Solutions to Confront Ethical Challenges from the Perspective of the Faculty Members : A Qualitative Study

Introduction dherence to ethical principles and values in all aspects of human life is the optimum solution for the promotion of health in the community (1). The subject of ethics in university has always been considered an abstract concept or a set of practical strategies which should be adopted in the future (2). Human behaviors are shaped at the university where principles and ethical values are expressed. In this regard, the behavior of faculty members in these centers can exert profound effects on students and the surrounding environment. The ethical performance of organizations is obviously dependent on the ethical standards of employees and managers. Therefore, they can contribute greatly to the formation of desirable professional behavior (3, 4). On the other hand, immoral behavior can have an adverse effect on student learning which is recognized as the ultimate goal of higher education (5). Given that professors can be role models for students, their ethical features can be conveyed to their students in educational environments through discoverable and hidden activities (1). Nonetheless, there has been serious criticism of professors’ ethics in some cases. A study was conducted by Bouzarjomehri et al. on A Abstract


Introduction
dherence to ethical principles and values in all aspects of human life is the optimum solution for the promotion of health in the community (1). The subject of ethics in university has always been considered an abstract concept or a set of practical strategies which should be adopted in the future (2). Human behaviors are shaped at the university where principles and ethical values are expressed. In this regard, the behavior of faculty members in these centers can exert profound effects on students and the surrounding environment. The ethical performance of organizations is obviously dependent on the ethical standards of employees and managers. Therefore, they can contribute greatly to the formation of desirable professional behavior (3,4). On the other hand, immoral behavior can have an adverse effect on student learning which is recognized as the ultimate goal of higher education (5). Given that professors can be role models for students, their ethical features can be conveyed to their students in educational environments through discoverable and hidden activities (1). Nonetheless, there has been serious criticism of professors' ethics in some cases. A study was conducted by Bouzarjomehri et al. on students' views on the professional ethics of professors. Students mentioned lack of time for students, uniformity in teaching methods, little attention to students' problems, and inaccuracy in the evaluation of students (3). In the study performed by Mousavi et al., it was also found that the professional ethics of educational managers were slightly higher than average. In addition, they pointed to the gap between the present status of professional ethics and the optimum one (6). Another study was carried out by Khaghanizadeh et al. which was based on the objective experiences of participants. The results of the mentioned study indicated that the professors who are responsible for ethics educations at universities are not qualified enough. Accordingly, they cannot contribute to students' moral development and advancement. Therefore, the researchers have proposed the training of specialists in the field of medical ethics (7). Higher education nowadays faces many daunting challenges, including ethical challenges, many of which are new and unexpected (8,9). A number of studies have been so far conducted on ethical challenges in academic settings (10)(11)(12). For instance, Gallo conducted a review study revealing that incivility is a real problem in higher education. It is worthy to note that misbehavior includes all kinds of adverse behaviors, such as category disturbance, disregard for the teacher, delay in entering categories or early departure from the category, academic incompetence, and bullying (10). The study performed by Nutt also mentioned ethical harassment, such as cheating on exams, sexual harassment, racial discrimination, speaking together, hostile verbal attacks, scaring other students, and physical threats (11). The study conducted by Abedini et al. suggested that according to university professors, the new ethical challenges faced by individuals are related to educational, research, and social ethics (12). Fazli et al. also found that students' ethics has changed from values to educational and administrative challenges. It brings serious problems, such as indifference, lack of conscientiousness, deception, credibility, the promotion of anti-values, and misrepresentation in students. Administrative challenges also spell these damages. On the other hand, ignorance of students' needs, lack of empathy, and discrimination among them can challenge students' ethics (13). Despite the challenges in higher education, their management is also of paramount importance. Dömeová and Jindrová pointed to the importance of efficient management of such ethical challenges since these problems can affect the nature of the university and its reputation. Accordingly, the immoral behavior of students and the personality of the instructors and managers of that institution will suffer irreparable harm (14). Ethical behaviors of individuals can be the result of ethical decisions based on their knowledge and ethical desires. Professors and students in the medical sciences universities should devote close attention to ethical phenomena, especially educational ethics. In addition, they need to be guided to arrive at an optimal solution and increase their awareness in this area (15). Considering the negative effects and consequences of these behaviors, university professors must take practical measures to address ethical challenges. The provision of necessary knowledge and skills to faculty members would empower them to deal with moral dilemmas. Consequently, such resources as power, worthiness, and the role model of supply will lead to the development and upgrading of the organization. The professors always try to institutionalize ethical values to avoid more serious problems. The failure to adopt effective solutions for ethical challenges can jeopardize the ethical integrity of both university and society.
