Feasibility assessment of adapting intensive care units to religious regulations: A qualitative study

Moravveji, Alireza; Nikpour, Mahtab; Sarmasti, Maryam; Raeyat Mohtashami, Abolfazl; Mashkoori, Ahmad

doi:10.48307/atr.2025.554868.1290

Feasibility assessment of adapting intensive care units to religious regulations: A qualitative study

Document Type : Original Article

Authors

Alireza Moravveji ¹

Mahtab Nikpour ²

Maryam Sarmasti ²

Abolfazl Raeyat Mohtashami ³

Ahmad Mashkoori ⁴

¹ Student Research Committee, Qom University of Medical Sciences, Qom, Iran AND Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran

² Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran

³ Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran AND Student Research Committee, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran

⁴ Spiritual Health Research Center, Qom University of Medical Sciences, Qom, Iran

10.48307/atr.2025.554868.1290

Abstract

Background: Respecting patients’ rights in intensive care units (ICUs) requires a delicate balance between clinical imperatives and religious obligations, including ritual requirements, jurisprudential rulings, ethical norms, and organizational policies. Practical and interdisciplinary evidence on the feasibility of designing and implementing ICUs that systematically integrate these dimensions in accordance with religious regulations remains limited.
Objectives: This study aimed to explore the principles, barriers, and operational strategies for adapting ICUs to religious considerations.
Methods: This qualitative research was conducted using a thematic analysis approach among 29 participants, including specialists in anesthesiology, medical ethics, ICU nursing, hospital management, hospital engineering, and family members of patients, across two university hospitals selected by purposive sampling. Semi-structured interviews were conducted until data saturation was achieved. Data were analyzed using MAXQDA software based on Braun and Clarke’s six-phase framework, and the trustworthiness of the findings was ensured according to Lincoln and Guba’s criteria.
Results: Data analysis yielded three main themes, 12 categories, 31 subcategories, and 84 codes. Theme 1, Religious Obligations and Patients’ Rights: This theme emphasizes ensuring opportunities for worship, maintaining privacy and dignity, providing transparent information, observing end-of-life religious principles, and guaranteeing halal nutrition and medication. Theme 2, Implementation Challenges: This theme highlighted constraints in human and physical resources, alongside the critical condition of patients, as significant barriers to fulfilling religious requirements. Theme 3, Operational Strategies: This theme focused on faith-based technical and managerial design, family involvement, and Islamic financial support as practical pathways for establishing religiously compliant ICUs.
Conclusion: Adapting ICUs to religious regulations requires a multidimensional and phased approach that integrates jurisprudence, engineering, and clinical medicine. Implementing the recommendations of this study may provide a robust foundation for developing a context-specific model of religiously compliant ICUs, along with protocols, monitoring indicators, and ethical-religious policies for hospital design.

Keywords

Patients&rsquo

rights, Religion and medicine, Pastoral care, Intensive care units, Hospitals

1. Ekong M, Monga TS, Daher JC, Sashank M, Soltani SR, Nwangene NL, et al. From the intensive care unit to recovery: managing post-intensive care syndrome in critically ill patients. Cureus. 2024;16(5). doi:10.7759/cureus.61443. PMID: 38953087; PMCID: PMC11215031.

2. Jones C, Bäckman C, Capuzzo M, Egerod I, Flaatten H, Granja C, et al. Intensive care diaries reduce new onset post traumatic stress disorder following critical illness: a randomised, controlled trial. Crit Care. 2010;14(5):R168. doi: 10.1186/cc9260. PMID: 20843344; PMCID: PMC3219263.

3. Che Jamaludin FI, Abdullah M, Endut M, Saifuddeen SM, Hamimi KA, Harun S. Developing a Shariah-compliant medical services framework in Malaysia: an expert system approach using fuzzy Delphi method and interpretive structural modelling. BMJ Open. 2025;15(1):e082263. doi:10.1136/bmjopen-2023-082263. PMID: 39762112; PMCID: PMC11749868.

4. Jamaludin FIC, Abdullah MRTL, Endut MNA-A. Establishing a Sustainable Shariah-Compliant Hospital in Malaysia: Exploring the Pertinent Concept. KnE Soc Sci. 2023:670–85-–85. doi:10.18502/kss.v8i20.14631.

5. Shariff SM, Rahman ARA. Shari ah compliant hospital; from concept to reality: a Malaysian experience. Bangladesh J Med Sci. 2016;15(1):1-4. doi: 10.31344/ijhhs.v2i2.27.

6. Hamilton DK, Gary JC, Scruth E, Anderson III HL, Cadenhead CD, Oczkowski SJ, et al. Society of Critical Care Medicine 2024 guidelines on adult ICU design. Crit Care Med. 2025;53(3):e690-e700. doi:10.1097/CCM.0000000000006572. PMID: 39982130.

