alturath Nursing Journal

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.

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.

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.

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.