Al-Turath Journal of Nursing (ATJN) Al-Turath Journal of Nursing is a peer-reviewed scientific journal that seeks to promote the development and exchange of knowledge directly relevant to all spheres of nursing practice. Journal content includes clinical topics, integrative or systematic literature reviews, research, and practice improvement initiatives that provide nurses globally with implications for translating new knowledge into practice. ATJN publishes 4 issues per year and accepts original articles, review papers, and case reports in different areas of nursing sciences. Al-Turath University is the publisher of ATJN. The journal publishes under the Creative Commons Attribution 4.0 International (CC-BY) license. We use Turnitin to prevent plagiarism and ensure the originality of submitted manuscripts. Journal Identity Journal Title: Al-Turath Journal of Nursing Initials: ATJN Abbreviation: Al-Turath Med. J. P-ISSN: 3080-5759 E-ISSN: 3080-5767 Discipline: Science (Multidisciplinary) Language: English Country: Iraq Metrics & Publisher Frequency: Quarterly | 4 issues per year Publication Months: March, June, September, December Accessibility: Open Access Media: Printed & Online Publisher: Al-Turath University Editor-in-Chief: Prof. Dr. Hala Saadi Abduwahid Acceptance Rate: 45% Citation Analysis: SCOPUS | WoS | Google Scholar Submission Guidelines First-time Users: To register, please click on "Register" in the navigation bar at the top of the page and fill in the required information. After successful registration, you will receive an email with instructions to verify your account. Important: If you have received an email from us containing an assigned user ID and password, please do not register again. Simply use that information to log in instead. You can change your username and password after registration. Repeat Users: Click the "Login" button in the menu above to access your account. Authors: Log in as an "Author" by clicking the "Login" button. You can then submit your manuscript and track its progress through the system. Reviewers: Log in as a "Reviewer" by clicking the "Login" button. This will allow you to view or download the manuscripts assigned to you for review and submit your comments to the editor and authors. To Change Your Username and/or Password: After registration, you can update your contact information, username, and password at any time. Simply log in to the system and click "Update My Information" in the navigation bar at the top of the page.
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Prevalence, Causes, and Prevention Strategies of Medication Errors in Nursing Practice in Iraqi Teaching Hospitals: A Mixed-Methods Study
Background: Medication errors are a leading preventable cause of patient harm worldwide and remain under-characterized in Iraqi teaching hospitals, particularly through approaches that triangulate documented incident data with frontline nurse perspectives. Aim: To estimate the documented prevalence of medication errors and characterize their causes and proposed prevention strategies in three Iraqi teaching hospitals using a mixed-methods approach. Methods: A sequential explanatory mixed-methods study was conducted between October 2024 and February 2026, reporting in line with the Good Reporting of A Mixed Methods Study (GRAMMS) framework [1] and the STROBE statement [2] for the quantitative components. The protocol was prospectively registered (ATU-RIR-2025-09, registered 4 August 2025). Phase 1 was a 12-month retrospective review of all formally reported medication-error incident reports (n = 480) across the medical–surgical, intensive care, and emergency wards of three teaching hospitals (Salah Al-Din, Baghdad, Kirkuk). Each event was classified by stage in the medication-use process (prescribing, transcription, dispensing, administration, monitoring), by error type, by NCC MERP severity index (Categories A–I), and by Reason's Swiss-Cheese contributory factors. Phase 2 was a cross-sectional survey of 350 ward nurses (320 complete responses, 91.4%) using a structured 56-item instrument covering perceived causes, reporting behavior, and prevention strategies. Phase 3 integrated quantitative findings against the nurse-reported causes to produce a hospital-level prevention roadmap. Results: The documented medication-error rate was 8.4 per 1,000 patient-days (95% CI 7.7–9.2). By stage, 41.0% of errors originated in prescribing/transcription, 38.1% in administration, 12.5% in dispensing, and 8.4% in monitoring. Wrong-dose (28.5%), wrong-time (21.0%), and omitted-dose (16.5%) were the most common error types. NCC MERP severity distribution was: Category A–B 30.4%, C–D 56.0%, E–F 11.7%, G–I 1.9% (no fatal events were captured). Nurse-reported leading causes were heavy workload (78.4%), distractions during administration (71.9%), look-alike/sound-alike packaging (68.4%), illegible prescriptions (62.5%), and lack of double-check protocols (54.7%). Of nurses, 52.2% reported having witnessed unreported errors in the prior six months; the principal deterrents were fear of disciplinary action (61.3%) and perceived lack of feedback on submitted reports (54.7%). Conclusion: Medication errors in Iraqi teaching hospitals occur at rates comparable to international benchmarks, with most events of low-to-moderate severity but with substantial under-reporting and a clear concentration of contributory factors at the workload, packaging, prescription-legibility, and double-check-protocol levels. A hospital-level prevention roadmap should prioritize a non-punitive reporting culture, structured double-check protocols for high-alert medications, packaging-driven distinguishability of look-alike products, and protected medication-administration time.