7. Ahmadi F, Khodayarifard M, Zandi S, Khorrami-Markani A, Ghobari-Bonab B, Sabzevari M, et al. Religion, culture and illness: a sociological study on religious coping in Iran. Ment Health Relig Cult. 2018;21(7):721-36. doi:10.1080/13674676.2018.1555699.

8. Heidari A, Kazemi A, Abbasi M, Adeli SH, Ahmari Tehran H, Eskandari N, et al. Developing a charter of spiritual care for patients. Int J Qual Health Care. 2021;33(1). doi:10.1093/intqhc/mzaa172. PMID: 33367741.

9. Memaryan N, Ghaempanah Z, Aghababaei N, Koenig HG. Integration of Spiritual Care in Hospital Care System in Iran. J Relig Health. 2020;59(1):82-95. doi:10.1007/s10943-019-00864-0. PMID: 31227979.

10. Memaryan N, Rezaei Khodadadi F. A Spiritual care department: practical experience. BMJ Support Palliat Care. 2024;14(3):365-6. doi:10.1136/spcare-2024-004809. PMID: 38429113; PMCID: PMC11347240.

11. Jamaludin FIC, Abdullah MRTL, Endut MNAA, Saifuddeen SM, Hamimi KA, Harun S. Developing a Shariah-compliant medical services framework in Malaysia: an expert system approach using fuzzy Delphi method and interpretive structural modelling. BMJ Open. 2025;15(1):e082263. doi:10.1136/bmjopen-2023-082263. PMID: 39762112; PMCID: PMC11749868.

12. Yahaya RR. What is shariah compliant hospital criteria and scope. Int J Acad Res Bus Soc Sci. 2018;8(5):1057-65. doi: 10.6007/IJARBSS/v8-i5/4483.

13. Larijani B, Mobasher M, Zahedi F, Tahmasebi M. Ethical Decision-Making Regarding Life Sustaining Treatment in End-Of-Life Care: A Scoping Review of the Similarities and Differences Between Two Viewpoints. Arch Acad Emerg Med. 2025;13(1):e17. doi:10.22037/aaem.v13i1.2402. PMID: 39670241; PMCID: PMC11635538.

14. Masud I, Halim SA, Shafi SM, Ramli NAA, Awang MZ, Subhan IA. What is Ibadah friendly hospital. J Br Islam Med Assoc. 2021;7(3):53-60.

15. Zawawi M, Othman K. An overview of Shari’ah compliant healthcare services in Malaysia. Malaysian J Consum Fam Econ. 2018;3(1):91-100.

16. Nayfeh A, Conn LG, Dale C, Fowler R. Exploring the quality of end-of-life care in the intensive care unit: a qualitative multiple case study approach with family members of Muslim patients. BMJ Open. 2025; 15(1):e087871. doi:10.1136/bmjopen-2024-087871. PMCID: PMC11749587.

17. Zagloul M, Mohammed B, Abufares N, Sandozi A, Farhan S, Anwer S, et al. Review of Muslim Patient Needs and Its Implications on Healthcare Delivery. J Prim Care Community Health. 2024;15: 21501319241228740. doi:10.1177/21501319241228740. PMID: 38270090; PMCID: PMC10812098.

18. Klimasiński MW. Spiritual care in the intensive care unit. Anaesthesiol Intensive Ther. 2021;53(4):350-7. doi: 10.5114/ait.2021.109920. PMID: 34714016; PMCID: PMC10165982.

19. Tareen M. Disclosure Practices in Muslim Patients and the Impact on End-of-Life Care: A Narrative Review. Am J Hosp Palliat Care. 2024:10499091241303684. doi:10.1177/10499091241303684. PMID: 39588585; PMCID: PMC12433535.

20. Hosseini FA, Momennasab M, Yektatalab S, Zareiyan A. The spiritual needs of surgical patients in Iranian hospital settings: a qualitative study. BMC Res Notes. 2025;18(1):155. doi:10.1186/s13104-025-07228-w.

21. Hatamipour K, Rassouli M, Yaghmaie F, Zendedel K, Majd HA. Spiritual needs of cancer patients: a qualitative study. Indian J Palliat Care. 2015;21(1):61-7. doi:10.4103/0973-1075.150190. PMID: 25709188; PMCID: PMC4332130.

22. Rassouli M, Shirinabadi Farahani A, Hatamipour K. Spiritual Needs of Cancer Patients in Iran. In: Büssing A, editor. Spiritual Needs in Research and Practice: The Spiritual Needs Questionnaire as a Global Resource for Health and Social Care. Cham: Springer International Publishing; 2021. p. 159-71.

23. Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qual Res Sport Exerc Health. 2019;11(4):589-97. doi: 10.1080/2159676X.2019.1628806.

24. Kakar ZUH, Rasheed R, Rashid A, Akhter S. Criteria For Assessing And Ensuring The Trustworthiness In Qualitative Research. Int J Bus Reflect. 2023;4:150-73. doi:10.56249/ijbr.03.01.44.

