Nour Ali Alrida

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

Background/Aims: Spirituality may influence how women cope with antenatal anxiety and fear of birth. This study aimed to examine associations between antenatal anxiety, fear of birth and spirituality among pregnant women in Jordan. Methods: This cross-sectional study involved 150 pregnant women recruited from maternity care settings. Participants' responses to questionnaires containing the Prenatal Anxiety Screening Scale, the Fear of Birth Scale and the Spiritual Well-Being Scale were analysed using descriptive statistics and correlation analyses. Results: High risk of antenatal anxiety was identified in 67.3% of participants and 50.7% reported clinically significant fear of childbirth. Spirituality was negatively correlated with antenatal anxiety, but there was no significant association between spirituality and fear of birth. Conclusions: Spiritual wellbeing may serve as a protective factor against antenatal anxiety, highlighting the value of holistic approaches in antenatal care. Implications for practice: Routine antenatal care should include validated screening for antenatal anxiety and fear of childbirth, with clear referral pathways. Midwives should assess women's spiritual needs and incorporate culturally appropriate spiritual support when appropriate.

Background: Suicidal ideation is a major public health concern and an important indicator of suicide risk among university students. Undergraduate nursing students may be particularly vulnerable because of the combined academic, clinical, and emotional demands of nursing education. Despite growing concern regarding students’ mental health, evidence on the prevalence of suicidal ideation and its associated factors among nursing students in Jordan and Palestine remains limited. This study aimed to determine the prevalence of suicidal ideation and identify factors associated with suicidal ideation among undergraduate nursing students in Jordan and Palestine. Methods: A cross-sectional study was conducted between October and December 2025 among undergraduate nursing students enrolled in public and private universities in Jordan and Palestine. Participants were recruited using convenience sampling and completed a structured online self-administered questionnaire comprising a researcher-developed sociodemographic questionnaire and the validated Arabic version of the Beck Scale for Suicidal Ideation (BSS). Descriptive statistics were used to summarize participants’ characteristics and estimate the prevalence of suicidal ideation. Spearman’s rank correlation and multiple linear regression analyses were performed to identify factors independently associated with suicidal ideation scores. Statistical significance was established at p < 0.05. Results: A total of 646 undergraduate nursing students participated in the study. Using a BSS cutoff score of ≥ 6, 490 participants (75.9%) were classified as having elevated suicidal ideation. Bivariate analysis demonstrated that previous history of mental illness, economic status, younger age, and sleep duration were significantly correlated with suicidal ideation scores. In the multiple linear regression analysis, previous history of mental illness (β = 0.20, p < 0.001), higher perceived economic status (β = 0.13, p = 0.001), and younger age (β = −0.10, p = 0.010) were independently associated with higher suicidal ideation scores. Sleep duration was not independently associated with suicidal ideation after adjustment for other variables ( p = 0.059). Conclusion: Elevated suicidal ideation was highly prevalent among undergraduate nursing students in Jordan and Palestine. Previous history of mental illness, younger age, and higher perceived economic status were independently associated with higher suicidal ideation scores. These findings highlight the importance of implementing routine mental health screening, strengthening accessible psychological support services, and developing culturally appropriate suicide prevention strategies within nursing education programs to promote students’ mental well-being and facilitate early identification of those at increased risk.

Introduction/Aims: Understanding stress, anxiety and depression is crucial for developing effective interventions to strengthen the midwifery workforce. This study evaluated the psychometric properties of a translated assessment tool among Jordanian midwives. Methods: A cross-sectional survey was used to assess depression, anxiety and stress among 321 Jordanian midwives. Factor analysis and reliability testing were used to analyse use of the translated tool. Results: Exploratory factor analysis revealed a three-factor structure explaining 58.37% of the variance. Confirmatory factor analysis supported model validity and reliability was confirmed with Cronbach's alphas of 0.95 for depression, 0.78 for anxiety and 0.81 for stress. Conclusions: Although the final model differed from the original and other Arabic versions, the findings support that the modified scale is a valid and reliable tool for assessing psychological distress among midwives in Jordan. Implications for practice: The translated tool can facilitate routine mental health screening among Jordanian midwives, enabling early identification of psychological distress and informing targeted support strategies to promote workforce wellbeing.

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.

This study aims to assess critical care nurses’ knowledge of blood transfusion safety in a university hospital in Jordan. A descriptive cross-sectional study was conducted among 200 critical care nurses who completed a questionnaire assessing knowledge of transfusion procedures, safety protocols, and management of transfusion reactions. Of the participants, 58% were female, with a mean clinical experience of 9.37 years (SD = 5.4); 68% had more than 10 years of experience. The mean blood transfusion safety score was 18.9 (54%) out of 35 (SD = 5.92), indicating poor overall knowledge. Major gaps were noted in recognizing acute transfusion reactions (86.5%) and identifying drug restrictions during transfusion (74.5%). In contrast, most nurses were knowledgeable about informed consent (90.5%) and blood cross-matching (87%). Knowledge levels differed significantly by gender, education, experience, and workplace ( P < .05), with intensive care unit nurses scoring lower than those in emergency, burn, or dialysis units. Multiple linear regression showed that the workplace was the only significant predictor, explaining 10.3% of the variance. Significant knowledge gaps in transfusion safety were identified, underscoring the need for targeted education and training to improve nurses’ competency, enhance patient safety, and reduce transfusion-related adverse outcomes.

