Fatma Refaat Ahmed

We sincerely thank Professor Yousef Khader for his careful reading of our article

Aim: This study examined cross-sectional associations between sociodemographic, clinical, behavioral, knowledge-based, and psychological factors and three behavioral scales of heart failure (HF) self-care: Maintenance, Symptom Perception, and Management. Self-Care Confidence was examined as a separate 10-item outcome. Methods: This cross-sectional study recruited 516 consecutive adults with confirmed HF at two tertiary-care HF clinics in northern Jordan between May and November 2025. Self-care was assessed using the SCHFI v7.2, HF knowledge using the AHFKT, and anxiety and depression using the HADS. Separate multivariable ordinary least-squares regression models estimated adjusted associations with Maintenance, Symptom Perception, Management, and Confidence. Association-rule mining was used to identify descriptive co-occurrence profiles. Results: Median SCHFI scores were 50.00 for Maintenance, 43.48 for Symptom Perception, and 51.52 for Management. All four regression models included 516 participants and showed limited explanatory performance (adjusted R² = 0.076–0.127). Each 10-percentage-point increase in the AHFKT percentage-correct score was associated with higher Maintenance (unstandardized coefficient B = 2.02, 95% CI 0.50–3.54), Symptom Perception (B = 2.26, 95% CI 0.78–3.73), and Management (B = 3.81, 95% CI 2.32–5.30). HADS depression was inversely associated with Maintenance (B = −0.94, 95% CI −1.57 to −0.31), Symptom Perception (B = −1.47, 95% CI −2.10 to −0.83), and Management (B = −1.09, 95% CI −1.70 to −0.48). HADS anxiety was positively associated with Symptom Perception (B = 1.37, 95% CI 0.74–2.00) and Management (B = 0.92, 95% CI 0.33–1.51). Elementary and secondary education were associated with lower Maintenance scores. Current smoking (B = −6.69, 95% CI −10.78 to −2.60) and no prior HF admission (B = −4.32, 95% CI −8.21 to −0.42) were separately associated with lower Symptom Perception. Association-rule mining retained 10 exploratory co-occurrence profiles; the highest-lift profile involved male sex, sleeping difficulty, and an HF knowledge score from 50% to <60% for Management scores < 70 (50/51 participants; confidence = 98.0%; lift = 1.25). For the separate Confidence outcome, no profiles met the same final criteria. Conclusions: Most participants had scores below 70 across the three behavioral scales. Higher HF knowledge was associated with higher scores across self-care maintenance, symptom perception, and self-care management, and higher HADS depression was associated with lower self-care confidence, whereas HADS anxiety was positively associated with self-care confidence; education, smoking, and prior HF admission showed further scale-specific cross-sectional associations.

Background: ST-elevation myocardial infarction (STEMI) complications are widespread and have a direct effect on the length of stay (LOS) and mortality of patients. Reperfusion therapy via Percutaneous Coronary Intervention mainly impacts outcomes within the first few hours. Consequently, delaying this procedure is a key concern in STEMI management. The door-to-balloon (D2B) time is a crucial predictor of clinical outcomes. This study investigates whether D2B time can predict post-STEMI complications and length of hospital stay, accounting for sociodemographic and clinical variables. Methods: This prospective observational study involved 536 patients with confirmed STEMI, recruited consecutively from 8 hospitals in Amman, Jordan. Patients were classified as delayed if their D2B time was ≥2 h. Logistic regression analyzed the impact of delay on complications, while multiple regression assessed how delay time affected LoS. Results: The median D2B time was 108 min (IQR 65–395). The delayed group and patients with a previous AMI had 2.22- and 1.41-times higher risks of complications, respectively, compared to their counterparts. Patients with a history of HTN and DM faced 1.24- and 1.18-times higher risks of complications versus their respective groups. Each additional hour of door-to-balloon delay was associated with an increase of 0.294 days in hospital length of stay. Conclusions: D2B ≥ 2 h is linked to increased complications and longer LoS. Timely management can reduce complications, shorten LoS, and lower hospital resource use.