Medication Errors; Patient Safety; Nursing; Iraq; Risk Management, Healthcare; Mixed-Methods Research
Copyright (c) 2026 THIS IS AN OPEN ACCESS ARTICLE UNDER THE CC BY LICENSE http://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by/4.0
Patient Safety Culture and Nurses' Compliance with Healthcare-Associated Infection Control Standards in Iraqi Teaching Hospitals: A Multicenter Cross-Sectional Correlational Study
Background: Healthcare-associated infections (HAIs) remain a leading cause of preventable harm in low- and middle-income hospitals. Patient safety culture is a recognized organizational determinant of nurses' adherence to infection-control standards, but multicenter Iraqi data linking the two are limited. Aim: To characterize patient safety culture among nurses in four Iraqi teaching hospitals using the AHRQ Hospital Survey on Patient Safety Culture (HSOPSC), measure observed compliance with HAI-control standards, and quantify the association between safety culture and compliance. Methods: A multicenter cross-sectional correlational study was conducted between September 2025 and February 2026 across the medical–surgical, intensive care, emergency, and neonatal wards of four teaching hospitals in central and northern Iraq, in line with the STROBE statement. The protocol was prospectively registered (ATU-RIR-2025-14, registered 5 September 2025). The HSOPSC (42 items, 12 dimensions) was administered to 380 eligible nurses; 358 returned complete responses (response rate 94.2%). Direct unobtrusive observation captured 1,200 hand-hygiene opportunities using the WHO Five Moments framework, alongside structured audits of personal protective equipment (PPE), sharps and waste management, isolation precautions, and environmental hygiene. Pearson correlations and multivariable linear regression with cluster-robust standard errors at the hospital level were used to identify predictors of total HAI compliance. Results: Overall HSOPSC positive response rate was 56.4% across 12 dimensions, with the highest rates for teamwork within units (78.4%) and organizational learning (71.2%), and the lowest for non-punitive response to error (38.1%) and staffing adequacy (42.7%). Mean overall HAI compliance was 68.5% (95% CI 66.4–70.6); hand hygiene compliance was 64.2%, PPE 71.4%, sharps and waste 78.6%, isolation precautions 65.1%, and environmental hygiene 63.2%. Total HSOPSC score correlated moderately with overall HAI compliance (r = 0.42, p < 0.001); the strongest dimension-level correlations were management support for safety (r = 0.46) and feedback and communication (r = 0.41). In the adjusted model, total HSOPSC score (β = 0.34, p < 0.001), prior infection-control training (β = 0.21, p < 0.001), and ICU posting (β = 0.17, p = 0.004) independently predicted higher HAI compliance. Conclusion: Patient safety culture is a meaningful, modifiable predictor of HAI compliance among Iraqi teaching-hospital nurses. Hospital management should prioritize improvements in non-punitive error reporting, staffing adequacy, and management visibility around safety, alongside repeated infection-control training. The two-instrument framework used here is feasible for routine quality monitoring.
Cross-Infection; Hand Hygiene; Hospitals, Teaching; Iraq; Nurses; Patient Safety; Safety Culture
Artificial Intelligence Decision Support and Nursing Care Quality in Iraqi Teaching Hospitals: A Multicenter Cluster Quasi-Experimental Study
Background: Clinical decision-making in nursing is a complex, high-stakes activity, yet evidence on artificial-intelligence-based clinical decision support systems (AI-CDSS) inside Iraqi teaching hospitals remains scarce. Aim: I evaluated the effect of an AI-CDSS intervention on the quality of nursing care in three Iraqi teaching hospitals and identified moderating contextual factors. Methods: A multicenter, ward-level cluster-randomized, quasi-experimental pre–post study was conducted from January to August 2025 across 18 wards (six per hospital) in three teaching hospitals in central Iraq, reporting in line with the CONSORT-AI and DECIDE-AI extensions. The protocol was retrospectively recorded in the the Al-Turath University Research Implementation Registry (ATU-RIR-2025-04). Eighteen wards were randomly allocated 1:1 (nine per arm) using block randomization stratified by hospital, with concealed allocation by an independent statistician; sample-size calculation incorporated an intracluster correlation coefficient (ICC) of 0.07 and a design effect of 2.02. A total of 280 registered nurses received either the AI-CDSS intervention (n = 140) or matched-intensity control content (n = 140) for 16 weeks. The intervention was a gradient-boosted, locally recalibrated AI module embedded in the electronic nursing record (pre-deployment AUROC 0.84, 95% CI 0.81–0.87; week-8 calibration slope 0.93–0.99 across sites). Primary analyses used linear mixed-effects models with random intercepts for hospital and ward; sensitivity analyses used GEE with cluster-robust standard errors. Subgroup fairness audits were performed across sex, age, and ward type. Analyses followed an intention-to-treat principle (3.2% missingness, multiple imputation). Results: In mixed-effects analysis, decision accuracy increased by 12.6 percentage points (95% CI 9.8–15.4) in the AI-CDSS arm relative to controls (Bonferroni-adjusted p < 0.001; ICC 0.06). Medication errors fell by 3.7 events per 1000 patient-days (95% CI 2.9–4.5; ICC 0.08). The QNCI rose by 14.5 points (95% CI 11.7–17.3). Subgroup audits revealed no major effect-size disparities by sex or age. Patient-level safety outcomes (falls, pressure ulcers) showed favorable trends but did not reach significance. Conclusion: AI-CDSS implementation showed initial associations with improved nursing process measures in Iraqi teaching hospitals, with no significant effect on patient-level safety outcomes within the 16-week window. Because primary measurement relied partly on clinical vignettes and the QNCI is investigator-developed, replication with longer follow-up, real-bedside outcomes, external QNCI validation, prospective registration, and full economic evaluation is required before any scaling decision.
Artificial Intelligence; Clinical Decision-Making; Decision Support Systems, Clinical; Iraq; Nursing Care; Patient Safety
The Impact of Nurse-Patient Communication on Patient Outcomes and Satisfaction in Acute Care Settings
Background: Effective nurse-patient communication is fundamental to quality healthcare delivery. Despite its recognized importance, variations in communication practices continue to affect patient outcomes across healthcare settings. Objective: This study aimed to examine the relationship between nurse-patient communication quality and patient outcomes, including patient satisfaction, medication adherence, length of hospital stay, and readmission rates in acute care settings. Methods: A cross-sectional descriptive study was conducted with 450 patients and 120 registered nurses across three acute care hospitals. Data were collected using validated instruments including the Communication Assessment Tool (CAT), Patient Satisfaction Questionnaire (PSQ-18), and hospital administrative records. Results: Significant positive correlations were found between communication quality scores and patient satisfaction (r = 0.72, p < 0.001). Units with higher communication ratings demonstrated 23% shorter average length of stay and 31% lower 30-day readmission rates. Patient-reported understanding of discharge instructions was significantly higher when nurses employed teach-back methods (M = 4.6 vs. M = 3.2, p < 0.001). Conclusion: Quality nurse-patient communication significantly impacts multiple patient outcome measures. Implementing structured communication training and standardized protocols can enhance patient safety and satisfaction while reducing healthcare costs.
