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This unique volume presents the experience of 37 U.S. military nurses sent to the Iraq and Afghanistan theaters of war to care for the injured and dying. The personal and professional challenges they faced, the difficulties they endured, the dangers they overcame, and the consequences they grappled with are vividly described from deployment to discharge. In mobile surgical field hospitals and fast-forward teams, detainee care centers, base and city hospitals, medevac aircraft, and aeromedical staging units, these nurses cared for their patients with compassion, acumen, and inventiveness. And when they returned home, they dealt with their experience as they could. The text is divided into thematic chapters on essential issues: how the nurses separated from their families and the uncertainties they faced in doing so; their response to horrific injuries that combatants, civilians and children suffered; working and living in Iraq and Afghanistan for extended periods; personal health issues; and what it meant to care for enemy insurgents and detainees. Also discussed is how the experience enhanced their clinical skills, why their adjustment to civilian life was so difficult, and how the war changed them as nurses, citizens, and people.

Twenty-five years in the Navy had made Cheryl Ruff an independent, resilient, strong woman - and a master at providing patient care while serving at various Navy hospitals around the world. But nothing prepared her mind, body, soul, and spirit for what she experienced on the frontlines of the Iraq war as a member of the Bravo Surgical Company. Known as the \"devil docs,\" they followed directly behind the 1st Marine Expeditionary Force as they entered Iraq at the onset of Operation Iraqi Freedom in March 2003. Right along with the Marines, Commander Ruff, the only female nurse anesthetist at the front, and the rest of her surgical team learned to endure the brutal conditions of the desert while regularly confronting questions of life and death. Working in temperatures well over 100 degrees in full MOP gear, Ruff and her team set up mobile hospital tents in the sand wherever needed. As Black Hawk helicopters brought in steady streams of the wounded, they found it impossible to maintain standard sterilization procedures, and clean up often amounted to just shovelling the blood-soaked sand out of the tent. During surgery they often wore lighted helmets so they could continue operating if the generator failed and donned gas masks when warnings were issued. These horrific conditions, coupled with the gruesome images of shredded bodies and the cries of wounded children, became Ruff's world. This is her story of the war, up close and personal. It is a story of sacrifice, survival, and courage, movingly written by a woman unconditionally dedicated to the life-saving mission of the United States Navy Nurse Corps.

Background: Moral sensitivity is crucial for ethical decision‐making in nursing, enabling nurses to respond appropriately to ethical dilemmas in clinical settings. Emotional intelligence and empathy have been identified as key factors influencing moral sensitivity. However, limited research examines the interplay between these variables, particularly in nursing practice. Objective: This study explores the relationships between emotional intelligence, nursing empathy, and moral sensitivity among nurses in Mosul teaching hospitals and examines empathy’s mediating role in these relationships. Methods: This study employed a descriptive cross‐sectional design. It involved 300 nurses from Mosul teaching hospitals in Iraq. Data collection occurred from July 1, 2024, to October 1, 2024. Validated measurement tools were used, including the Emotional Intelligence Scale (EIS), the Jefferson Scale of Empathy, and the Moral Sensitivity Questionnaire. Statistical analyses, including Pearson’s correlation, multiple regression, and mediation analysis, were conducted to examine the relationships among emotional intelligence, empathy, and moral sensitivity. Results: Emotional intelligence and nursing empathy were significantly positively correlated with moral sensitivity ( r  = 0.58 and r  = 0.66, respectively; p < 0.01). Multiple regression analysis revealed that both emotional intelligence ( β  = 0.30, p < 0.01) and nursing empathy ( β  = 0.52, p < 0.01) significantly predicted moral sensitivity, explaining 39% of the variance. Mediation analysis indicated that empathy partially mediated the relationship between emotional intelligence and moral sensitivity ( p < 0.01). Conclusion: This study highlights the significant roles of emotional intelligence and empathy in enhancing nurses’ moral sensitivity, with empathy acting as a partial mediator. Interventions that promote emotional intelligence and empathy development in nursing education and clinical practice could improve ethical decision‐making and patient care quality. Further research is needed to explore these relationships longitudinally and in diverse healthcare settings.