The ethical values of people in society, especially those working in universities, are of utmost importance, and realizing ethics at individual and organizational levels will increase productivity. On the other hand, very few studies have been so far conducted on the management of ethical challenges. With this background in mind, the current study was performed to answer the crucial question faced by faculty members in dealing with ethical challenges. A qualitative method was applied in the present study since we intended to investigate human experiences and evaluate the feelings and views of individuals based on the depth of their experiences. Therefore, the present study aimed to provide effective solutions to ethical challenges from the perspective of faculty members as a qualitative study.

Methods
This research was carried out as a qualitative content analysis. This research method is used to discover individuals' perceptions of everyday life phenomena and the interpretation of mental data. The study population of the study included all 300 faculty members of Hormozgan University of Medical Sciences. Among this population, 35 professors were selected from a variety of male and female faculty members in different disciplines and faculties. They were selected by purposeful sampling and those who declared their willingness to participate were interviewed. Inclusion criteria entailed the willingness to participate in the research, having a master's or doctoral degree in medical sciences, and a minimum of one-year experience of teaching in medical sciences departments. Exclusion criteria included reluctance to continue participating in the study and unwillingness to express ethical experiences and be interviewed.
Before the commencement of the study, the required formal qualifications were obtained. Thereafter, in order to collect the data, deep, face-to-face, semi-structured, and personal interviews were performed. To conduct interviews, a list of different disciplines and schools of Hormozgan University of Medical Sciences was first provided. An interview guide was used to direct the interview. The interview guide was a series of open-ended responses that were developed based on research objectives and research team opinions and reviewed with each interview as needed. Each interview lasted for 55-110 minutes until data saturation.
Before the beginning of the study, the research objectives, the reasons for the recording of the interview, voluntary participation, the confidentiality of the information, and the identity of the interviewers were explained. Participants allowed their voices to be recorded, and written consent was obtained from all of them. Participants were asked to determine the time and place of the interview at their own convenience. At the beginning of each interview, participants were asked to introduce themselves and answer some questions about their age, the field of study, and workplaces. Thereafter, the questions concerning the desired phenomenon were put, and the insights into the participants' experiences continued to address the ethical challenges. The interview form included two categories of questions. The first category consisted of the main questions, and the second category covered the follow-up questions. The questions were designed based on the purpose of the present research and theoretical knowledge and, if necessary, could be modified during the interviews. The basic questions included: What are your experiences with ethical problems? How can you better meet these problems? What memories do you have about facing ethical problems?
Interviews continued until data saturation, and they were recorded with the permission of the participants. Subsequently, they were immediately transcribed word by word upon the completion of the interview on the same day. The transcriptions were written and duplicated on the paper to provide feedback for subsequent interviews or the adequacy of the data. Written interviews were again compared with recorded information. The keywords or codes were extracted from the texts and then analyzed. Participants' demographic information was analyzed using descriptive statistics methods. The analysis of qualitative data was simultaneously carried out with data collection by qualitative content analysis method using the eight steps of Elo and Kynga¨s (2008). These eight steps include selecting the analysis units, immersing in the information and creating a general sense, open coding, entering information into the coding sheets, grouping, classifying, abstracting, and conceptual mapping or categories (16).
After selecting the analysis units, data analysis initiated with the frequent reading of the text to immerse them and find a general sense. In the open-source stage, the basic ideas of the data were extracted and indexed. Wordby-word and line-by-line of each text were thoroughly read with a sufficient pause. All the codes related to the purpose of the research were noted on the margin of the text. For initial coding, participants 'words and implicit codes (researchers' perceptions of the statements) were used (17,18). Units of meaning were extracted from the analysis units; thereafter, with the deletion of the moves, the units of meaning were compressed and placed in the form of codes. After encoding multiple readouts, the same codes merged into one category. The code sets were categorized according to the original code proportions based on their differences or similarities, and the codes were classified as subcategories after the explanation of the label. The named categories and subcategories were grouped into main categories, and the themes were identified. By abstracting concepts, in order to describe the studied phenomenon, a comprehensive definition of "solutions to the ethical challenges faced by faculty members" was presented. On a final note, evidence was quoted from the text of the data for every concept.