nurse-patient communication, patient outcomes, patient satisfaction, acute care nursing, therapeutic communication, healthcare quality
Copyright (c) 2025 THIS IS AN OPEN ACCESS ARTICLE UNDER THE CC BY LICENSE http://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by/4.0
Effect of Nurse-Delivered Mindfulness-Based Stress Reduction on Postpartum Depression among Primiparous Women: A Randomized Controlled Trial
Background: Postpartum depression affects 10-20% of new mothers. Non-pharmacological interventions are preferred by breastfeeding mothers, yet evidence for mindfulness-based approaches remains limited. Objective: To evaluate nurse-delivered Mindfulness-Based Stress Reduction on depressive symptoms and stress biomarkers among primiparous mothers with elevated PPD risk. Methods: Single-center parallel RCT (n = 90). Mindfulness-Based Stress Reduction group (n = 45): eight 90-minute weekly sessions; Control (n = 45): standard postpartum care. Primary: EPDS at 12 weeks. Secondary: salivary cortisol, GAD-7, SF-12. Analysis: LMM, ITT. Results: Mindfulness-Based Stress Reduction achieved clinically significant EPDS reduction (14.2→7.4 vs 14.5→11.8; difference: -4.1; 95% CI: -5.8 to -2.4; p < .001; d = 1.12). The 4.1-point improvement approximates the clinical efficacy of first-line antidepressants, supporting MBSR as a viable alternative for breastfeeding mothers. Cortisol decreased more in MBSR (d = 0.89). Depression history mothers showed larger effects (d = 1.45; interaction p = .024). Remission rate: 82.2% vs 37.8% (NNT = 2.3). Conclusion: Nurse-delivered MBSR significantly reduces PPD symptoms and stress biomarkers. Findings support MBSR as a first-line non-pharmacological intervention.
Nurse-Delivered; Mindfulness; postpartum depression; primiparous
Nurse-Led Mind–Body Intervention and Its Biobehavioral Effects on Postpartum Mental Health: A Randomized Controlled Trial
Background: Postpartum depression (PPD) affects 10–20% of mothers with significant consequences for maternal-infant dyads. HPA axis dysregulation represents a key neurobiological mechanism. Non-pharmacological interventions are often preferred by breastfeeding mothers. Objective: To evaluate a nurse-led mind-body intervention on biobehavioral outcomes (depressive symptoms and cortisol) among primiparous mothers with elevated PPD risk. Methods: Single-center parallel-group RCT with 1:1 allocation and assessor-blinded evaluation. Ninety primiparous mothers (aged 18–40) with EPDS 10–19 at 2 weeks postpartum. Mind-body group (n=45): Eight 90-minute weekly sessions combining mindfulness, slow breathing (6/min), yoga, and loving-kindness. Control (n=45): Standard postpartum care. Results: 84 participants (93.3%) completed follow-up. EPDS: 14.2→7.4 (mind-body) vs 14.5→11.8 (control); between-group difference −4.1 points (95% CI: −5.8 to −2.4; d=1.12; p<.001). Cortisol: 18.5→12.4 vs 18.2→16.5 nmol/L (d=0.89; p<.001). Cortisol mediated 28.4% of EPDS improvement (partial mediation). Remission: 82.2% vs 37.8% (NNT=2.3). Depression history was associated with larger effects (d=1.45; interaction p=.024). Conclusions: Nurse-led mind-body intervention produced clinically significant biobehavioral effects, with EPDS reductions within ranges reported for pharmacotherapy, supporting consideration as a first-line intervention option for at-risk postpartum mothers.
postpartum depression; mind-body intervention, Biobehavioral Effects
Comparative Effectiveness of Teach-Back Method Versus Standard Education on Glycemic Control and Self-Management in Adults with Type 2 Diabetes: A Pragmatic Randomized Controlled Trial
Background: Effective diabetes education is essential for glycemic control, yet 40-50% of patients fail to achieve targets despite standard education. Objective: To compare teach-back method versus standard education on glycemic control and self-management in adults with type 2 diabetes. Methods: Pragmatic RCT (n = 80) at outpatient diabetes clinics. Teach-back group (n = 40) received four 60-minute sessions with comprehension verification; control (n = 40) received identical content via standard approach. Primary: HbA1c at 6 months. Analysis: Linear mixed-effects models, ITT. Results: Teach-back achieved clinically significant HbA1c reduction (8.82%→7.42% vs 8.88%→8.28%; difference: -0.80%; 95% CI: -1.18 to -0.42; p < .001; d = 0.94). The 0.80% improvement exceeds the 0.50% clinically meaningful threshold and approximates the magnitude achieved with adding a second-line oral hypoglycemic agent. DSMQ improved more in teach-back (d = 0.87). Lower education patients showed larger effects (d = 1.24 vs d = 0.64; interaction p = .031). Conclusion: Teach-back significantly improves glycemic control and self-management. Findings support integration into routine diabetes nursing practice
Teach-back method; standard education; Glycemic Control; self-management;; type 2 diabetes
Immunomodulatory Effects of Systematic 2-Hourly Repositioning on IL-6 and TNF-α in Non-Septic Mechanically Ventilated ICU Patients: A Single-Center Randomized Controlled Trial
Background: Systemic inflammation contributes to morbidity in mechanically ventilated ICU patients, yet the immunomodulatory effects of routine nursing interventions such as repositioning remain poorly understood. Objective: To evaluate systematic 2-hourly repositioning effects on serum IL-6 and TNF-α in non-septic mechanically ventilated patients. Methods: Parallel-group RCT (n=60) following CONSORT guidelines. Experimental group received systematic repositioning every 2 hours; control received routine care (mean 4.6-hourly). IL-6 and TNF-α measured via blinded ELISA at days 1, 3, and 7. Linear mixed-effects models with Bonferroni correction (α=0.025). Results: IL-6 decreased 31% in experimental group versus 11% in control; Cohen's d=1.19 (95% CI: 0.64-1.74). TNF-α: d=0.82 (95% CI: 0.29-1.35). Respiratory failure patients showed larger effects (d=1.42) than post-operative patients (d=0.78). Conclusion: Systematic repositioning significantly reduces pro-inflammatory cytokines in non-septic patients. Findings require validation in larger, multicenter trials including septic populations and powered for clinical endpoints.
