Predictors of War-Related Stress and Resilience among Palestinian Nursing Students Experiencing Chronic War Exposure

Abstract

Background

Nursing students who are currently enrolled in colleges and live in conflict-torn regions have faced unique and sustained experiences of psychological distress related to both the demands of their studies and their long history of living under constant war-related pressure. Palestinian nursing students face challenges to their resilience from long-term armed conflict, continuous military escalations, ongoing states of military occupation and warfare, ongoing trauma, and continuing uncertainty.

Objectives

This study aimed to identify predictors of war-related stress and resilience among Palestinian nursing students who were exposed to war on a long-term basis.

Method

This study used a descriptive, cross-sectional design to collect data from 650 nursing students attending Al-Quds University from March to May 2025. A structured questionnaire was used to collect sociodemographic and academic characteristics, to assess the level of war-related stress and levels of resilience. The war-related stress scale and the resilience inventory were used to assess war-related stress and the level of resilience among students. Multiple linear regression was used to analyze predictions of war-related stress and resilience.

Results

The mean score for war-related stress was 3.30 ± 1.36. Almost half of students reported moderate to high levels of stress. The mean resilience score was 4.33 ± 2.98, and the majority possessed normal levels of resilience. The relationship between older age, enrollment in upgrading courses, greater academic success, and low-income stress from war is significant. Students who are married also reported significantly less stress than unmarried students. Female students and students with low and high incomes are less resilient than other students; first-year nursing students are less resilient than fourth-year nursing students. The regression analyses accounted for 11.9% of the variance in war-related stress and 6.9% of the variance in resilience.

Conclusion

Palestinian nursing students experience high levels of psychological stress from the continuous long-term conflict in which they live, and resilience is influenced by sociodemographic and academic characteristics. Therefore, there is an urgent need for gender-sensitive, academic, focused resilience building and mental health supports in nursing education programs for students affected by the conflict.

Keywords

nursing students resilience stress from war war exposure Palestine

Introduction

Nursing students are generally understood as being at a heightened risk of suffering from psychological pain due to the extremely challenging nature of their academic work, numerous tests and exams, very competitive learning environments, and the emotionally demanding nature of their clinical training as part of being trained for a nursing career.^1,2 Beyond what are already seen as demanding theoretical courses, nursing students have direct patient contact. They must deal with suffering, death, ethical dilemmas, and some of the most significant medical and clinical decisions to be made in their professional lives at such an early stage of their career.³ These elements have been consistently shown to cause higher levels of psychological stress (anxiety, depression, and burnout), which can negatively impact academic performance, clinical competence, and ultimately, professional retention.^4,5

Although academic stress is common to nursing students around the world, it is much more intense and has more serious psychological effects in settings that are affected by conflict and that have political instability.⁶ Armed conflict creates various chronic stressors, including, but not limited to, exposure to violence, insecurity, and displacement, losing family members, disruption in daily living, and uncertainty about their future.⁷ In places of war, stress does not occur in short bursts but rather as a constant, chronic state due to repeated and prolonged exposure to multiple trauma situations.⁸ Young adults living in war zones have been shown to experience disproportionately high rates of posttraumatic stress disorder (PTSD), anxiety, depression, and somatic symptoms compared to young adults living elsewhere.^9,10 The Palestinian context is one of the longest-standing conflict zones globally and is defined by decades of military occupation, ongoing military escalations, and ongoing humanitarian crises. Numerous researchers have examined the enormous amount of psychological stress and trauma experienced by Palestinian youth, with a high incidence of traumatic exposure, chronic stress, and mental health illnesses.¹¹ Additionally, for nursing students, their educational and clinical obligations are made more difficult because they function within a fragile healthcare system.¹² Nursing students are exposed to substantial trauma, death, and emotionally distressing situations in clinical settings at times of military escalation when the healthcare system becomes overwhelmed with casualties, shortages of resources, and ethical dilemmas.^13,14 As a result of both types of psychological trauma, war-related and professional, nursing students face a “double burden” and are at increased risk for psychological injury and premature burnout.^15,16