Background: Digital transformation is reshaping higher education globally, particularly in nursing education where technology integration is essential for improved learning outcomes. In Iraq, however, there is limited evidence regarding nurse educators’ perceptions and readiness for this shift. Objectives: This study aimed to assess Iraqi nurse educators’ perceptions, digital readiness, and the barriers and support systems related to digital transformation in nursing education. Methods: A descriptive cross‐sectional study was conducted with 153 nurse educators from public and private colleges across Iraq. Data were collected via a structured questionnaire and analyzed using SPSS, including chi‐square tests and logistic regression. Results: The majority (65%) of participants agreed that digital tools enhance student engagement, while only 34% had received formal training in digital teaching. Significant barriers included lack of infrastructure (71%) and insufficient training (68%). Logistic regression revealed that educators with prior digital training were significantly more likely to report high digital readiness (OR = 2.84, p < 0.01). Key facilitators included institutional IT support (75%) and regular workshops (70%). Conclusion: Despite positive perceptions, gaps in training and infrastructure hinder digital integration in Iraqi nursing education. Enhancing institutional support, providing structured training programs and developing digital education policies are crucial for sustainable transformation.

Background Artificial intelligence (AI) is becoming increasingly important in healthcare, with a significant impact on nursing practice. As future healthcare practitioners, nursing students must be prepared to incorporate AI technologies into their job. This study aimed to explore the associated factors with nursing students’ intention to use AI. Methods Descriptive cross-sectional multi-centre design was used. A convenience sample of 1713 university nursing students from Bahrain, Egypt, Iraq, Jordan, Kuwait, Lebanon, Oman, Palestine, Saudi Arabia and the United Arab Emirates completed a self-reported online instrument divided into five sections covering: (1) demographic sheet, (2) knowledge, (3) attitude, (4) perception and (5) intention questionnaire. Results Most nursing students in Arab countries have moderate levels of knowledge, attitude, perception and intention towards the use of AI. There was a significant positive association between knowledge, attitude, perception and intention towards the use of AI. A multivariate regression analysis revealed that understanding of AI technologies, self-perception as tech-savvy, age, clinical performance in previous semesters and knowledge of AI were significant and positively correlated with intention. Conclusion The findings highlight the importance of targeted educational interventions and customised strategies to support AI integration within nursing education settings across Arab countries, equipping future nurses with the necessary skills and knowledge to use AI effectively in their practice.

BackgroundTwo decades have passed since the beginning of the Iraq War in 2003. Iraq has long suffered from conflicts and instability, where the people have limited access to healthcare. The coronavirus disease (COVID-19) pandemic brought additional disruption to health service provision.ObjectivesAt the midpoint towards universal health coverage (UHC) in 2030, this study aims to gain a better understanding of the trends of UHC progress in Iraq in the context of the conflicts and the COVID-19 pandemic and to indicate possible pragmatic options.DesignThis study employed Bayesian hierarchical regression models to estimate trends and projections of health service availability and coverage indicators up to 2030. Furthermore, for health service coverage, four scenarios were defined based on the availability of health services, and projections were made for each scenario up to 2030.SettingOur approach used the yearly data from the Ministry of Health and four nationally representative household surveys between 2000 and 2020. We evaluated the subnational-level progress in three health service availability indicators and 13 health service coverage indicators in 18 governorates in Iraq from 2000 to 2030.ResultsThe findings from 2000 to 2020 revealed a lack of progress in the indicators of health facility and inpatient bed, and pronounced detrimental effects from major conflicts and the pandemic on all measured health service coverage indicators. Despite these setbacks, several health service coverage indicators demonstrated resilience and elasticity in their recovery. The projected trends for 2021 to 2030 indicated limited alternations in the health service availability. By 2030, five health service coverage indicators will achieve the designated 80% targets. A scenario-based analysis predicts improved coverage of antenatal care, and child immunisation and treatment if health service availability is bolstered to globally recommended standards. Under this scenario, several governorates—Anbar, Baghdad, Nainawa, Qadissiyah, Salahaddin, Thiqar and Wasit—presented improved health service coverage in more indicators.ConclusionStrengthened health service availability has the potential to significantly improve fragile health service coverage indicators and in more vulnerable governorates.

