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   Table of Contents      
Year : 2022  |  Volume : 27  |  Issue : 1  |  Page : 81

Value-based education and critical clinical settings

1 Student Research Committe, Golestan University of Medical Sciences, Gorgan, Iran
2 Department of Nursing, School of Nursing & Midwifery, Golestan University of Medical Sciences, Gorgan, Iran
3 Education Development Center, Golestan University of Medical Sciences, Gorgan, Iran
4 Department of Biomedical Ethics, Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Date of Submission04-May-2020
Date of Decision06-Jul-2020
Date of Acceptance06-Oct-2021
Date of Web Publication25-Jan-2022

Correspondence Address:
Dr. Forouzan Akrami
Department of Biomedical Ethics, Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijnmr.IJNMR_77_20

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How to cite this article:
Jahanshahi R, Sanagoo A, Jouybari L, Akrami F. Value-based education and critical clinical settings. Iranian J Nursing Midwifery Res 2022;27:81

How to cite this URL:
Jahanshahi R, Sanagoo A, Jouybari L, Akrami F. Value-based education and critical clinical settings. Iranian J Nursing Midwifery Res [serial online] 2022 [cited 2022 Nov 29];27:81. Available from: https://www.ijnmrjournal.net/text.asp?2022/27/1/81/336445

Dear Editor-in-Chief,

Value-based education is known as one of the affecting factors of professional dignity of medical practitioners, as well as their informed decision-making in critical clinical settings. Critical situations are the best opportunities to convey professional and moral practice and also the most difficult.[1] The resuscitation or blue code involves calling in a special team to take immediate actions for a patient who has developed cardiopulmonary arrest to bring the patient back to a stable state. The important point is the speed of action that is often life-saving in the cooperative effort of the resuscitation team with the stake of nurses. In contrast, “slow code” that is mainly enacted in end-of-life patients, is limited in terms of number, duration, intensity, or all three. Lantos et al.[2] have defined the slow code as a short-term intervention that is practically symbolic and apparently effective. In this manner, it seems that we are trying to save the patient life, but we are in fact deceiving the family.

Doing cardiopulmonary resuscitation to address the interests and grief of “other important people” is morally unfounded and deceptive. The team knows that doing everything for an end-of-life patient is futile, and interventions are not only ineffective but actually harmful. All the challenges in slow code arise due to low awareness of the patient's family, whereas we can prevent the futile actions by establishing a clear relationship and empathy with them.

”Tailored code” is a valuable alternative, especially in end-of-life situations, where high-quality resuscitation is performed within defined specific limits. In this manner, family members are clearly informed about what will and will not be done,[3] and sound communication can make hope and patience, and prevent futile care, whereas performing essential and personalized actions without family deception.[4]

The review of medical sciences students' curriculum, especially nursing ones, indicates that mentioned issues are not specifically addressed and most of the learning occurs through a hidden curriculum. Thus, the development of a value-based curriculum is needed to transfer both ethical values and professional teachings in critical settings, with an integrated approach of theoretical and practical education.[5] Furthermore, given the more exposure of nurses to stressful situations, ethical analysis of clinical cases, which enables nursing students to develop moral sensitivity and reasoning as essential skills to face and solve moral dilemmas, is recommended.

Financial support and sponsorship


Conflicts of interest

Nothing to declare.

  References Top

Breslin JM, MacRae SK, Bell J, Singer PA, University of Toronto Joint Centre for Bioethics Clinical Ethics Group. Top 10 health care ethics challenges facing the public: Views of Toronto bioethicists. BMC Med Ethics 2005;6:E5.  Back to cited text no. 1
Lantos JD, Meadow WL. Should the “slow code” be resuscitated? Am J Bioeth 2011;11:8-12.  Back to cited text no. 2
British Medical Association. Guidance from the Resuscitation Council (UK) and the Royal College of Nursing: Decisions relating to cardiopulmonary resuscitation. 2016;3,1. https://www.bma.org.uk/media/1816/bma-decisions-relating-to-cpr-2016.pdf.  Back to cited text no. 3
Forman EN, Ladd RE. Why not a slow code? AMA J Ethics 2012;14:759-62.  Back to cited text no. 4
Lawlor R. Moral theories in teaching applied ethics. J Med Ethics 2007;33:370-2.  Back to cited text no. 5


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