Metabolic syndrome (MetS) is a cluster of cardiometabolic risk factors, including central obesity, elevated blood pressure (BP), hyperglycemia, elevated triglyceride (TG), and low high-density lipoprotein cholesterol. This condition has been identified under various terms, including cardio metabolic syndrome (CMS), syndrome X, dysmetabolic syndrome, plurimetabolic syndrome, insulin resistance syndrome, and ultimately, CMS [1]. The recognition of CMS as a disease entity by the American Society of Endocrinology (ASE), National Cholesterol Education Program (NCEP), and World Health Organization (WHO) underscores its significance. These cardiovascular and metabolic abnormalities, both independently and collectively, substantially raise the likelihood of experiencing cardiovascular disease and stroke, making CMS a prominent and potent risk factor for severe and premature cardiovascular ailment. In comparison with those without CMS, individuals with this syndrome face significantly higher risks of stroke, chronic heart disease (CHD), and myocardial infarction (MI) [2].

In the aspect of cardiometabolic research, when it’s not possible to evaluate disease incidence or mortality, researchers focus on studying indicators of cardiometabolic risk instead. The most recent global burden of disease report revealed a staggering figure of 11 million deaths worldwide attributed to dietary risk, comprising a significant 22% of all adult deaths. Among these diet-related fatalities, approximately 10 million were linked to cardiovascular disease (CVD), while 34,000 deaths were directly associated with type 2 diabetes (T2D). The comprehensive report examined 15 different dietary aspects, with one of them being the consumption of sugar-sweetened beverages (SSBs). However, it did not delve into the total intake of sugars [3].

This study aims to assess nurses’ knowledge about the cardio metabolic syndrome and to find out the association between nurses’ knowledge and their demographic data.

Study design

This study employed a descriptive cross-sectional design study was utilized to explore the level of knowledge among critical care nurses regarding metabolic syndrome.

Setting and Period

The study was conducted among nurses who work in critical care units in two teaching hospitals in Al-Diwaniya city. The study was carried out during the period from 1st November 2022 to 30th April 2023. The total number of nurses working in the two cardiac care units is 168.

Study Participants

The study population included all nurses in the cardiac care units who were available during the data collection time and had been working in the adult cardiac care unit for more than 6 months in the teaching hospitals of Diwaniya city, Iraq.

Inclusion and Exclusion Criteria

All permanent staff nurses working at the selected hospitals in critical care units were included. The inclusion criteria were nurses working in the selected CCUs for at least 6 months, caring for patients with dysmetabolic syndrome, and being available during the study period. Exclusion criteria included staff nurses who did not cooperate in filling out the administered questionnaire and those working in other hospital departments.

Sampling and Sample Size

Non-probability purposive sampling was used to include 118 CCUs nurses from two teaching hospitals in Diwaniya city. The study sample included 118 nurses working in Al-Diwaniya Teaching Hospital and the specialized center for catheterization. The representative sample of the study was calculated using Yamane’s Formula for calculating sample size: \[N=\frac{N}{1+N(e^2)},\] \[n =\frac{168}{1+168(0.05^2)}, n=118.\]

Study Instruments and Data Collection Procedure

Data were collected using a self-administered questionnaire from November 10th to December 30th, 2022. The study instruments consisted of two parts. Part one, the Nurse Information Tool, included six questions about the demographic characteristics of the nurse, prepared by the researchers. Part two dealt with nurses’ knowledge toward metabolic syndrome and consisted of 25 multiple-choice questions developed by the researcher based on a review of the literature. The correct response to the items used two options for answering (where 1 = Incorrect answer, 2 = Correct answer). The cutoff point was calculated as \(1+2\div=1.5\). The cutoff point for assessing the nurse’s knowledge of the studied sample is as follows: (1-1.33) = poor knowledge, (1.34-1.67) = moderate knowledge, and (1.68-2) = good knowledge.

Ethical Considerations

Ethical permission (Ethics committee permission number No. 1/10/2022-1778) was obtained from the relevant University of Qadisayah / College of Nursing, Clinical Research Ethics Committee, institutional permission from the Faculty of Nursing, and from the selected hospitals’ ethical boards before data collection began. Participation was completely voluntary, and written informed consent from nurses was obtained, assuring them that their responses would be confidential.

Data Analysis

Descriptive and inferential statistical procedures were conducted. Descriptive analysis was presented with frequency and percentage, mean, and standard deviation. The Chi-square test was employed to determine the association between positive health behaviors and certain demographic characteristics. Statistical significance was considered when the p-value < 0.05. All data were analyzed with SPSS Statistics (version 20).

Our study was carried out on 118 nurses. As shown in Table 1, most of the participating nurses were female. The mean age of participants was 28.236 years. Among the respondents, 49% were in the age range of 28-37 years old, and the majority held bachelor’s degrees (63%). The majority of the study participants were female, accounting for 52.55% of the total participants, while males constituted 47.45%. Most of the study participants (76.27%) were between 20-30 years old. Regarding the level of education, 50% of them held a diploma in nursing, and most of them were single (49.15%). Concerning the experience of nurse’s employment in nursing, 72.88% of participants had an experience of less than 5 years. Most participating nurses reported having a training course for cardiac rehabilitation outside of Iraq.

The Table 3 investigates the relationship between sociodemographic variables and nurses ’knowledge toward metabolic syndrome, there was a statistically significant with level of education, years of experience in nursing. Furthermore, no relationship was found between age, gender, marital status, and training course.