While there is a large volume of research documenting the mental health effects of war-related exposure, there is substantial variability in the psychological responses of individuals and communities to extended periods of adversity.¹⁷ One important factor that appears to mitigate the negative impact of prolonged stressors is resilience, which is defined as the ability to positively adapt and cope after experiencing significant trauma and stress.¹⁸

Those who possess resilience can manage their emotions better than most people; they can cope with challenges and continue to function while experiencing adversity.^19,20 Resilient nursing students have lower levels of stress, more effective ways of dealing with stress, and greater academic success than non-resilient nursing students, and have a reduced risk of burnout.^21,22 Resilience does not occur evenly among all individuals; rather, factors such as sociodemographic characteristics or mental health may affect an individual's ability to achieve resilience.^23–25

As research on Palestinian youth's mental health continues to grow, there remains a significant gap in empirical evidence regarding war-related stress and resilience for Palestinian nursing students. Most studies conduct research with general student populations or health professionals and do not include unique vulnerabilities and adaptive capabilities of nursing students as both educationally challenged learners and frontline providers of care in times of war.²⁶ Thus, identifying variables that relate to heightened levels of stress and lower levels of resilience in Palestinian nursing students will help inform targeted interventions, which in turn will help support the well-being of students while building and developing a stronger nursing workforce for the future.²⁷

This study was conducted to identify predictors of war-related stress and resilience among the Palestinian nursing student population, which is subjected to ongoing exposure to war. The main goal of this study is to identify sociodemographic and academic variables that relate to the psychological outcomes experienced by Palestinian nursing students, in order to use this information to develop contextually relevant, resilient building strategies for nursing students living in war-torn areas of the world.

Methods

Study Design

A descriptive cross-sectional study was used to determine the predictors of war-related stress and resilience among Palestinian nursing students as they have lived under and been exposed to chronic war.

Setting and Participants

A total of 650 nursing students attended the study; therefore, the final number of nursing students recruited for the study was 650. The study was conducted on Al-Quds University's campus in Palestine from March 2 to May 10, 2025. The target population was undergraduate nursing students enrolled in either regular or upgrading nursing programs, as the study was interested in recruiting participants for their 18 years of age or older and who were registered in any academic year of the study's time frame and had consented to participate in the study. However, participants were excluded if they did not complete their questionnaire; however, no students were excluded because they had incomplete questionnaires.

Sampling Procedure

Convenience sampling was employed to recruit nursing students for this study. Data collection was performed during scheduled class time for all eligible students who were present during data collection to have the opportunity to participate in the study. Potential participants were knowledgeable about the research aim and it was stressed to them that their contribution to this study was completely voluntary.

Instrumentation

Data collection was implemented using a format developed to collect information through an online survey that incorporated three main sections:

Socio-Demographic and Academic Characteristics

A total of seven questions provided demographic information related to the participants’ age, sex, marital status, academic year, program of study (either regular or upgrade), their academic achievement (cumulative average), and their estimated household income.

The War Stress Scale

Stress related to war exposure was measured using an established, validated 21-item survey.²⁸ The 21 items can be grouped into three areas/categories: (1) Society-Related Stressors (8 items); (2) Person-Related Stressors (7 items); (3) Security-Related Stressors (6 items).

Developers of the WRSS Vargová et al, 2024²⁸ encouraged researchers to modify the WRSS based on different cultures, geographic locations, and time periods since the original scale was developed. This recommendation was followed by making one minor change to item five in the Society-related Domain (originally stated “Concern about the war going to the EU or the world” changed to “Concern about the war going to the West Bank or Jerusalem”), so that it was more representative of Palestine's sociopolitical situation in 2024, following the start of chronic war exposure.