To confirm the validity and accuracy of the research, four criteria proposed by Lincoln and Guba were assessed. They include credibility, confirmability, dependability, and transferability of data. Data and findings of the qualitative research should be acceptable and trustworthy which requires the collection of exact data. Increasing the number of interviews was the first step to increase the accuracy of the data. In addition, according to many researchers, collecting data from various sources can increase the acceptability and external validity of the study. Therefore, complementary methods of data collection, such as observation, recording the behavior, and providing more interaction with participants during the interview, will be effective in the improvement of the validity of the findings. To ensure credibility and dependability, the researcher built a good relationship with the participants. Moreover, the findings of the study were given to participants after the transcription of interviews. Consequently, they could assess the consistency of the findings with their experience and their accuracy. In addition, collaborative reflection on the emerged themes was conducted by the research team. In this regard, apart from the researchers, a qualitative research specialist was asked to examine the texts and evaluate the accuracy of the analysis process. He reviewed the interviews, extracted meanings, and role models. Other activities to ensure the study accuracy included: conducting research based on the study design, recording and transcribing the participants' quotes, and revising them by participants prior to analysis in order to verify their precision. Furthermore, the other factors ensuring the confirmability included researcher's interest in the studied phenomenon, continuous involvement in the data, review by qualitative research specialists, search for evidence and contrary articles, and trying to gather other's viewpoint in the field. In addition, the current study was conducted in a team and with the guidance and supervision of experts that enabled dependability and confirmability of data. In the current study, to increase the transferability of data during sampling, the purposive sampling method was used to provide the background for the transferability of data by expansive descriptions of other's judgment and assessment.
In order to observe ethical considerations, participants were reminded that they could withdraw from the study at any stage of the research. Notably, participants' profiles were kept confidential during the research period. In this regard, the names of the interviewees were not included on the stripes and texts, rather the codes and figures were used. It is worthy to note that the utmost trust and integrity was observed in the use of resource at different stages of research. Furthermore, the research was carried out after receiving the ethics code from the Ethics Committee of Hormozgan University of Medical Sciences (HUMS.REC.1395.98).

Result
This qualitative study was conducted on 35 professors of Hormozgan University of Medical Sciences in fields of medicine, nursing, midwifery, paramedics, health, dentistry, and pharmacy. The analysis of the interviews yielded three themes and nine categories. The themes included valuecentering, belief in values, and developing the values. The solutions to the ethical challenges of the faculty members in Hormozgan University of Medical Sciences were defined using the themes and categories extracted as follows: ''In order to effectively deal with ethical challenges, three major themes need to be emphasized. They include value centering, the belief in values, and developing the values. Value centering entails dimension of ethical orientation in management, ethical orientation in the evaluation, and ethical knowledge management in the educational community. Belief in values includes motivating individuals, increasing their moral sensitivity, and teaching spirituality. Developing the values is achieved by promoting morality in the educational society, introducing appropriate role models for individuals, reflection on values, and providing appropriate feedback in the organization.
1. Value centering The emphasis on ethical values in educational issues is important for the development of morality, and it is necessary to observe ethical principles in all aspects of educational and academic issues. In other words, apart from building and educating values in educational environments, it is necessary to devote special attention to ethics in the management and ethics of valuation.

1-1. Ethical orientation in management
If managers of educational institutions emphasize ethical values and principles, they must adhere to these principles themselves. Moreover, they should adhere to ethical guidelines for the management of educational issues related to faculty members and students.
"Managers rush to judgment without asking a question, while they should give people the opportunity to defend themselves since the problem can lie in another factor. They must first observe morality themselves. " According to the participants in the current study, motivation, increased moral sensitivity, and spirituality can lead to value-building in educational settings.