The findings of this study were that nurses working in critical care units have had satisfactory knowledge level toward metabolic syndrome. Out of (118) subjects participated in current study the majority of the age group was among the ages 20-30 years of old which constituted (76.27%) of the study sample, the older than 50 years were the small ratio. The current result was supported by [4] where they found in their study that most of the study participant nurses (46.0 %) are between the ages (21-30) years.

The study confirmed by Ahmed et al. [5], in same line with the current study where they found that the highest proportion of nurses was young with (48.3%) at the age of (21-30). The researchers see that finding related to that the nurses in the age group 30-40 are the most knowledge about metabolic syndrome in al-diwaniya teaching hospital because they have recently graduated and the information is still in their memory and also because nursing colleges and institutes are now receiving outstanding students in preparatory studies because of central appointment. Gender-related results indicate that female was more than half of study findings and represented that (52.54%) out total number and the remaining proportion were male. This result is consistent with previous studies, where the found that the percentage of females is higher than that of males [6, 7, 8] This result also supported by the result founded by [9] ,where they found in their study that the percentage of female nurses in the study sample was greater than that of males. While this study reflected the results of two studies conducted in Iraq 2021, where they found in their study that the percentage of males participating in the study is relatively higher than that of females [10] .The researchers see that finding related to the female nurses are the most knowledge about metabolic syndrome in Al-Diwaniya teaching hospital because the nursing specialty accepts females with lower academic rates than males, and there is another reason, which is the nursing preparatory school, which is specific to females only.In terms of marital status, the single participants were predominated; it constituted (49.15%). Regarding educational level, the study showed that a relatively high percentage (50%), of the participating in the study are diploma in nursing. This result was in same line with the result of the study conducted at Basra teaching hospital by [11] , where they found that more than half of the study sample (54%) with a diploma in nursing. The findings of the current study were in tune with a previous report [12] who stated that majority of them were have institute graduate (40%), (50%) of the nurses were single and the remainder was married. The researchers see that finding related to the nurses with diploma in nursing are the most knowledge about metabolic syndrome in Al-Diwaniya teaching hospital because the Faculty of Nursing at Al-Qadisiyah University is modern and has not graduated more students than the diploma in Nursing. the study findings show, most of the participants were years of experience in medical unit less than 5 years, it composed (72.88%).

This study strongly agree with [13, 14] who found that (75.6) of nurses in the study had less than five years of experience in nursing. Finally, in regarding a training course for the challenges of metabolic syndrome, most of the sample reported that they are participating in courses inside Iraq (88.13%), this result was supported by the study of [15] where they found that the majority of the study sample was participant in the training course inside Iraq. Overall nurses’ knowledge toward metabolic syndrome, the findings indicate that (62%) of nurses’ knowledge fair level , while 24% of the nurses had good knowledge. Additionally, 32% of the studied nurses had poor knowledge in all knowledge items.This result can be explained from the researchers point of view that, the lack of knowledge about metabolic syndrome in Al-Diwaniya teaching hospital among the CCU nurses can be attributed to many reasons, including; the lack of training courses on this topic, continuing education in hospitals do not give proper attention to cardio metabolic in their curriculum. The current result was supported by the study of [16], conducted Al-Nasirihya teaching hospitals related nurses’ knowledge about cardiac disease where they found in their study that (68.8%) of the study sample had moderate level of knowledge. In fact, there are many factors that affect on nurse’s knowledge it may be related to some aspects of demographic data like age, gender, etc. Level of qualification or the academic degree is the primary source for building a body of knowledge, results of this study revealed that only (26.27%) are graduate from college of nursing and the highest percentage of the participants in the study were holders of a diploma in nursing this result may explain the difference in the level of knowledge which is reflected moderate and low [17]. The current study showed that there is a statistically significant relationship just between the nurses’ educational level, years of experience in nursing and their knowledge, while there is no significant relationship between their knowledge and their other demographic data at p-value more than (0.05).The current study is supported by many previous studied [15, 18] showed there is statistically significant relationship between the knowledge of nurses and their educational level. Previous studies found significant differences between nurses knowledge and their years of experience [19, 20] .As for the absence of a statistically significant relationship between the knowledge of the nurses with the other demographic data, this result is consistent with the study conducted by [13]. The results of the current study agree with a study conducted in Mosul in terms of the existence of a statistically significant relationship between the knowledge of nurses and their educational level. It also agrees with the result of the absence of a statistically significant relationship between the age and gender of the nurses with their level of knowledge. In addition, this study disagrees with the current finding regarding marital status [21]. In addition, this study agrees with a study conducted in Diwaniyah Governorate, in that there are no statistically significant relationships between nurses’ knowledge and some of their demographic data (such as age, gender, and marital status) [22, 23].

The study concluded, based on the study findings indicated that the levels of knowledge of critical care units’ nurses about metabolic syndrome were acceptable, but few numbers of nurses had poor knowledge level about MetS. We recommended conducted educational needs of this at-risk population, particularly those with limited formal education or inadequate lipid management, along with targeted health education strategies, needs to be systematically implemented in clinical practice.

All authors made equal contributions to this research.

The authors thank the nurses who agreed to participate in the study.

This research paper received no external funding.

The authors declare no conflicts of interest.

All authors contributed equally to this paper. They have all read and approved the final version.

Informed consent was obtained from all participates in the study as needed.

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