Respondents rated their level of concern or difficulty associated with each item on a scale of 1 (no concern/difficulty) to 7 (a great deal of concern/difficulty). Based on the cut-off points for stress levels: low (1-3), moderate (3.01-5), and high (5.01-7).

The instrument has been shown to possess acceptable levels of reliability and validity. The content validity of the individual items has previously been established. In addition, the instrument was administered to a representative sample of Slovaks (N = 1851). A series of psychometric tests, including exploratory and confirmatory factor analyses, convergent validity tests, and network analysis, showed evidence of the validity and reliability of the measure.²⁸ Validity and Internal consistency reliability for this instrument were established through Cronbach's alpha, which was 0.95.

Resilience Inventory

Psychological resilience was assessed using a measure of psychological resilience through the brief resilience inventory. All responses to each of the six items were assessed using a five-point Likert scale from 1 (strongly disagree) to 5 (strongly agree), together forming an index where higher values denoted higher levels of resilience, with possible scores ranging from 6 to 30.

The 6 item index is based on the Brief Resilience Scale (BRS) established by Smith, Dalen²⁹ in (2008), which was designed specifically to measure an individual's ability to recover after experiencing stress or adversity.

The BRS has been translated into several languages including Dutch,²⁴ where it showed acceptable reliability (α = .83; ICC = .94), and Malaysian,³⁰ where the results indicated strong psychometric properties (α = .93). Overall reliability indicators for the BRS indicated satisfactory internal consistency (α = .83) and test-retest reliability (ICC = .69).

The confirmatory factor analysis showed on the Spanish version of the BRS supported the single factor model (χ²/df = 2.36; SRMR = 0.036; GFI = 0.980; CFI = 0.984; IFI = 0.984; RMSEA = 0.067) as well as confirmed the BRS is a reliable measure of resilience by demonstrating strong evidence of both convergent and concurrent validity, as well as predictive validity.³¹

In addition, the confirmatory factor analysis demonstrated all six items loaded significantly above .05 onto the overall factor. A participant's resilience score was indicated by a high score. Both validity and reliability were assessed for the instrument in previous research.²⁹ In the current research study, internal consistency reliability was established through Cronbach's alpha, equal to 0.86. According to the resilience cut-off points: low (1.00-2.99), normal (3.00-4.30), and high (4.31-5.00).

Ethical Considerations

Ethical approval was gotten from the institutional review board (IRB) of Al-Quds University, which approved this project (RESC/2024-38A), and all participants were assured their involvement in this study was voluntary. Data collection began after ethical approval had already been provided to conduct the study, and therefore, all activities performed complied with legally applicable standards, including the Declaration of Helsinki.

Participation was voluntary, and written informed consent was gained from all participants before data collection. Confidentiality and anonymity were confirmed by assigning numerical codes to questionnaires and storing data securely.

Statistical Analysis

The IBM SPSS Version 22 was used to analyze the data. Categorical data were reported as means and frequencies, while continuous data were reported as means and standard deviations (SD). In this study, there was no missing data. A multiple linear regression analysis was used to examine factors associated with the two outcomes: war-related stress and resilience among nursing students. The assumptions for multiple linear regression were assessed for linearity, independence, homoscedasticity, normality of residuals, and multicollinearity. All of these assumptions were attained, and the multicollinearity parameters were reported in the given tables. Moreover, the values of unstandardized beta coefficients (B), and the standardized beta coefficients (Beta) were reported in the given tables. All hypotheses were tested as two-tailed with a p-value less than 0.05.

Results

This study comprised 650 nursing students. The majority of participants were females (62.5%), single (82.2%), between 21 and 23 years old (46.8%), and with high income (30.2%) (Table 1). Concerning academic characteristics, most students are enrolled in regular studies (88.9%), in their fourth academic year (46.2%), with a moderate cumulative average (53.2%) (Table 1).

Table 1.

