kufa Journal for Nursing sciences

Background: Managing diabetes in children requires lifelong insulin therapy and learning how to inject insulin properly to keep blood sugar levels stable and avoid complications. However, many children struggle with fears, anxiety, and low confidence, which can make learning this important skill challenging. Recently, using games as a teaching tool has shown promise in making learning more engaging and supportive.
Objectives: This study aimed to evaluate the effectiveness of a therapeutic training game on improving insulin self-injection performance among children with diabetes and to identify the association of learning outcomes with demographic and clinical factors.
Methodology: An experimental study was conducted with 33 children with diabetes mellitus at Al-Sadr Medical City, Iraq. A validated insulin self-injection performance scale was administered pre- and post-training game. The training game incorporated visual, auditory, and kinesthetic learning methods, including videos, posters, and hands-on practice using dolls. Data were analyzed using SPSS version 20 and p < 0.05 was considered statistically significant.
Results: The mean performance score significantly improved from 70.2 ± 7.32 pre-intervention to 86.0 ± 4.74 post- training game (p < 0.001). Higher post-training scores were associated with older age (11–13 years), middle school education, urban residence, later age at diagnosis (≥9 years), absence of injection-site pain, and regular glucose monitoring (all p < 0.05).
Conclusion: The therapeutic training game significantly enhanced children’s insulin self-injection skills and promoted independence in diabetes management. Interactive, child-centered educational approaches that integrate emotional support, family involvement, and multimodal learning are recommended to improve diabetes self-care and long-term outcomes

Background: Circadian rhythms govern endocrine, metabolic, and immunological homeostasis. Early morning wakefulness, particularly between 04:00–05:00 AM, coincides with a transitional hormonal window that may influence systemic physiology and gene expression.
Objectives: This study aimed to evaluate the biochemical and molecular effects of early morning wakefulness on circadian hormone regulation, metabolic synchronization, and human systemic health.
Methodology: A randomized experimental study was conducted from August 2023 to September 2024 in five Indonesian regions with 210 healthy adults. Participants were randomized into an intervention group (early wakefulness at 04:00–05:00 AM for 4 weeks) and a control group (usual sleep patterns). Outcome measures included serum cortisol, melatonin, insulin, fasting glucose, β-hydroxybutyrate (BHB), and expression of core clock genes (BMAL1 (Brain and Muscle ARNT-Like 1) , PER2 (Period Circadian Regulator 2), CLOCK (Circadian Locomotor Output Cycles Kaput), CRY1 (Cryptochrome Circadian Regulator 1)) assessed via qRT-PCR (Quantitative Reverse Transcription Polymerase Chain Reaction).
Results: The early wakefulness group exhibited a 45% increase in morning cortisol levels and a 30% reduction in melatonin (p < 0.001). Fasting glucose and insulin decreased significantly, while BHB levels increased (p < 0.05), indicating a metabolic shift. Clock gene expression showed significant up regulation of BMAL1 and PER2 (1.5-fold, p < 0.01), correlating inversely with HOMA-IR scores.
Conclusion: Consistent early morning wakefulness positively modulates circadian hormonal dynamics, enhances metabolic flexibility, and up regulates key circadian genes, suggesting potential health benefits in metabolic and endocrine regulation. These findings provide molecular evidence supporting early wakefulness as a non-pharmacological intervention for circadian and metabolic alignment.

Background: Mental health can be affected by a complex interplay of individual, family, community, and structural factors at any given moment. Community-oriented mental health services are typically favored over hospital-based options because they minimize structural obstacles to seeking assistance, decrease social isolation, and lower the risk of human rights violations that can occur in hospital environments.
Objectives: A descriptive correlational was used in this study which aims to determine students’ attitudes toward seeking mental health services, find out the association between students’ age and attitudes toward seeking mental health services, and investigate the differences in the attitudes toward seeking mental health services between the groups of gender and marital status.
Methodology: The study was conducted through an online survey among university students across Iraq. A non-probability convenience sample of undergraduate and graduate students were recruited to participate in this study. Based on a margin of error of 5%, a confidence level of 95%, a population size of 82.000, and a response distribution of 50%, the recommended sample size will be 386. The final sample size is 400. The study instrument encompasses the students’ sociodemographic sheet (age, gender, marital status) and the Community Attitudes toward Seeking Mental Health Services. Data were analyzed using the statistical package for social sciences for windows, version (27).
Results: The study results displayed that the majority demonstrated a neutral attitude toward seeking mental health services (n = 329; 82.3%), followed by those who demonstrated a positive attitude (n = 58; 14.5%), and those who demonstrated a negative attitude (n = 13; 3.3%). There is a statistically significant correlation between students’ age and their attitudes toward seeking mental health services (r = .100).
Conclusion: The study concluded that most of the study participants have neutral attitudes toward seeking mental health services, and that the older the students, the positive the attitudes toward seeking mental health services.