25. Ahmadi A, Zargaran A, Mohagheghzadeh A. Patient rights in the history of Persian and Islamic hospitals from beginning to 8 Century Hijri. J Islam Iran Tradit Med. 2012;3(3):334-40.

26. Mardiyati FY, Ayuningtyas D. Analysis of implementation standards of Sharia minimum services in the hospital: Case study at Sari Asih Sangiang Hospital 2018. J Indones Health Policy Adm. 2021;6(1):4.

27. Ngatindriatun N, Alfarizi M, Widiastuti T. Impact of Sharia hospital service standards and religiosity commitment on patient satisfaction and loyalty: insights from certified Sharia hospital in Indonesia. J Islam Account Bus Res. 2024. doi:10.1108/JIABR-12-2022-0344.

28. Miller AC, Khan AM, Hebishi K, Castro Bigalli AA, Vahedian-Azimi A. Ethical Issues Confronting Muslim Patients in Perioperative and Critical Care Environments: A Survey of Islamic Jurisprudence. Anesthesiol Clin. 2020;38(2):379-401. doi: 10.1016/j.anclin.2020.01.002. PMID: 32336391.

29. Saeed F, Kousar N, Aleem S, Khawaja O, Javaid A, Siddiqui MF, et al. End-of-Life Care Beliefs Among Muslim Physicians. Am J Hosp Palliat Care. 2015;32(4):388-92. doi: 10.1177/1049909114522687. PMID: 24526765.

30. Anderson RJ, Bloch S, Armstrong M, Stone PC, Low JT. Communication between healthcare professionals and relatives of patients approaching the end-of-life: A systematic review of qualitative evidence. Palliat Med. 2019;33(8):926-41. doi: 10.1177/0269216319852007. PMID: 31184529; PMCID: PMC6691601.

31. Miah S, Mangera A, Osman NI, Venugopal S, Catto J, Rosario D. Islam and the Urinary Stoma: A Contemporary Theological and Urological Dilemma. Eur Urol Focus. 2019;5(2):301-5. doi: 10.1016/j.euf.2017.06.015. PMCID: 28753875.

32. M Hussein A, Aboul Fadl S. Quality of life in Egyptian stoma patients. Egypt J Surg. 2001;20(3):597-605. PMID: 28759426.

33. Ismail SA, Hamid B, Sulistiadi W. Journey to shariah hospital: an Indonesian experience. KnE Life Sci. 2018:315–28-–28. doi: 10.18502/KLS.V4I9.3582.

34. Rababa M, Al-Sabbah S. The Use of Islamic Spiritual Care Practices Among Critically Ill Adult Patients: A Systematic Review. Heliyon. 2023. doi:10.1016/j.heliyon.2023.e13862. PMCID: PMC10006532.

35. Altimier L, Barton SA, Bender J, Browne J, Harris D, Jaeger CB, et al. Recommended standards for newborn ICU design. J Perinatol. 2023;43(Suppl 1):2-16. doi:10.1038/s41372-020-0766-2.

36. Zakaria A, Isa NM, Hairudin T, Ismail HN. The satisfaction of the users with the islamic design quality in instant hospitals for non-critical covid-19 patients in malaysia. J Islam Thought Civiliz. 2021;11(1):355-73. doi: 10.32350/JITC.111.19.

37. Katiman D, Shaikh Mohd Salleh SMS, Ismail H, Abu Shamsieh K. Exploring End-of-Life Issues and Determination of the Surrogacy Ladder in Malaysia. Environ-Behav Proc J. 2022;7(22):63-9. doi:10.21834/ebpj.v7i22.4150.

38. Melgaard SK, Neergaard MA. Medical students do not feel confident in managing palliative care as future doctors. Prog Palliat Care. 2020;28(3):201-6. doi: 10.1080/09699260.2019.1696007.

39. Mortell M. PATIENT Advocacy Among Saudi Arabian Adult Intensive Care Nurses: A Grounded Theory Study. 2018.

40. Assilmi KAT. Implementasi Fatwa Dsn-Mui No: 107/Dsn-Mui/X/2016 Tentang Pedoman Penyelenggaraan Rumah Sakit Berdasarkan Prinsip Syariah Di Rumah Sakit Qolbu Insan Mulia Batang: IAIN Pekalongan; 2022.

41. Samsudin MA, Kashim MIAM, Yahaya MZ, Ismail AM, Khalid RM, Lalulddin H, et al. The concept of establishing a Syariah Supervisory Committee in Malaysian hospitals. Procedia Soc Behav Sci. 2015; 174: 1202-6. doi: 10.1016/j.sbspro.2015.01.737.

42. Sadeghi-Gandomani H, Karimi Rozveh A. The role of spiritual care departments in Iranian hospitals: a holistic approach to healing. J Multidiscip Care. 2024;13(1):1-2. doi:10.34172/jmdc.1330.