Systematic 2-Hourly Repositioning; interleukin-6; tumor necrosis factor-α; mechanical ventilation; intensive care unite; mechanotransduction
Knowledge, Attitudes, and Use of Generative AI (ChatGPT) Among Nurses in Iraqi Teaching Hospitals: A Multicenter Cross-Sectional Survey
Background: The rapid uptake of generative artificial intelligence (GenAI) tools, particularly ChatGPT, has outpaced institutional guidance in many low- and middle-income health systems. Evidence on Iraqi nurses' knowledge, attitudes, and clinical use of these tools is limited. Aim: To assess Iraqi nurses' knowledge, attitudes, and self-reported clinical use of ChatGPT, and to identify factors associated with its use. Methods: A multicenter cross-sectional survey was conducted between January and March 2026 in three teaching hospitals in central Iraq, in line with the STROBE statement. The protocol was prospectively registered (ATU-RIR-2025-19, registered 12 December 2025). A 50-item self-administered questionnaire covering demographics, knowledge of GenAI (15 items, multiple-choice), attitudes (20 Likert items), and use practices (15 items) was developed and pilot-validated (Cronbach's α: knowledge 0.81, attitudes 0.84). A stratified sample of 412 registered nurses across medical–surgical, intensive care, and emergency wards was approached; 387 returned complete responses (response rate 93.9%). Descriptive statistics, t-tests/ANOVA for group differences, and a multivariable logistic regression model (with cluster-robust standard errors at the hospital level) were used to identify predictors of ChatGPT use. Results: Mean knowledge score was 64.2 ± 14.8 of 100, with the lowest scores on data privacy and patient confidentiality (38.4% correct). Attitudes were cautiously positive (mean 3.43 ± 0.71 on a 5-point scale): 64.1% agreed GenAI could enhance work efficiency, but 51.4% worried it might erode clinical judgment. In total, 38.0% (147/387) reported any clinical use of ChatGPT in the prior six months, most commonly for literature search (28.2%), drug information (22.0%), and patient-education materials (18.1%). The strongest concerns were information accuracy (78.0%), patient privacy (72.1%), and professional liability (67.7%). In the adjusted model, age <30 years (aOR 2.12, 95% CI 1.34–3.36), high English proficiency (aOR 2.84, 1.78–4.52), and prior digital health training (aOR 2.41, 1.55–3.74) were independent predictors of clinical use. Conclusion: Iraqi nurses are using ChatGPT in clinical contexts despite moderate knowledge and unresolved concerns about accuracy and privacy. Hospitals should issue institutional GenAI policies, integrate AI literacy into nursing curricula, and establish patient-data safeguards before deployment broadens further.
Artificial Intelligence; ChatGPT; Cross-Sectional Studies; Iraq; Nurses; Patient Privacy.
Effectiveness of a Nurse-Led Educational Program on Medication Adherence and Glycemic Control in Adults with Type 2 Diabetes Mellitus: A Quasi-Experimental Study
Background: Type 2 diabetes mellitus (T2DM) is a leading cause of preventable morbidity in Iraq, and medication non-adherence is a known driver of poor glycemic control in the region. Evidence on structured nurse-led educational interventions in Iraqi outpatient diabetes clinics is limited. Aim: To evaluate the effectiveness of a six-week nurse-led structured educational program on medication adherence, glycemic control, self-care behaviors, and disease knowledge in Iraqi adults with T2DM. Methods: A two-arm pre-post quasi-experimental study was conducted between August 2025 and February 2026 in the diabetes outpatient clinics of two Iraqi teaching hospitals (Salah Al-Din General Teaching Hospital and Baghdad Teaching Hospital), reporting in line with the TREND statement [1]. The protocol was prospectively registered (ATU-RIR-2025-08, registered 22 July 2025). Adults aged 30–70 years with HbA1c ≥7.5% on ≥6 months of oral antidiabetic therapy were enrolled by alternating allocation (160 enrolled; 144 completed [90.0%]; intervention n = 73, control n = 71). The intervention comprised six weekly nurse-led 60-minute group sessions covering disease pathophysiology, medication management, self-monitoring, diet, physical activity, foot care, and complication screening, supplemented by an Arabic patient handbook and weekly telephone follow-up. Controls received routine monthly clinic visits. Outcomes—Morisky Medication Adherence Scale-8 (MMAS-8), HbA1c, Diabetes Knowledge Test-2 (DKT-2), and the Summary of Diabetes Self-Care Activities (SDSCA)—were measured at baseline and at week 12. Analyses used ANCOVA adjusted for baseline values, age, and sex, with intention-to-treat principles and 4.4% missing data handled by multiple imputation. Results: Groups were balanced at baseline. At week 12, HbA1c fell from 9.4 ± 1.3% to 8.1 ± 1.2% in the intervention arm and from 9.3 ± 1.2% to 9.0 ± 1.4% in controls (adjusted between-group difference −1.0%, 95% CI −1.4 to −0.6, p < 0.001). MMAS-8 score increased by 1.8 (95% CI 1.4–2.2) in the intervention arm vs 0.3 (95% CI −0.1 to 0.7) in controls (between-group p < 0.001). DKT-2 knowledge scores improved by 27.4% in the intervention arm vs 4.1% in controls. SDSCA self-care scores improved significantly for diet, exercise, and foot care in the intervention arm only. Conclusion: A structured six-week nurse-led educational program was associated with clinically meaningful improvements in glycemic control, medication adherence, knowledge, and self-care in Iraqi adults with T2DM. The program is low-cost and deliverable within existing outpatient nursing infrastructure, and warrants larger replication with longer follow-up to assess durability and effect on diabetes-related complications.
Diabetes Mellitus, Type 2; Glycated Hemoglobin; Medication Adherence; Nursing Education; Patient Education; Iraq.
Employed Women's Knowledge and Health Beliefs About Osteoporosis Prevention : A Comparative Study
Background: Osteoporosis is a chronic skeletal disease characterized by decreased bone density and deterioration of bone microstructure, leading to an increased risk of fractures and serious health consequences, particularly among women. Understanding women’s knowledge and health beliefs is essential for effective osteoporosis prevention; therefore, this study aimed to compare employed women’s knowledge and health beliefs regarding osteoporosis prevention based on type of residence (urban versus rural). Methods: A cross-sectional study was conducted at AL-Dewaynia Governorate , Iraq, from December 20, 2024, to May 1, 2025. A convenience sample of 200 employed women was recruited. Data were collected using the Osteoporosis Health Belief Scale (OHBS) and a structured questionnaire for socio-demographic characteristics. Anthropometric measurements were obtained to calculate body mass index (BMI). Data were analyzed using descriptive and inferential statistical methods. Results: The mean age of participants was 42.2 ± 6.3 years, with 53% aged 35–44 years. Significant differences were observed between urban and rural women in knowledge and health beliefs related to osteoporosis prevention. Urban women reported higher perceived severity of osteoporosis, greater perceived benefits of exercise and calcium intake, and higher health motivation, whereas rural women experienced greater barriers to exercise and lower health motivation. Conclusion: The study revealed significant disparities in knowledge and health beliefs about osteoporosis prevention between urban and rural employed women. These findings highlight the need for targeted educational interventions, particularly in rural areas, to improve health literacy, motivation, and engagement in osteoporosis preventive behaviors.