Religious beliefs are defined as thinking, feeling and behaving in accordance with the beliefs and teachings of a religious system. In other words, religious beliefs are indicative of the role of religion in the individual and social life of people, as well as adherence to values and beliefs in daily life, performing religious practices and rituals and participating in activities of religious organisations. Religious beliefs are a set of dos and don’ts, and values are considered one of the most important psychological supports that can provide meaning in all moments of life and save a person from meaninglessness by providing explanatory support in specific situations. In addition, work conscience is defined as a feeling of inner commitment to comply with agreed-upon requirements for work. In other words, work conscience means heartfelt satisfaction and practical commitment to the tasks that a person is supposed to perform properly, in a way that there will be no negligence in performing the duty even if no supervisor oversees the activity. Given the significant role of nurses in hospitals, especially during the coronavirus disease 2019 (COVID-19) pandemic, the religious beliefs of healthcare employees have become more important. Therefore, the present study aimed to evaluate the effect of religious beliefs on the work conscience of 1800 Muslim nurses in Iraq during the COVID-19 pandemic in 2021. Standard questionnaires were applied to assess the respondents’ religious beliefs and work conscience. In addition, data analyses (Cronbach’s alpha, Pearson’s correlation, etc.) were performed in Statistical Package for the Social Sciences (SPSS). According to the results, religious beliefs have a positive effect on nurses’ work conscience (p = 0.822).Contribution: The findings of this study showed that the employees of an organisation, especially nurses and healthcare staff, can rely on their religious beliefs and benefit from their advantages in order to strengthen their work conscience during a hard time such as the COVID-19 pandemic.

Background: Psychological distress is expressed as a sign that may lead to the development of some psychological disorders. Nurses face work‐related psychological difficulties, and it is important to determine the level of psychological distress before it leads to the development of psychological problems. The aim of this study is to examine the psychological distress in nurses working in hospitals in Iraq. Methods: This cross‐sectional study was carried out with 315 volunteer nurses working in hospitals in Babylon, Iraq, between January and May 2022. Data were collected using a Sociodemographic Characteristics Form and the Kessler Psychological Distress Scale (K6). Data analysis included descriptive statistical methods (numbers, percentages, min‐max values, mean, and standard deviation), the Mann–Whitney U test for the difference between two independent groups in the comparison of quantitative data, and the Kruskal–Wallis H test for the comparison of more than two independent groups. In case of a difference, Bonferroni correction was employed to find the group that caused the difference. Results: The mean score of the nurses in the study on the K6 was 19.26 ± 6.14 for the total scale, 6.34 ± 2.13 for the anxiety subdimension, and 13.92 ± 4.17 for the depression subdimension. There was a statistically significant difference between the nurses’ mean scores on the K6 according to their age, gender, total work experience, weekly working hours, department, and the status of shift work ( p < 0.05). Conclusion: Psychological distress in nurses was high. Mental health protection and improvement interventions can be performed to increase nurses’ mental well‐being. Through these interventions, positive contributions can be made to nurses’ health and quality of care by acting early before mental disorders develop. The design of workplace mental health protection interventions and psychological support programs for nurses is recommended.

Purpose To describe vicarious posttraumatic growth in U.S. military nurses who served in the Iraq and Afghanistan wars. Design A cross‐sectional descriptive design was used. Methods Respondents were asked to complete the Posttraumatic Growth Inventory (PTGI), Core Beliefs Inventory (CBI), and six open‐ended write‐in questions as an electronic survey. Findings Appreciation of life and Personal strength were the strongest dimensions on the PTGI. This was also evident in participant responses to the open‐ended questions. The five dimensions of the PTGI were significantly correlated, indicating as growth increased in one dimension, growth increased in all dimensions. The CBI showed moderate to strong positive correlations with all items. Thus, the relationship between the total PTGI scores and the total CBI scores showed a strong, positive correlation, which indicated higher overall core belief scores associated with more growth in total PTGI scores. Conclusions This study provided initial evidence that some nurses who served in the Iraq and Afghanistan wars experienced posttraumatic growth. While healthcare providers need to be educated about their vulnerability when exposed to trauma, they also need to be aware of potential growth when caring for casualties. Clinical Relevance Nurses preparing to serve in war, as well as those returning, need to pay attention to their physical, psychological, emotional, and spiritual health. Following return from war deployment, the military services need to take deliberate and careful measures to ensure that no returning personnel “fall through the cracks” in getting the help they need.