hidden curriculum provides a capacity for transmission of messages beyond curriculum, which can be means of better training and finally better performance. Hidden curriculum, influenced by the organizational culture and especially role models, may be contrary to formal curriculum and the explicit educational goals. This is especially significant in clinical stages of medical education in which the actions of professors and others whose behavior is accepted as reference, accompanied by the overall atmosphere of the educational settings play a major role.It seems that to teach spirituality with the above-mentioned goals, it is necessary to take advantage from the capacity of hidden curriculum (7). Firstly, because it can be helpful in preventing against the negative consequences of what is implicitly taught in educational contexts, and secondly, to prepare the ground for utilizing it to develop and strengthen these competencies and meet existing challenges in areas such as medical ethics, professionalism, social accountability, and integrity. So, despite acknowledging spirituality and especially spiritual care as a part of formal curriculum, it seems that the effect of hidden curriculum is clearly greater on this dimension of health compared with other aspects of health. Although hidden curriculum exerts its effects in an implicit and at times unintended manner, targeted and planned interventions can lead to desirable effect on the learners. So it is recommended to consider spirituality in different levels from policy-making to planning, implementation and evaluation.

Parental divorce can cause distress for the children of a family and they may not be able to easily adjust themselves to it. Therefore, it is necessary to identify the factors that can improve their distress and facilitate the process of their adjustment. The present study aimed to evaluate the effectiveness of spiritual-religious interventions on: anxiety, depression, and adjustment to parental divorce in female high school students.

This quasi-experimental study was conducted based on a pretest-posttest design with a control group. The population consisted of all female high school students whose parents had divorced in Malayer, Iran, in 2019. In total, 28 female high school students were selected through convenience sampling method and were divided randomly into intervention and control groups. Furthermore, the intervention group was subjected to spiritual-religious interventions. The data were collected using the child behavior checklist and divorce adjustment inventory revised. In addition, the data were analyzed in SPSS software (version 22) through multivariate analysis of covariance.

The results showed that spiritual-religious interventions had significant effects on the results of post-test anxiety (F=24.22 and P<0.05), depression (F=4.50 and P<0.05) and adjustment to parental divorce (F=6.75 and P<0.05).

According to the findings of this study, spiritual-religious interventions can improve anxiety, depression, and facilitate the process of adjustment to parental divorce in female high school students. The results of this research can have many practical implications.

Breast cancer is associated with unique changes and experiences in all physical, psychological, social, and spiritual aspects of one’s life. In this regard, the present study aimed to investigate the spiritual experiences of breast cancer patients.

This qualitative study was conducted using a hermeneutic phenomenological approach. In total, 20 eligible breast cancer patients were selected, through maximum variation and purposive sampling method, from the oncology ward of Shahid Beheshti Hospital in Qom, Iran in 2019. The required data were collected using semi-structured in-depth interviews which lasted between 50-75 min. The collected data were analyzed using the six-step Van Manen method.

After the data analysis, the main theme of the spiritual experience of the patients was "return to the Holy". This theme included "spiritual beliefs and attitudes", "spiritual growth and excellence", "spiritual support", and "restoration of the power of life".

According to the lived experiences of the participants of this study, breast cancer highlights the spiritual aspect of one’s life and the tendency towards spirituality. Therefore, the healthcare team can use the findings of this study to develop educational plans and provide spirituality-based services to breast cancer patients.

Death of a child can be the source of many problems for mothers. Therefore, the present study aimed to investigate the effects of the spiritual-religious intervention on complicated grief disorder and the psychological hardiness of mothers suffering from this disorder.

The present quasi-experimental study was conducted using a pretest-posttest design with a control group. The statistical population consisted of all mothers with complicated grief disorder in 2019 in Karaj, Iran. This study was performed on 28 mothers who were selected through purposive sampling method and were divided randomly into intervention and control groups. The intervention group received spiritual-religious interventions while the control group did not receive any intervention. The data were collected through the inventory of complicated grief (ICG) and personal views survey questionnaire (PVSQ). Moreover, the collected data were analyzed in SPSS software (version 26) using the analysis of covariance.

The results showed that spiritual-religious intervention has a significant effect on the complicated grief disorder (F=31.96, P=0.001) and psychological hardiness (F=39.09, P=0.001).

According to the findings, a spiritual-religious intervention can reduce complicated grief disorder syndrome and increase the psychological hardiness of mothers suffering from this disorder. Therefore, it is suggested to offer spiritual-religious interventions in clinical settings for people with complicated grief disorder.

Nowadays adolescents as the human capital of every society, in addition to the pressures of transition from adolescence period, are affected by environmental pressures, such as poverty, violence, and substance abuse. Given these factors, resilience plays an important role in this period. The present study aimed to investigate the role of happiness, attachment styles, and religious attitudes in predicting the resilience of students.

This descriptive correlational study was performed on 354 students selected through the multistage cluster sampling method from the students of junior high schools in Najafabad, Iran. Data collection tools included the Oxford Happiness Questionnaire (1989), Attachment Style Questionnaire by Hazen and Shaver (1987), Religious Attitude Questionnaire by Barahani and Golriz (1975), and Connor-Davidson Resilience Scale (2003). In order to analyze the relationships between the variables and predict resilience, the Pearson correlation coefficient and stepwise regression analysis were used.

Our findings showed that happiness, religious attitude, and secure attachment style had a significant relationship with the resilience of students (P<0.01). The results of the regression analysis revealed that the strongest predicting variables of resilience in students were happiness, religious attitude, and secure attachment style (P<0.01).

According to the results of this study, happiness, religious attitude, and secure attachment style could be regarded as important factors in the resilience of students.