Osteoporosis; Health beliefs; Knowledge; Employed women
Prevalence, Patterns, and Risk Factors of Workplace Violence Against Emergency Department Nurses in Iraqi Government Hospitals: A Multicenter Cross-Sectional Study
Background: Emergency department (ED) nurses face among the highest rates of workplace violence in healthcare. In Iraqi public hospitals, the combination of overcrowded waiting areas, intermittent security presence, and limited de-escalation training plausibly increases this risk, but multicenter prevalence and risk-factor data are limited. Aim: To estimate the 12-month prevalence and patterns of workplace violence against ED nurses in five Iraqi government teaching hospitals, characterize reporting behavior and short-term consequences, and identify modifiable risk factors. Methods: A multicenter cross-sectional survey was conducted between October 2025 and February 2026 across the EDs of five government teaching hospitals in central and northern Iraq, in line with the STROBE statement [1]. The protocol was prospectively registered (HHI-RIR-2025-22, registered 18 September 2025). The Workplace Violence in Health Care Instrument (WVHI) [2] was administered alongside a 28-item demographic, occupational, and consequence questionnaire to 318 eligible ED nurses; 287 returned complete responses (response rate 90.3%). Descriptive statistics, chi-square tests, and multivariable binary logistic regression with cluster-robust standard errors at the hospital level were used to identify independent predictors of any-violence exposure. Results: The 12-month prevalence of any workplace violence was 67.6% (95% CI 62.0–72.8). Verbal abuse affected 64.5% of nurses, physical assault 17.4%, and sexual harassment 8.0%; 14.3% had experienced both verbal and physical violence. The most common perpetrators were patients' relatives (53.1% of incidents), and the most common locations were the triage area and waiting room. Only 31.4% of incidents were formally reported, with fear of retaliation (47.4%) and a perception of no actionable response (42.3%) being the leading deterrents. Short-term consequences included sleep disturbance (52.1%), reduced job satisfaction (49.5%), at least one short-term sick day (28.6%), and intent to leave the ED (33.4%). In the adjusted model, lack of security presence on the unit (aOR 2.74, 95% CI 1.62–4.62), no prior de-escalation training (aOR 2.31, 1.43–3.74), <5 years of ED experience (aOR 2.08, 1.27–3.41), and ≥10 night shifts per month (aOR 2.36, 1.45–3.84) were the strongest independent predictors. Conclusion: Two in three Iraqi ED nurses experience workplace violence in any given year, mostly verbal and predominantly under-reported. Hospital management should prioritize visible security in triage and waiting areas, mandatory de-escalation training, simplified non-punitive reporting pathways, and structured post-incident psychological support.
Workplace Violence; Emergency Service, Hospital; Nurses; Iraq; Risk Factors; Occupational Health.
The Role of Artificial Intelligence–Assisted Clinical Decision Support Systems in Enhancing Nursing Practice and Patient Outcomes in Iraqi Hospitals
Clinical decision support systems (CDSSs) augmented by artificial intelligence (AI) are revolutionising modern health care, but little is known about their use in Iraqi tertiary hospitals. Nurses are the primary decision-makers in clinical practice, and poor decision support can pose a patient safety risk. Objective: The aim of this study was to compare the effectiveness of AI-supported CDSS with traditional (non-AI) methods in improving nursing practice and certain patient outcomes in tertiary hospitals in three Iraqi governorates. Methods: A prospective, comparative, cross-sectional design was used, involving 294 registered nurses grouped into three categories: Group I (non-CDSS, n = 98), Group II (simple rule-based CDSS, n = 96), and Group III (AI-assisted CDSS, n = 100). Eight-month data (February-September 2023) was gathered via structured observation checklists, validated measures of nursing practice, hospital records and patient satisfaction surveys. Data were analysed using one-way ANOVA with Bonferroni post hoc tests (p < 0.05). Results: AI-CDSS implementation produced marked improvements in clinical decision accuracy (84.7 ± 6.1% vs. 61.4 ± 8.2% in controls; p < 0.001), substantial reductions in medication error rates (2.1 ± 0.9 vs. 6.8 ± 1.9 per 100 orders; p < 0.001), shorter hospital stays (6.4 ± 1.7 vs. 9.8 ± 2.4 days; p < 0.001), and higher patient satisfaction scores (86.5 ± 6.9 vs. 63.2 ± 9.8; p < 0.001). The main challenges for implementation were the lack of digital infrastructure (74.5% for Group I) and AI-literacy training for nurses (81.6%). Conclusion: AI-powered CDSS resulted in improved nursing practice and patient outcomes in Iraqi hospitals. Continued infrastructure development and AI literacy training for nursing staff are vital for future use.
artificial intelligence; clinical decision support systems; nursing; patient outcomes; hospitals in Iraq; medication safety; e-health
Impact of Nurse Burnout and Workload on Patient Safety and Quality of Care in Critical Care Units in Iraq
Background: Burnout is a worldwide occupational hazard, especially in resource-stretched health systems. In Iraqi intensive care units (ICUs), the increasing workloads, resource scarcity and institutional support systems make the environment a perfect storm for burnout; however, few quantitative studies have linked burnout with patient safety events in the Iraqi ICU literature. Objective: The present study aimed to investigate associations between nurse burnout, workload, patient safety events and quality of care outcomes in intensive care units (ICUs) of tertiary hospitals in Iraq. Methods: We conducted a cross-sectional, multi-site study, involving 294 ICU nurses from eight tertiary hospitals in the governorates of Baghdad, Basra and Salah al-Din. The Maslach Burnout Inventory - Human Services Survey (MBI-HSS) was used to measure burnout. Nurses were divided into low (n = 86), moderate (n = 112) and high (n = 96) burnout categories. Data on patient safety and quality were extracted from hospital surveillance systems and patient care records for a concurrent six-month period. Predictors of high burnout were determined by binary logistic regression. Results: High-burnout nurses managed significantly more patients per shift (9.8 ± 2.1 vs. 5.4 ± 1.2; p < 0.001) and worked longer weekly hours (58.7 ± 6.3 vs. 44.2 ± 5.1; p < 0.001). Medication errors (6.7 ± 1.8 vs. 1.8 ± 0.7 per 100 orders), patient falls (4.3 ± 1.1 vs. 0.9 ± 0.4 per 100 bed-days), and 30-day mortality indices (13.4 ± 2.8% vs. 5.1 ± 1.6%) were substantially higher in the high-burnout group (all p < 0.001). Logistic regression identified patient load ≥ 8 per shift (OR = 4.62; 95% CI: 2.91–7.34) and weekly hours ≥ 56 (OR = 3.87; 95% CI: 2.43–6.16) as the strongest risk factors for high burnout. Conclusion: Nurse burnout is strongly and negatively related to patient safety and quality of care in Iraqi ICUs. Evidence-based workload management policies, institutional psychological support strategies and mentoring programs by peers should be developed.