Background: Telenursing uses digital technologies to support remote nursing care. As telehealth expands in the UAE, nursing students need adequate knowledge and skills to use these tools effectively. Objectives: This study examined nursing students’ knowledge and perceptions of telenursing and their attitudes toward eHealth and technology. Methods: A cross‐sectional study was conducted among 258 undergraduate nursing students using a demographic questionnaire, the Telenursing Knowledge Scale, and the Perceptions and Attitudes Towards eHealth and Technology Scale. Data were analyzed using descriptive and inferential statistics. Results: Students exhibited positive perceptions ( M = 3.65 ± 0.98) and positive attitudes ( M = 3.67 ± 0.84) towards telenursing and eHealth and technology, respectively. The majority of the participants (78.3%) agreed with the incorporation of telenursing in nursing curriculum at the college level, and 77.9% were willing to utilize it as another type of health service in future professional practice. Many participants knew about the benefits of telenursing, such as increased staff effectiveness (70.2%) and improved communication between patients and staff (72.1%), which gave a mean advantage score of 3.56 ± 0.82. But there were issues about technical difficulties (59.3%), lack of patient interaction (59.3%), and society's vulnerability due to excessive dependence on technology (62.4%). Most significantly, 87.6% misunderstood telenursing with the help of the definition of telemedicine, indicating their poor conceptual knowledge. Internet usage was significantly related to positive perception and attitude ( p ≤ 0.05) on all the outcome variables, but academic year and clinical courses had no effect. Conclusion: Nursing students generally had positive views of telenursing and eHealth, but stronger practical education in digital health is needed.

Aim: To explore the experiences of Jordanian adults living with T2DM and understand the influence of sociocultural, religious, emotional, and healthcare factors on their daily self-management practices. Background: T2DM prevalence is alarmingly high and increasing in Jordan. However, there is a lack of understanding about the daily experiences and challenges faced by T2DM patients in the complex cultural and social environment. Understanding the experiences of T2DM patients in the complex cultural and social environment is crucial for the design and implementation of appropriate interventions. Methodology: A qualitative phenomenological approach was used for the study. Semi-structured in-depth interviews were conducted with 20 participants with T2DM. Participants were selected from the major tertiary care hospital in Northern Jordan. Reflexive thematic analysis, supported by NVivo software, was used for the data analysis. Triangulation, audit trail, peer debriefing, and member checking were used for the establishment of the trustworthiness of the study. Results: Six major themes were identified. Cultural pressures concerning food, challenges in adhering to the prescribed medication, religious and cultural influences, emotional and psychological burdens, gaps in healthcare services, and facilitators and coping strategies. Conclusion: Self-management practices for T2DM patients in Jordan are significantly influenced by cultural, religious, emotional, and healthcare factors. Interventions for T2DM patients in Jordan need to be appropriate and tailored to the culture and community. Implications for Nursing: It is the duty and responsibility of the nurse to provide appropriate education and advice based on the culture and community. Family involvement in the care process for T2DM patients in Jordan is crucial.

Background: Metabolic syndrome (MS), characterized by a constellation of interrelated cardiometabolic abnormalities, markedly amplifies cardiovascular risk. Despite the high prevalence of atherosclerotic cardiovascular disease (ASCVD) in the Middle East, evidence regarding the burden and determinants of MS in this high-risk population remains limited. This study aimed to estimate the prevalence of MS and identify its independent predictors among Middle Eastern patients with established ASCVD. Methods: This comprehensive analysis integrated data from two complementary sources: a prospective cohort derived from the Jordan SMuRF-less Study, which enrolled adults (≥18 years) with confirmed ASCVD across nine centers in Jordan, and a pooled retrospective dataset from six regional cardiovascular registries. Standardized case report forms were used to collect demographic, clinical, and laboratory data. Participants were stratified according to the number of standard modifiable risk factors (SMuRFs) into three categories (0, 1–2, and 3–4 SMuRFs). Multivariable logistic regression analysis was conducted to determine independent predictors of MS. Results: Among 1016 patients with ASCVD, MS was present in 42.7% of the cohort. The prevalence of MS demonstrated a significant graded increase with higher SMuRF burden, rising from 2.2% in patients without SMuRFs to 28.3% in those with one to two SMuRFs and 62.2% in those with three to four SMuRFs (p < 0.001). Patients with MS were significantly older and exhibited higher body mass index and triglyceride levels, lower high-density lipoprotein cholesterol, and a greater prevalence of hypertension, diabetes mellitus, dyslipidemia, chronic kidney disease, and heart failure (all p < 0.001). Independent predictors of MS included advanced age, diabetes mellitus, hypertension, chronic kidney disease, heart failure, elevated body mass index, and increased triglyceride levels. In contrast, higher HDL cholesterol and smoking were inversely associated with MS. Conclusions: MS is highly prevalent among Middle Eastern patients with ASCVD and is strongly associated with cumulative SMuRF burden in a graded manner. These findings highlight the urgent need for targeted, region-specific strategies focusing on early identification and comprehensive management of cardiometabolic risk in this vulnerable population.