Background: Maternal anthropometric factors - such as body mass index (BMI), weight, height, and mid-upper arm circumference (MUAC) - play a critical role in predicting neonatal health outcomes, particularly birth weight, length, and head circumference
Objectives: this study investigated the relationship between maternal anthropometric and sociodemographic factors and neonatal birth outcomes—specifically birth weight, length, and head circumference—among 50 women delivering at two hospitals in Sulaymaniyah, Iraq.
Methodology: Data collection involved direct maternal measurements, neonatal assessments immediately after birth, and a structured questionnaire capturing background variables. Key maternal predictors included gestational age, gravidity, weight, height, body mass index (BMI), weight gain, and hemoglobin concentration, as well as residence, educational level, and occupational status. Multiple linear regression analyses were employed to assess the simultaneous effects of all maternal predictors on each neonatal outcome. Additionally, Pearson product-moment correlation coefficients were calculated to evaluate bivariate associations between maternal and neonatal variables. Categorical predictors were numerically coded or dummy-encoded prior to inclusion in statistical models. Statistical significance was determined at a threshold of p < 0.05.
Results: showed that gestational age was the only statistically significant predictor of neonatal weight (p = 0.0266), while no other maternal or sociodemographic factor showed significant associations in the regression models for weight, length, or head circumference. Gravidity demonstrated a significant positive correlation with head circumference (r = 0.311, p = 0.028), and urban residence was significantly and negatively correlated with neonatal length (r = –0.330, p = 0.019). No significant associations were found for maternal BMI, weight gain, or hemoglobin concentration with any of the three neonatal measurements.
Conclusion: These findings suggest that gestational age remains a key determinant of neonatal birth weight, while gravidity and residential context may play modest roles in shaping head circumference and length, respectively. The lack of significant effects for BMI and hemoglobin may be due to sample size limitations or low variability in these measures. Further research with larger and more heterogeneous populations is recommended.

Background: Chronic kidney disease (CKD) significantly affects patients' quality of life, especially those undergoing hemodialysis. Effective management requires strict adherence to treatment protocols, including medication intake, dietary and fluid restrictions, and regular session attendance. Non-adherence can negatively impact clinical indicators such as electrolytes, hemoglobin, creatinine, and blood urea levels, which are essential for monitoring patient stability.
Objectives: This study aimed to investigate the relationship between treatment adherence and clinical outcomes among patients receiving hemodialysis.
Methodology: A cross-sectional study was conducted among 122 hemodialysis patients at Raparin and Sulaymaniyah Dialysis Centers. Data were collected through structured interviews using a modified treatment adherence questionnaire. Clinical outcomes were obtained from patient records. Data analysis included descriptive and inferential statistics using SPSS version 27.
Results: The majority of the 122 patients were men, poorly educated, and jobless. Medication and session attendance were well adhered to, however; diet and hydration adherence were less so. Education level (p = 0.015) and comorbidity type (p = 0.014) had a significant impact on treatment adherence. Serum phosphate and adherence were significantly correlated (p = 0.030), but not with other clinical indicators.
Conclusion: Patients on hemodialysis generally adhered well to medication schedules and appointments but showed lower compliance with dietary and fluid guidelines. Improved adherence particularly in diet and fluid management through patient education and monitoring may enhance clinical stability and reduce complications.

Background: Train the trainer programs are widely utilized in healthcare to disseminate knowledge and build capacity among professionals. In a field where resources are limited, healthcare professionals must address increasingly complex challenges. However, management-focused training is often absent from traditional university curricula, particularly in medicine, underscoring the need for specialized training programs.
Objectives: to assess healthcare professionals knowledge and evaluate the impact of a train the trainers’ course on their knowledge.
Methodology: A quantitative design, descriptive study was employed, using a non-probability purposive sample of 50 healthcare professionals. The instruments reliability was determined through stability reliability, test-retest approach. Data were collected via checklist before and after a training course. A post-test was administered on the final day of training to measure outcomes.
Results: The majority of participants (aged 20–35 years) were government employees, with educational backgrounds from nursing institutes and colleges. About 64% were hospital employees, while others worked in healthcare centers. (60%) had 0–5 years of professional experience. (74%) had not previously attended a train the trainer course. Before the training course only (12%) of them had a high level of knowledge regarding train the trainer while after completing the training, (100%) of participants reported high level of knowledge.
Conclusion: This study confirms the effectiveness of train-the-trainer programs in significantly improving healthcare professionals knowledge, particularly in management skills lacking in traditional education. The dramatic pre-to-post-test knowledge gains demonstrate these programs value for workforce development in resource-limited settings, advocating for their wider implementation to strengthen healthcare systems.