nurse burnout; workload; patient safety; quality of care; intensive care unit; Iraq; Maslach Burnout Inventory; medication errors
The Role of Nurses in Infection Prevention and Control: Post-COVID-19 Challenges and Practices in Iraqi Healthcare Systems
Background: COVID-19 has had a significant impact on global health care, revealing significant deficiencies in infection prevention and control (IPC) systems and nursing capacities, especially in low- and middle-income settings like Iraq. Nurses are at the forefront of IPC implementation, but little is known about how the pandemic has long-term reshaped their knowledge, practices and the enabling factors in the Iraqi context. This study sought to compare IPC knowledge and practice adherence, healthcare-associated infection (HAI) prevalence and other barriers across three groups of nurses - pre-COVID, COVID-19 era, and post-COVID - in Iraq's hospitals. Methods: A cross-sectional multi-site design was used. A sample of 294 registered nurses from eight tertiary-care hospitals in Baghdad, Basra, Salah al-Din, and Kirkuk governorates were divided into three cohorts based on the time period of their data collection: Pre-COVID (n=97), COVID-Era (n=101), and Post-COVID (n=96). We used a validated IPC knowledge questionnaire, a World Health Organization (WHO)-compatible direct-observation practice assessment tool, and HAI surveillance data from participating hospitals. One-way ANOVA and Tukey post-hoc tests, and chi-squared tests were performed. Results: IPC composite knowledge scores improved significantly from Pre-COVID (52.4 ± 9.8) through COVID-Era (71.6 ± 8.4) to Post-COVID (81.3 ± 7.2) (p<0.001). Hand hygiene compliance rose from 61.4 ± 10.2% to 92.8 ± 5.7% (p<0.001). Overall HAI rates declined from 14.8 ± 3.6% to 5.9 ± 1.9% (p<0.001), with corresponding falls in CLABSI (4.8 to 1.6 per 1,000 device-days), VAP, CAUTI, and SSI rates. IPC fatigue was highest in COVID-Era (56.4%) and decreased post-pandemic (32.3%). Widespread availability of PPE rose from 38.1% to 91.7% (p<0.001). Conclusion: COVID-19 inadvertently provided the impetus for ongoing IPC improvements in Iraq's hospitals. There remain issues with staffing levels and fatigue, which highlight the need for structured strategies to consolidate and build on post-pandemic gains, and to focus on long-term workforce resilience in nursing.
infection prevention and control; COVID-19 pandemic; nursing practice; healthcare-associated infections; Iraq; hand hygiene; PPE compliance
The Relationship Between Evidence-Based Nursing Practice and Patient Recovery Outcomes in Hospital Settings in Iraq
Evidence-based nursing practice (EBNP) combines the best current research evidence with clinical and patient values to inform practice. While EBNP is known to enhance patient outcomes in global health care, EBNP implementation in Iraq is not uniformly adopted by nurses, due to research infrastructure and cultural barriers. Aim: This research explored the association of EBNP adoption and patient recovery in Iraqi hospitals, and determined the main factors impeding and facilitating the adoption of EBNP among nurses. Methods: This cross-sectional, multi-site study included 294 registered nurses in seven Iraqi teaching and district hospitals in Baghdad, Diyala and Salah al-Din governorates. EBNP was assessed via the Evidence-Based Practice Questionnaire (EBPQ) and participants were divided into low (n = 91), moderate (n = 108) and high (n = 95) EBNP adoption groups. Recovery outcomes were collected via hospital records during the ongoing six-month study. Results: High-EBNP nurses were associated with markedly shorter hospital stays (6.2 ± 1.7 vs. 10.4 ± 2.8 days; p < 0.001), substantially lower 30-day readmission rates (7.4 ± 2.3% vs. 19.8 ± 4.6%; p < 0.001), superior pain management adequacy (86.4 ± 7.1 vs. 58.3 ± 10.2; p < 0.001), and lower inpatient mortality (3.0 ± 1.1% vs. 7.2 ± 2.1%; p < 0.001). Lack of access to research literature (82.4%), lack of time to read research (78.0%) and lack of research skills training (76.9%) were the most frequently identified barriers in the low-EBNP group. Conclusion: EBNP use is strongly correlated with a better recovery profile for patients in various outcome measures in Iraqi hospitals. Organisational approaches such as research skills training, study weeks, journal clubs and EBNP mentorship schemes are needed to progressively increase EBNP adoption and its resulting benefits to patients.