Background: Coronary artery bypass graft (CABG) surgery is an invasive procedure done to resolve symptoms and improve quality of life in patients with coronary artery disease. However, it is a major operation that has its own complications and risks. Delayed extubation (DE) after surgery has been associated with higher-than-average rates of morbidity and mortality. The objective of this study was to determine the incidence and most important predictors of DE following CABG surgery. Methods: This prospective observational study was conducted on 300 adult patients who underwent non-urgent CABG. Data were collected from 4 hospitals in Alexandria, Egypt, by trained research assistants and were analyzed using logistic regression, independent t-testing, and Fisher's exact test. Results: Seventy-five participants (25%) developed DE. Patients with age ≥60 years, operation time ≥7 hours, cardiopulmonary bypass time ≥120 minutes, or body mass index ≥28 kg/m2 had a 1.71, 1.88, 2.25, or 2.33 times higher risk of developing DE than those in the counterpoint groups. The only protective variable was the ejection fraction (EF). Patients with EF ≥50% were 21% less likely to develop DE than those with EF less than 50%. Participants who developed DE stayed longer in the intensive care unit (mean±standard deviation [SD], 7.9±1.60 vs. 3.1±1.2; P<0.001) and in the hospital (mean±SD, 22.6±3.1 vs. 15.1±2.9; P<0.001) than those who did not develop DE. Conclusions: Performing CABG as early as possible, controlling body mass index, shortening the operation and cardiopulmonary bypass times, and enhancing EF might decrease the occurrence of postoperative DE and its associated mortality.

Background: This study explores how bullying negatively affects intern nurses’ assertiveness, performance, and the quality of patient care. It emphasizes the need for supportive, respectful clinical environments to enhance interns’ confidence, safety, and professional development. Aim of the study: This study aims to explore the intern nurses’ responses to bullying in the ICU. Methods: A convergent mixed-methods design was used to gain a comprehensive understanding of bullying among intern nurses in the ICUs of Alexandria University Hospitals in Egypt. questionnaire. Of 610 invited interns, 200 completed the questionnaire, and 29 provided narrative responses; a pilot study with 10% of the sample tested feasibility before data collection. The quantitative data were collected using the Negative Act Questionnaire (NAQ-R), and the qualitative data were collected using three questions developed by the researcher. Results: The study revealed that over half of the intern nurses (53%) experienced bullying and about half witnessed it (47%), mainly due to their limited experience, unfamiliarity with ICU routines, and hierarchical workplace stress. The overall mean bullying score was (2.17 ± 1.00), with work-related bullying observed to have the highest mean score at (2.37 ± 1.17), followed by physically intimidating behaviors (2.35 ± 1.25), and person-oriented bullying (2.01 ± 0.97). In addition, there were statistically significant associations between the three dimensions of bullying experience and intern nurses’ age ( p < 0.001, p < 0.001, and p = 0.002). Professional and social vulnerability to workplace bullying, the emotional reactions to bullying and its effect on intern nurses’ professional conduct, coping with bullying, and intern nurses’ explicit messages and suggestions were the four main identified themes from the qualitative analysis. Conclusions: The study revealed a high prevalence of workplace bullying among intern nurses, mainly work-related and physically intimidating, emphasizing the need for institutional interventions and support systems. It calls for pre-internship training on coping strategies, faculty mentorship programs, and clear, confidential reporting procedures to prevent and address bullying effectively.

Limited clinical placements for mental health courses in the United Arab Emirates have made it difficult to provide consistent experiential learning for undergraduate nursing students. As a result, nurse educators are considering technology-enabled learning approaches to deliver clinical skills training. This Viewpoint presents a reflective, theory-informed account of the first-year integration of an artificial intelligence (AI)–enabled, voice-interactive simulated patient into an undergraduate mental health nursing practicum. Grounded in Kolb’s experiential learning cycle and aligned with established simulation best practices, the initiative was designed to support therapeutic communication, psychiatric assessment, and clinical reasoning through structured prebriefing, immersive interaction, and guided debriefing. The paper describes the educational rationale, scenario development, implementation processes, and contextual challenges encountered during real-world deployment across university and clinical environments. AI-supported simulations offered a standardized and psychologically safe context for students to engage with complex psychiatric scenarios, particularly when direct patient interaction is constrained. We discuss operational insights related to technical reliability, environmental requirements, faculty preparation, and assessment integration alongside considerations for scalability and sustainability in resource-limited settings. While AI-supported objective structured clinical examinations have been incorporated to support assessment consistency, formal psychometric validation and outcome comparisons have not been undertaken at this stage. By sharing lessons learned from early implementation, this Viewpoint contributes practical insights for nursing educators facing similar structural constraints. AI-enabled simulation is presented as a strategic complement to, rather than a replacement for, traditional clinical placements, with future empirical research needed to evaluate educational outcomes and long-term impact.