Background: Wound management is still a major worldwide healthcare issue that requires advanced nursing competencies for effective healing. Nurses often face limitations due to knowledge gaps and insufficient training.
Objectives: This study intends to increase the knowledge and abilities of staff nurses in wound assessment and management by means of focused educational interventions.
Methodology: An intervention study of a single-group was used by quasi-experimental technique on 80 nurses in the Raparin administration hospitals from 5th January 2025 to 31st March 2025. The intervention was a lecture and hands-on seminars via using wound medical simulators and a bilingual pamphlet (Kurdish and English). Participants’ knowledge and wound-dressing skills were evaluated before and after the intervention using a questionnaire and checklist.
Results: The results showed a significant improvement in nurses wound care knowledge and skills following the educational intervention. The mean knowledge score increased from 10.84 (SD = 2.13) to 13.61 (SD = 2.53), and the mean skill score rose from 42.93 (SD = 5.26) to 56.95 (SD = 5.91). Both improvements were statistically significant (p < 0.001), according to Wilcoxon signed-rank tests.
Conclusion: The study revealed that targeted educational interventions can significantly enhance nurses’ knowledge and skills in wound care. Integrating regular training and evidence-based guidelines into clinical practice is essential to maintain high standards of care and promote ongoing professional development.

Background: It is essential to establish sustainability practice in the university environment, this can be evolved through raising the positive attitudes among university students especially among undergraduate health and medical sciences students for being future responsible citizens.
Objectives: To assess the attitudes of medical and nursing undergraduate university students in Babylon university, Iraq.
Methodology: This was a cross-sectional comparative study conducted on convenient samples of undergraduate nursing and medical students in Babylon university (nursing and Hammurabi medical colleges) during the period October 2024, through January 2025, data collection was done through a self-filled pre-determined and validated questionnaire adopted from other studies, this approach included the demographic characteristics and questions related to students beliefs about sustainable development goals mainly (environment, economy, society and education), differences of attitudes between the two group were assessed using t independent statistical test.
Results: Total of 302 students from both schools were enrolled in this study, males are predominant among medical students, more than half of the study sample were rural dwellers. There was a significant correlation for attitudes toward sustainable development goals (SDGs) as perceived by nursing and medical students across the four dimensions: environment, economy, society, and education. Overall, the results highlight that attitude toward SDGs are interrelated, with stronger correlations observed in the economy and society dimensions for both groups. The high mean score in the societal dimension in this study indicates that both nursing and medical students place significant importance on societal well-being and equity.
Conclusion: Both groups share a common positive attitude regarding economic dimension, nursing students had higher attitudes score in education dimension. Contents about SDGs strategy should be introduced in the college curricula, further large-scale analytic studies are strongly requested.

Background: Older adults, seek (or do not seek) hearing healthcare, are not always aware of the magnitude of their hearing loss. Sometimes, they do not believe they would benefit from using a hearing aid. They often have low Self-Efficacy and fear from not having the skills to learn new things (e.g., how to handle the hearing aids).
Objectives: This study aims to (1) identify factors predicting Self-Efficacy for using hearing aids, and (2) investigate the differences in the HBM constructs among the groups of marital status, level of education, general health, gender, using hearing aid, and having diabetes mellitus.
Methodology: The researcher used a descriptive predictive correlational design. The study included a convenience sample of 306 older adults who were recruited from two geriatric homes. The study instrument includes participants’ sociodemographic characteristics, medical profile, and the Hearing Beliefs Questionnaire. Data was analyzed using the statistical package for social science.
Results: Participants’ age and Perceived Barriers negatively predict their Self-Efficacy for using hearing aids. Cues-to-Action and Perceived Susceptibility positively predicted more Self-Efficacy for using hearing aids. There are statistically significant differences in the Perceived Severity, Perceived Benefits, and Perceived Self-Efficacy among the level of education groups.
Conclusion: The younger the age and the lesser the Perceived Barriers, the greater the Self-Efficacy of using hearing aids. The greater the Cues-to-Action and Perceived Susceptibility, the greater the Self-Efficacy for using hearing aids.