Intrauterine insemination (IUI) is one of the methods of infertility treatment. When is the best time to do this assisted reproduction procedure? There are many Islamic narrations about the appropriate time for fertilization in order to give birth to a physically, mentally, and spiritually healthy child. Therefore, this study examined the relationship between the time of IUI performance and its consequences according to Islamic narrations.

The present historical cohort study was conducted at an Infertility Center affiliated with the Academic Center for Education, Culture, and Research of Qom, Iran using the medical records of patients who underwent sex selection IUI procedure from 2011 to 2015. The data were collected using a researcher-made checklist consisting of demographic characteristics, factors affecting the pregnancy outcome in terms of medicine and narrations, as well as the pregnancy outcome. The collected data were analyzed in SPSS software (version 20).

The findings indicated that the time of IUI performance based on Islamic recommendations and the pregnancy test result had a significant relationship (P=0.003). Moreover, the time of IUI based on Islamic recommendations had a significant relationship with pregnancy outcomes (P=0.023). The highest number of abortions and neonatal disorders were observed in pregnancies that had happened at the disapproved times according to the narrations (e.g., the end of the lunar month and when the moon is in Scorpio). Besides, the highest number of births of healthy infants happened when the insemination had happened at the recommended times (e.g., Thursday noon).

Due to the relationship between the time of IUI based on Islamic recommendations and the pregnancy outcome, it is recommended that IUI be performed based on Islamic recommendations and at times other than the disapproved times so that better results will be achieved in pregnancy. However, further studies are needed in this regard.

Islamic work ethics is influenced by several variables, such as some psychological components. In this regard, the present study aimed to investigate the relationship of flexibility and resilience with Islamic work ethics.

The statistical population of the current descriptive-correlational study included all the employees of Shahid Mahallati Hospital in Tabriz in 2019.  A total of 200 individuals were selected using nonprobability convenience sampling and answered the questionnaires of resilience, flexibility, and Islamic work ethic. The obtained data were analyzed in SPSS software using the Pearson correlation coefficient and regression test. A p-value less than 0.05 was considered statistically significant.

As evidenced by the obtained results, Islamic work ethic has a positive significant correlation with the components of resilience (personal competence (P<0.001), confidence in one’s instincts (P<0.003), positive acceptance of change and secure relationships (P= 0.001), control and spiritual influences (P<0.004) and the components of flexibility (task flexibility (P<0.008), skill flexibility (P<0.001) and behavioral flexibility (P <0.00)). It was also found that resilience with 60% and flexibility with 45% can predict Islamic ethics among the staff of Shahid Mahallati Hospital in Tabriz.

Considering the impact of resilience and flexibility components on Islamic ethics, it can be concluded that people with a high degree of resilience and flexibility demonstrate a stronger tendency and commitment to Islamic ethics.

Islamic work ethics is influenced by several variables, such as some psychological components. In this regard, the present study aimed to investigate the relationship of flexibility and resilience with Islamic work ethics.

The statistical population of the current descriptive-correlational study included all the employees of Shahid Mahallati Hospital in Tabriz in 2019.  A total of 200 individuals were selected using nonprobability convenience sampling and answered the questionnaires of resilience, flexibility, and Islamic work ethic. The obtained data were analyzed in SPSS software using the Pearson correlation coefficient and regression test. A p-value less than 0.05 was considered statistically significant.

As evidenced by the obtained results, Islamic work ethic has a positive significant correlation with the components of resilience (personal competence (P<0.001), confidence in one’s instincts (P<0.003), positive acceptance of change and secure relationships (P= 0.001), control and spiritual influences (P<0.004) and the components of flexibility (task flexibility (P<0.008), skill flexibility (P<0.001) and behavioral flexibility (P <0.00)). It was also found that resilience with 60% and flexibility with 45% can predict Islamic ethics among the staff of Shahid Mahallati Hospital in Tabriz.

Considering the impact of resilience and flexibility components on Islamic ethics, it can be concluded that people with a high degree of resilience and flexibility demonstrate a stronger tendency and commitment to Islamic ethics.

Recognition of the factors associated with drug abuse in students can have a significant impact on the prevention of their tendency towards substance abuse. Therefore, the present study was conducted to determine the relationship of the tendency towards substance abuse with spiritual and psychological well-being in students of Zanjan University of Medical Sciences.

This descriptive-correlational study was performed on undergraduate and doctoral students (n=1759) of Zanjan University of Medical Sciences in the academic year of 2016-17. The sample size was calculated using the Cochran formula and was estimated at 315 subjects who were selected through the random sampling method. The data were collected using a substance abuse questionnaire which was based on Minnesota multiphasic personality inventory-2, psychological well-being questionnaire by Reef, and spiritual well-being questionnaire by Paloutzian and Ellison. Out of 315 distributed questionnaires, 295 questionnaires were completely filled and returned. The data analysis was performed using descriptive statistics, Pearson correlation, and multiple linear regression tests.

According to the findings, there was a significant relationship between the variable of total spiritual well-being and the tendency towards substance abuse and the components of addiction potential and acknowledgment (P<0.05). Moreover, it was confirmed that there was a relationship between personal growth and addiction acknowledgment (P<0.05). Furthermore, the component of self-acceptance had a correlation with the tendency towards substance abuse and addiction acknowledgment (P<0.05). Besides, spiritual well-being, religious well-being, and the component of self-acceptance can predict and explain the variable of the tendency towards substance abuse to 26%, 19.9%, and 18%, respectively. In addition, the two components of personal growth and self-acceptance were able to explain the addiction acknowledgment to 19.6% and 18.4%.

Finally, it can be concluded that self-acceptance and spiritual well-being are predictors of the tendency towards substance abuse in students.