evidence-based nursing practice; patient recovery; hospital outcomes; Iraq; EBPQ; clinical guidelines; nursing-sensitive indicators; research utilisation
Bacterial Colonization and Histopathological Changes in Foreskin Tissue of Circumcised Children
Background: The penile foreskin is a retractable fold of skin covering the glans and is rich in microbial flora. Circumcision, one of the most common pediatric procedures performed for cultural, religious, or medical reasons (such as pathological phimosis), removes this tissue and may alter local microbial colonization and infection risk. Post-operative wound infections remain a concern, with both Gram-positive and Gram-negative bacteria implicated This study aims to identify the bacterial species colonizing the foreskin of young children and to examine the histopathological effects of these microbes on foreskin tissue. Methods: Foreskin samples were collected from 49 boys (aged 1 day to 12 years) undergoing circumcision. Prior to excision, a sterile swab of the inner foreskin was taken and cultured on nutrient media to isolate bacteria. Isolates were identified using biochemical tests (e.g. catalase) and confirmed with an automated VITEK© system. Foreskin tissue specimens were fixed in 10% formalin, processed and embedded in paraffin, sectioned at 6 μm, and stained with hematoxylin and eosin (H&E) for histological examination. Results: Bacterial growth was obtained from 40/49 (81.6%) swabs. The most common isolates were Staphylococcus aureus (33%) and Escherichia coli (30%), followed by Klebsiella pneumoniae (15%), Pseudomonas aeruginosa (12%), and Proteus mirabilis (10%). Microscopic examination of the foreskin tissue revealed no significant age-related differences in baseline skin structure. However, samples with bacterial colonization showed notable inflammatory and degenerative changes. There was subepidermal inflammatory cell infiltration, vascular congestion, hemorrhage, and focal necrosis of the stratified squamous epithelium, along with fragmentation of the keratin layer and collagen fibers in the dermis. E. coli in particular was associated with intense dermal inflammation, edema, and accumulation of neutrophils, whereas other aerobes (e.g. S. aureus, P. mirabilis, K. pneumoniae) tended to cause milder superficial changes. These findings indicate that bacteria play a central role in post-circumcision tissue damage and inflammation. Conclusion: The foreskin of children is frequently colonized by potentially pathogenic bacteria, notably S. aureus and E. coli. Circumcision samples demonstrated histopathological evidence of inflammation and tissue injury associated with these microbes. Awareness of the common organisms and their effects on wound tissue can inform preventative strategies and prompt treatment to reduce post-circumcision infectious complications.
Alterations in Serum Interleukin-2 and Interleukin-10 Levels in Patients Infected with Entamoeba histolytica in Tikrit, Iraq
Background: The host immune response plays a pivotal role in the pathogenesis and outcome of amebic infections caused by Entamoeba histolytica. Cytokines such as interleukin-2 (IL-2) and interleukin-10 (IL-10) are key regulators of immunity, with IL-2 promoting cell-mediated responses and IL-10 suppressing inflammatory reactions. Understanding how E. histolytica infection influences these cytokine levels can provide insight into disease mechanisms and potential prognostic indicators. Objective: This study evaluated the serum levels of IL-2 and IL-10 in E. histolytica-infected patients compared to uninfected healthy individuals in Tikrit, Iraq. We aimed to determine if E. histolytica infection is associated with significant changes in these cytokines, and whether such changes vary with patient age. Methods: A case-control study was conducted involving 50 patients with confirmed E. histolytica infection (diagnosed via stool exam and PCR) and 20 healthy, uninfected controls matched for age and sex. Patients were stratified into four age groups (1–15, 16–30, 31–45, 46–60 years). Serum samples were collected and IL-2 and IL-10 concentrations were measured using enzyme-linked immunosorbent assay (ELISA) kits specific for human IL-2 and IL-10. Mean cytokine levels (±SD) in each group were compared, and ANOVA with post-hoc tests was used to assess statistical significance. Results: E. histolytica-infected individuals exhibited significantly elevated cytokine levels compared to controls. IL-10 was markedly increased in all infected age groups; the highest IL-10 levels were observed in young adults (16–30 years, mean 155.2 ± 9.3 pg/mL) and middle-aged adults (31–45 years, 135.2 ± 10.3 pg/mL) versus controls (70.1 ± 4.1 pg/mL, P≤0.01). IL-2 levels were also elevated in infected patients, particularly in the 16–30 group (102.2 ± 7.4 pg/mL) compared to controls (75.1 ± 5.1 pg/mL, P<0.01). Notably, in older infected patients (46–60 years), IL-2 levels (77.0 ± 5.5 pg/mL) were not significantly different from controls, suggesting an age-related decline in the IL-2 response. Overall, statistical analysis confirmed that both IL-10 and IL-2 concentrations differed significantly among the study groups (P≤0.01 for IL-10; P<0.05 for IL-2), with infected groups showing higher levels. Conclusions: E. histolytica infection is associated with heightened systemic levels of IL-10 and IL-2, reflecting activation of both anti-inflammatory and pro-inflammatory pathways. The pronounced increase in IL-10 suggests a strong regulatory (possibly parasite-driven) immune response during amebiasis, which may help limit tissue damage but could also facilitate parasite persistence. The IL-2 response, while elevated in most patients, was blunted in older individuals, potentially indicating age-related immune senescence. These findings improve our understanding of the immunological milieu in amebic infection and point to IL-10 and IL-2 as potential biomarkers for infection severity and host response, which might inform prognosis or therapeutic interventions in amebiasis.
Circumcision; Foreskin; Pediatric infection; Balanoposthitis; Histopathology; Staphylococcus aureus; Escherichia coli; Microbiome
Exploring the Integrated Role of Pediatricians and Nursing Staff in Improving Pediatric Healthcare Quality: A Systematic Review and Analysis
This systematic review investigates the integrated role of pediatricians and nursing staff in enhancing the quality of pediatric healthcare. The literature highlights interprofessional collaboration and effective communication as critical factors influencing patient safety, healthcare quality, and job satisfaction among healthcare providers. Improved teamwork between pediatricians and nurses has been consistently linked to better patient outcomes, reduced medical errors, and increased staff retention. Additionally, involving parents through family-centered care strategies is recognized as pivotal in elevating pediatric care standards. Despite acknowledged benefits, several challenges—including hierarchical barriers, communication breakdowns, and role ambiguity—continue to impede successful interprofessional collaboration. The review emphasizes the importance of structured approaches, such as TeamSTEPPS®, and supportive frameworks that integrate both healthcare providers and family participation to achieve optimal pediatric care, including in home-based and palliative care settings.