Background: Candida species are among the most frequent opportunistic fungal pathogens in immunocompromised patients, often causing localized or systemic infections. Rising antifungal resistance has increased the need for regional studies on Candida prevalence and drug susceptibility.
Objectives: This study aimed to identify Candida species isolated from immunocompromised patients in Sulaimani, Kurdistan Region, Iraq, and to evaluate their susceptibility to commonly used antifungal agents.
Methodology: A total of 100 clinical samples were collected from patients with diabetes, renal failure, gastroenteritis, jaundice, and malnutrition. Samples were examined microscopically, cultured on Sabouraud Dextrose Agar and CHROMagar, and further tested using the germ tube method for species identification.
Results: Antifungal susceptibility testing was performed using the disk diffusion method against fluconazole, clotrimazole, and nystatin following CLSI guidelines. Five Candida species were identified. C. albicans was the most prevalent (42%), followed by C. glabrata (23%), C. krusei (15%), C. tropicalis (10%), and C. guilliermondii (10%). Antifungal susceptibility testing revealed universal resistance to nystatin. C. albicans was sensitive to fluconazole, while non-albicans species showed resistance. Clotrimazole exhibited broad sensitivity across all species tested, indicating its effectiveness as a primary therapeutic option. The predominance of C. albicans aligns with global data, but the emergence of resistant non-albicans Candida species highlights the need for routine species identification and antifungal susceptibility testing.
Conclusion: Clotrimazole demonstrated the highest efficacy and may serve as a preferred treatment option for oral candidiasis in immunocompromised patients. Continuous monitoring and rational antifungal use are essential to address the growing challenge of antifungal resistance.

Background: Headaches frequently affect nursing students, fueled by intense academic demands and psychological stress. Among these, migraine—a severe form of headache characterized by pulsatile pain, nausea, and light or sound sensitivity—poses a notable public health concern, particularly for university populations vulnerable to stress‑related triggers.
Objectives: This study aimed to assess the prevalence, clinical features, and daily impact of migraine among nursing students at the University of Sulaimani.
Methodology: A quantitative design, cross-sectional descriptive study was conducted among all stages of nursing students to assess prevalence, clinical features, and impact of migraine on daily functioning among nursing students at the University of Sulaimani from the period of 5th November 2023 to 15th June 2024 by using a standard tool based on the ICHD-3 criteria. Content validity was confirmed by five experts, and reliability was verified using split-half and Cronbach’s alpha (r = 0.83). Data were analyzed using SPSS version 24 with results presented as frequencies and percentages. Out of 109 students reporting headaches, only 48 (44%) had migraine headaches.
Results: 109 students 54.1% female and 45.9% were male experienced headaches. Out of these 109 students 48 (44.0%), 58.3% female and 41.7% male of them had migraine according to the International Classification of Headache Disorders, 3rd edition criteria tool for migraine. The most frequently cited trigger was too little sleep (77.1%), and the leading self‑care strategy was lying down or sleeping during attacks (82.6%). Unilateral head pain was the predominant symptom (68.8%), followed by phonophobia (56.9%) and pulsating quality (45.9%). Functionally, 62.4% missed 1–3 university days in the past three months due to headache, and 57.8% reported reduced study or work productivity on 1–3 days.
Conclusion: Headache is highly prevalent among nursing students, with nearly half of those affected meeting the criteria for migraine, and women disproportionately represented. Common triggers such as inadequate sleep and the widespread reliance on rest‑based relief strategies emphasize key areas for targeted support. Migraines clearly impair academic performance especially study and work productivity and daily functioning.

Background: Renal failure (RF) is global health problem, which strikes millions of people worldwide, and causing either a lifetime severs disability or death. Renal failure is treated in several ways, one of which is peritoneal dialysis, but this method is accompanied by many complications that affect the patient\'s life.
Objectives: A study focuses on the common complications associated with peritoneal dialysis and to find out relationship between the patient peritoneal dialysis catheter complications and their demographic characteristics.
Methodology: A descriptive cross-sectional study was carried out through the present study in order to achieve the early stated objectives. The study is conducted in Al-Najaf City/Al-Najaf Al-Ashraf Health Directorate/ Al-Furat Al-Awsat Center for Peritoneal Dialysis and Al-Najaf Teaching Hospital. The study was begun from October, 9th, 2024 to March, 1st, 2025. Data collected by use constructed questionnaire, which consisted of 3 parts, the first part was concerning with socio-demographic characteristics which includes (6) items and the second part was concerning with Clinical data that have (3) items, finally the last part of questionnaire which include catheter site complication.
Results: This cross-section study includes 80 patients under peritoneal dialysis, 41 males and 39 females. 45% of patients had bleeding as an early complication of peritoneal dialysis and 51.3% of patients had peritonitis as a late complication of peritoneal dialysis.
Conclusion: The results of this study conclude that patients subject to peritoneal dialysis are exposed to many complications, but most common complication is bleeding and peritonitis. Also, study conclude that a hypertension is the most common disease among peritoneal dialysis patients.