2-1. motivating In order to be valued in educational environments, people need to have strong incentives to subconsciously move towards morality, rather than compulsion and engagement in appearance, function, behavior, and moral speech. Therefore, motivation is one of the basic principles for laying the foundations of value in educational societies.
"People should be motivated. When a student encounters a professor who is morally perfect, apart from his high scientific and educational level, it gives him the incentive to follow in his/her footsteps. "(Participant No. 3 Professor of the Faculty of Pharmacy) 2-2. Increased moral sensitivity One way to deal with ethical challenges is to make people sensitive to ethical issues. Most importantly, the willingness of individuals to learn and observe ethical principles increases when the issues of observing values and morals are highlighted.
"Ethical issues are of utmost importance for faculty members and students; therefore, they have to strengthen their beliefs in different ways. Students would react to suspected immoral cases in universities or hospitals. Moreover, in case of violation of patients' privacy, they seek to resolve the problem or preserve the privacy of the patient. "(Participant No. 11, Professor of the Faculty of Nursing and Midwifery) 2-3. Teaching Spirituality One of the other effective methods which can be valued is teaching spirituality to individuals. Familiarizing students with spirituality and its consequences can be effective in increasing their tendency toward spiritual behavior. "We should work on students' beliefs. Children are sensitive. For example, say you are Muslim. Why you write recording of diastolic blood pressure without a device and should not be done. This makes some people come to their senses. At least 10 people affect one. "(Participant No. 14, Professor of the Faculty of Nursing and Midwifery) 3. Developing the values Growing and cultivating constructed values has been effective in developing and strengthening them and preventing stagnation and forgetting these values. In this regard, such solutions as promoting divisions, introducing role models, reflecting values, and managing ethical knowledge can be useful in fostering ethical values in universities.
3-1. Promoting morality It is imperative for students to know exactly what professional ethics are, and it is necessary to observe the ethical opinions in their profession. Training people on their job descriptions and ethical imperatives while performing these tasks will play a key role in promoting ethics.
"Everyone's performance should be based on their duties. For instance, job descriptions are provided by training experts or educational supervisors. And what are the ethical issues you are facing in the implementation of these tasks? They should have close monitoring. "(Participant No.21, Professor of the faculty of Paramedicine) 3-2. Introducing role models Students' imitation of professors or other successful peers is common in educational settings. Therefore, the appropriate ethical models should be highlighted and introduced to the students since these people are sometimes kept in the dark due to their modesty. These role models can contribute greatly to the future of students.
"Students must have a good and ethical model to behave well and morally. We should not let them choose the model themselves since they are prone to mistake. Many of the virtual spaces you enter into colleges and the wrong way of choosing. We need to introduce suitable role models for students. "(Participant No. 10, Professor of the Faculty of Dentistry) 3-3. Reflection of values Making and processing values in educational settings is of paramount importance in the promotion of ethics. In addition, we must devote special attention to these values and provide timely and appropriate feedback. Reflection on ethical behaviors has a part to play in developing and highlighting ethics.
"When someone does the right, they should be encouraged. In so doing, the others wish they were those approved people. Encouragement and appropriate feedback are noteworthy."(Participant No. 32, Professor of the faculty of Health).

Discussion
In terms of faculty members, solutions to ethical challenges fall into three categories of value centering, belief in values, and developing the values. Two points worth mentioning here before discussing the results and the subject matter. Firstly, no moral virtues and ethics exist any longer, and the adherence to moral values is preferred in contemporary moral writing. Secondly, moral values are intrinsically a matter of affection and will since they deal with the human soul. Therefore, ethical issues are not merely educational and need to be motivated and enforceable with their particular finesse (19).
Considering the two abovementioned points, it can be concluded that the intimate relationship between the teacher and the student develops in the form of ethical principles and norms, and behavioral injuries are formed in the same direction. Nonetheless, it is worth noting that the generation gap can pose a daunting challenge to this relationship.
According to the factual approach to the ethical challenges faced by faculty members, teachers and students share a set of common moral values. Consequently, they can rely on these common grounds to foster these values. As observed in this division, we are faced with a logical process for the reconstruction of ethical challenges.