Nterprofessional Collaboration, Pediatric Healthcare, Healthcare Quality, Pediatric Palliative Care, TeamSTEPPS®, Home-Based Care
Copyright (c) 2025 Al-Turath Journal of Nursing https://creativecommons.org/licenses/by/4.0
Oral Health Knowledge Primary School Children in Third Al- Rusafa Educational Directorate
Objective: oral health knowledge of primary school children, and to find out the relationship between oral health knowledge of primary school children with certain variables (child age, gender, education level of parent, economic status of family).in Third Al- Rusafa Educational Directorate. Methodology: A descriptive study of the oral health knowledge of primary school children. The study was conducted (November 1st 2020 to June 15th 2021). The selected was probability sampling (a simple random) of the study setting includes (34) primary schools out of (337) school. The schools selected (10%) of total number of schools. The students were selected using a probability sampling (a systematic random) of 346 students (male-197 and female-149) was selected from (34) school they were in the primary sixth class. The students selected (15%) of the total number of students and they were of age (11 to 13) year. The data was collected for the present study through the self- administration technique by using the questionnaire that designed by the researchers. Validity through a panel of (14) experts and the reliability of the questionnaire is determined through the pilot study. Results: The findings of present study revealed that (56.9%) from the sample were from males, and them were at age 12 years. (50.0%) of the study sample were from low socio-economic class. The knowledge is affected by same demographic characteristic example (age, education level of father, education level of mother, occupation of mother, and socio-economic status). Also, the results showed that students’ knowledge about oral health was middle (50.3%) and poor (45.1 %) respectively. Recommendations: The study recommended increasing students' awareness through the media about the importance of oral health and how to take care of it, and the Ministry of Education in Iraq should be included instructional programs about oral health and teeth in their curriculum of the schools.
Oral health, Knowledge, Primary School children
Application of modified nursing documentation system in Intensive Care Unit
A patient's medical record (chart) is a legal document in continuity of care and may be used in court as evidence, so it is important that every chart and record must be clear, simple and an accurate language. Methodology: A descriptive study was conducted to apply modified nursing documentation system in intensive care unit (I.C.U.) (7).A purposive sample of 50 nurses was selected from intensive care unit at main teaching hospital (Special surgeries, Baghdad teaching hospital, Al-Kadymia, Ibn Al-Nafis and Al-Yarmouk hospital) in Baghdad city from 10th October 2011 to 30 August 2012.The instrument was constructed and initiated of two sections; section one includes the nurses demographic characteristic, section two was the documentation tool which consists of 8 parts, first part consist of nursing admission assessment form, part two ventilation flow sheet, part three neuro-sensory flow sheet, part four intake-output fluid flow sheet, part five medication chart, part six wound assessment flow sheet, part seven weaning assessment chart and part eight discharge and health education record sheet. Descriptive and inferential statistical methods were used to analyze the data. Reliability of the instrument was done for the tool parts and flow sheets through test and retest, also a panel of experts determined the validity of the tool.Results; The findings of the study demonstrated that the majority of the sample was from special surgeries and Baghdad teaching hospital, they were married, at diploma and bachelor level of education, they were demonstrated a high percentage of applications to 8 parts of documentation tool, not involved in any I.C.U. Training courses in Iraq nor in a broad. The mean age of the sample was 31.9, ±9.07 years. The mean period of sample employment in intensive care unit was 5.3 years. There was significant association between study variables such as sample hospital distribution, I.C.U. involvement training courses, level of education to application of patient admission assessment form, the study presented significant association between some of study variables and nurses response to application of documentation systems flow sheets such as ventilation, neuro-sensory, wound and weaning, while no significant associate with intake-output, medication and discharge and education record.Recommendations: According to these findings, the research recommended to applying the modified nursing documentation system in all Iraqi intensive care unit., Provide a training course for intensive care unit nurse to practice patient information documentation in an accurate and systemic method and Applying more documentation tools in other hospital department in an electronic method, which is a new trend in nursing settings.
Breast cancer, Breast self-examination, Health education, Belief, Malaysia
Effectiveness of the health-belief model-based intervention in improving the knowledge, practices and awareness among females with breast lumps
Breast cancer is the most common cancer and the second principal cause of cancer deaths in women worldwide as well as in Iraq. Breast self-examination has a role in raising breast cancer awareness among women and educational programs play an important role in breast cancer preventive behaviour. The aim of this study is to develop, implement and evaluate the effectiveness of Breast Health Awareness program based on health belief model on knowledge of breast cancer and breast-self-examination and BSE practice among female students in Iraq. A single-blind randomized controlled trial was carried out among 162 female undergraduate students for three months in Al-Turath University in Iraq. Participants were randomized to either the intervention group or the control group. The educational program was delivered to the intervention group. The outcome measures were assessed at baseline, pre, and post one month after implementing the health educational program. Chi-square, independent samples t-test and two-way repeated measures ANOVA (GLM) were conducted in the course of the data analyses. Mean scores of knowledge on breast cancer (p<0.003), knowledge on breast self-examination (p<0.001), benefits of BSE (p<0.00), barrier of BSE (0.01) and confidence of BSE practice (p<0.00) in the intervention group had significant differences in comparison with those of the control group 6 and 12 months after the intervention. Also, among those who never practiced BSE at baseline, frequency of BSE practice increased pre and post one month after the intervention (p<0.05). The Breast Health Awareness program based on health the belief model had a positive effect on knowledge of breast cancer and breast self-examination and practice of BSE among females in Al-Turath University.
Assessment of suicidal tendencies among depressive patients in Psychiatric Hospital in Baghdad City
Objectives: To assess suicidal tendencies among depressive patients, to identify the significant differences of depressive patients with regard to their gender, age, level of education, occupational status, marital status, place of residence, income. Design: A descriptive analytical study starting from March to December 2023 such an assessment approach is applied to achieve the objectives of the study Methodology: A purposive non probability sample of 73 depressed patients from outpatient clinic in Ibn Rushd Hospital and Medical city in Baghdad Al- Rusafa. The tool is constructed by relying on the construction of a questionnaire survey of global psychiatric Society (WPS), previous studies and related literature. A pilot study was carried out through the panel of experts and reliability of the questionnaire.Data was collected through a semi structured interview from 1\4\2023 to 30\4\2023. Data were analyzed through descriptive statistical data analysis approach (frequency, percentage and mean) and inferential statistical analysis (Cronbach alpha correlation coefficient and Chi- square test). Results: This study showed the level of suicidal tendencies in depressive patients and showed the statistical differences between some of demographic characteristics of patients with suicidal tendencies Conclusion: A moderate level of suicidal tendencies was observed among depressive patients, no (age, and level of education, marital status, residential area, and income) differences was noticed, gender and occupational status were affecting suicidal tendencies. Recommendation: Family intervention programs should be started by mental health nurses to provide a adequate information regarding the nature of major depressive disorder, the need for long treatment, and to identify the early signs of suicidal tendencies. Social and financial support for chronically depressive patients living in the community who cannot get family and self support
suicidal tendencies, depressive patients, psychiatric hospital