Background: Postpartum haemorrhage (PPH) remains a leading cause of maternal mortality, particularly in low-resource settings. Active Management of the Third Stage of Labour (AMTSL) is a critical intervention for reducing PPH, yet midwives in underserved areas often face challenges accessing updated, practical training.Objective: This study explored midwives’ perceptions of a digital micro-learning video intervention (m-AMTSLV) on AMTSL and its effectiveness in improving knowledge and clinical practice in southern Jordan.Methods: A qualitative descriptive design involving semi-structured interviews with 13 midwives from two government hospitals was used. Purposive sampling was used to recruit midwives who had completed the m-AMTSLV intervention, worked full-time on labour and postpartum units, and had direct care of childbirth. Data were analysed using thematic analysis based on Braun and Clarke’s six-phase framework. Results: Four major themes emerged. Theme 1: effectiveness of Digital Learning in Real-World Practice, subtheme 1: realistic simulation that boosted clinical confidence and improved maternal care outcomes, and subtheme 2: flexible, self-paced access via phone without disrupting work or family duties. Theme 2: suitability for remote and low-resource settings, subtheme 1: addressing training gaps, and subtheme 2: practical Implementation without advanced tools. Theme 3: user-centred design and language accessibility, subtheme 1: preference for Arabic or bilingual content, and subtheme 2: engaging scenario-based videos. Finally, theme 4: technical and logistical challenges, subtheme 1: internet connectivity issues, and subtheme 2: limited access to traditional training opportunities. Conclusion: The m-AMTSLV intervention was perceived as effective, accessible, and relevant for enhancing midwives’ clinical competence in managing PPH, particularly in areas with limited resources. Integrating such micro-learning tools into national midwifery education strategies could strengthen maternal care outcomes in underserved settings.

Health equity is a primary principle of healthcare delivery, aiming to ensure that all healthcare recipients have access to quality healthcare equally, regardless of their social, demographic, and economic characteristics. The current paper explores the role of nurses in advancing healthcare equity and quality of care. A scoping review was conducted to investigate the relevant international and national articles in major databases, including CINAHL, MEDLINE, Google Scholar, EBSCO, and SCOPUS, using relevant keywords such as “Health Equity,” “Quality of Care,” and “Role of Nurses.” The review highlighted that, as nurses are the frontline healthcare providers in diverse healthcare settings, their roles extend beyond routine healthcare to incorporate more advanced roles in health education, advocacy, and support services, significantly improving access, quality, and equity in healthcare. Several barriers and issues have limited nurses’ impact in reducing disparities, but other strategies could be employed to address them. They include telehealth and school-based health centrer. Nursing professionals are in an exceptional position to be transformative in achieving health equity and delivering good quality and accessible healthcare to all individuals and communities.

Introduction: Cardiovascular diseases (CVDs) are considered the main reason for death around the world . This study investigated the impact of standard modifiable risk factors (SMuRFs) on cardiovascular risk, disease severity, and treatment patterns in Middle Eastern patients who have a history of premature cardiovascular disease, with outcomes including acute coronary syndrome and cerebrovascular accidents. Methods: We analyzed data from six established cardiovascular registries and the Jordan SMuRF-less cohort study. All datasets were integrated into a single harmonized database to ensure consistency in variable definitions and measurement. The combined dataset included standardized information on participants' demographic and clinical characteristics, cardiovascular risk factors, comorbidities, medication use, and one-year outcomes among individuals categorized as having 0, 1–2, or 3–4 Standard Modifiable Risk Factors (SMuRFs). In total, data from 1,859 participants with atherosclerotic cardiovascular disease (ASCVD) and a family history of early cardiovascular disease were included in the final analysis. Results: Age varied among the groups. The youngest group (G1) had a mean age of 51.9 ± 12.7 years, while the oldest group (G3) had a mean age of 57.1 ± 10.1 years ( p < 0.001). CKD and heart failure were more prevalent in the upper SMuRF groups ( p < 0.001 and p < 0.05, respectively). BMI and triglycerides rose with rising SMuRFs ( p < 0.001), and LDL levels differed between groups ( p < 0.01). Medication use was highest in G3, especially for statins (94.8% vs. 87.5%), beta blockers (76.0% vs. 66.7%), and oral hypoglycemics (28.6% vs. 2.1%). Conclusion: The study highlights the significant impact of SMuRFs on cardiovascular health. Older patients with a higher burden of SMuRFs show worse lipid profiles and increased medication use. Given the high prevalence of metabolic syndrome and diabetes in the region, targeted interventions, including lifestyle changes and early pharmacological management, are essential for reducing CVD risk in Middle Eastern populations. Clinical Trial Registration: ClinicalTrials.gov , NCT06199869.