In the first step, three ethical orientation options in management and ethics are essential in the evaluation and management of ethical knowledge to sustain ethical values. Professors' adherence to ethical principles and standards is an indispensable factor which must be taken into account in students' evaluation of professors. Based on the evaluation of the relationship between professional ethics and the professors' performance at Payam-e-Noor University, it was revealed that professors adhered to most of the nine ethical principles in their teaching practice. In addition, a positive and significant relationship was observed between the educational efficiency and the performance of the professors. In other words, the findings of the mentioned study confirmed that the observance of this principle by the professors increased the effect of teaching (20). On the other hand, ethics is a science which needs education. We should distinguish between the professional values and the ethical values of an organization. Ethical values are in fact moral responsibility, and faculty members should be attentive to the philosophy, norms, and the function of morality as the main thrust of moral philosophy. In one of the studies that examined the ethical status of faculty members, university professors respected their educational institution and colleagues during teaching. In addition, the components of moral teaching in most cases overlapped with effective teaching (12). In the survey conducted by Bruns et al., the methods of teaching ethics varied among teachers, with lectures and seminars being the most popular and textbooks the least in favor (21).
In the second stage, it is necessary for professors and students to accept and believe in moral values which are achieved by three elements of motivation, increasing moral sensitivity, and spirituality. Moral sensitivity is a feature that enables us to identify moral conflicts and the sensory and intellectual perception of vulnerable situations and awareness of moral outcomes in making decisions about others. This sensitivity is a combination of individual awareness of ethical dimensions, such as tolerance, calmness, accountability, and the importance of ethical issues (22). The results of the study performed by Mousavi et al. on moral sensitivity revealed that the moral sensitivity in both groups of students and nurses was higher than the average. Researchers suggested that promoting ethical sensitivity is effective in understanding the various aspects of a situation and adopting the optimum solution (23).
Nevertheless, in the third stage, it is necessary to develop moral values. It is also possible by promoting ethics, introducing role models, and reflecting on values. The common practice in teaching ethics in our society is direct learning, and this method lacks efficiency. The effective ways of teaching ethics in an organization are indirect methods, out of which both active learning and social learning are of crucial importance (12). Zirak et al. in their study on the level of moral development of nursing students in Tabriz indicated that only about half of the students were in an acceptable stage of moral development, and the rest fell at a lower level (24).
Furthermore, university professors are responsible for the correct transfer of scientific concepts on one hand and the practical and human model of ethical values in the working environment on the other hand. Therefore, their way of dealing with ethical challenges in educational environments is evident and hidden in student performance. Considering the important role of professors in shaping the behavior of students and the cultivation of ethical virtues, it is necessary to devote more attention to this issue (25). In the study carried out by Byrne et al., most ethics teaching was via informal discussions with faculty members (75.6%), Ethics ground Rounds (74.8%), and supervised clinical involvement in difficult cases (68.9%). The primary methodologies used in teaching ethics were either case-based or integrated case-based and lecture learning. Compared to academic programs, communitybased programs use more lecture-based didactics and less standardized patients, simulation programs, or other teaching activities. Participants believed that hands-on experience with difficult cases was most effective, while lecture-based didactics was the least effective method of teaching to deal with ethically challenging situations (26). Finally, the professors can act as objective models, and they influence the thoughts and actions of the students. Therefore, it is essential for faculty members to be sensitive to their speech and behavior, especially in the university environment, and avoid any abusive or inappropriate behavior. Furthermore, it is recommended that further studies be conducted on strategies for the development of ethical values in educational settings and the promotion of using appropriate ethical role models.
Every study has some limitations which must be addressed in the paper. In the current research, there were general limitations of qualitative studies, such as the use of voice recorder in interviews. However, the researchers tried to minimize this limitation by providing the participants with the research objectives. Moreover, they were ensured of the confidentiality of the obtained information and their permission to withdraw from the study at any stage of the study.

Conclusion
The results of this qualitative research indicated that three important issues of value centering, belief in values, and developing the values are regarded as effective solutions to ethical challenges which can help prevent and resolve these challenges in higher education. The achievement of these solutions requires specific requirements which need to be met in order to be realized. The influential factors which can affect the relationship between faculty members and students can be summarized as follows: a code of ethics should be developed for ethics training at the university and recognizing moral harms. All professors and students are required to carry out and develop ethical values in order to establish a calm and unrestricted atmosphere in universities.