Description of Demographic Characteristics of Nursing Students (N = 650).

Demographic Variable		N	%
Sex	Male	244	37.5%
Sex	Female	406	62.5%
Age	18–20 years	240	36.9%
	21-23 years	304	46.8%
	24–26 years	42	6.5%
	27 and above years	64	9.8%
Marital status	Single	534	82.2%
Marital status	Married	116	17.8%
Academic year	First-year	130	20.0%
	Second year	114	17.5%
	Third year	106	16.3%
	Fourth year	300	46.2%
Type of Study	Regular	578	88.9%
Type of Study	Upgrading	72	11.1%
Cumulative Average	Very low: 60%-69%	36	5.5%
	Low: 70%-79%	206	31.7%
	Moderate: 80%-89%	346	53.2%
	High: 90% & above	62	9.5%
Income Level	Very low:1850–2850 USD	176	27.1%
	Low: 2851–3850 USD	174	26.8%
	Moderate: 3851–4850 USD	104	16.0%
	High: ≥ 4851 USD	196	30.2%

Table 2 shows descriptive statistics for the two outcome variables: war-related stress and resilience. The average overall war-related stress score was 3.30 (SD = 1.36). The most prevalent level of war-related stress was low stress (51.4%), followed by moderate stress (35.4%). The average overall resilience score was 4.33 (SD = 2.98). The most predominant level of resilience was the normal level (60%), followed by the low resilience level (39.7%).

Table 2.

Descriptive Statistics of Nursing Students’ War-Related Stress and Resilience (N = 650).

Psychological Trait	Mean ± SD Or N	%
Stress	3.30 ± 1.36
Low Stress	334	51.4
Moderate Stress	230	35.4
High Stress	86	13.2
Resilience	4.33 ± 2.98
Low resilience	258	39.7
Normal resilience	390	60.0
High resilience	2	.3

Table 3 reports the findings of a multiple linear regression for factors associated with war-related stress among participants. The model was statistically significant (F = 5.345, p < 0.001); the model was able to predict 11.9% of war-related stress (R² = 0.119). Students enrolled in upgrading study reported lower stress than those enrolled in regular study (B = −0.40, p = 0.034). Students aged between 24 and 26 reported a higher level of stress than students aged 18–20 (B = 0.58, p = 0.043). Married students reported a lower level of stress related to war than that of stress reported by single students (B = −0.40, p = 0.029). Students with low, moderate, and high cumulative averages reported higher levels of stress than students with very low averages (B = 0.58, p = 0.019; B = 0.76, p = 0.002; B = 1.36, p < 0.001, respectively). Students with low income reported significantly lower levels of war-related stress than those with very low income (B = −0.34, p = 0.018). Finally, resilience score was a significant predictor for war-related stress (B = −0.33, p = 0.014); for each one unit increase in resilience, war-related stress decreased by 0.33 units.

Table 3.

Predictors of War-related Stress among Nursing Students (N = 650).

Variable	B	Std. Error	Beta	T	95.0% Confidence Interval for B		Significance	Collinearity Testing
Variable	B	Std. Error	Beta	T	Lower Bound	Upper Bound	Significance	Tolerance	VIF
Sex (female vs male)	.11	.12	.04	.914	−.123	.337	.361	.806	1.241
Age (21–23 vs 18–20)	.09	.18	.03	0.497	−.258	.433	.620	.335	2.984
Age (24–26 vs 18–20)	.58	.28	.10	2.029	.019	1.133	.043	.532	1.881
Age (≥ 27 vs 18–20)	.50	.30	.10	1.496	−.141	1.045	.135	.319	3.134
Marital status (married vs single)	−.40	.19	−.11	−2.188	−.766	−.041	.029	.518	1.930
Academic year (second year vs first)	.22	.17	.06	1.236	−.127	.558	.217	.588	1.699
Academic year (third year vs first)	.41	.20	.11	2.020	.011	.808	.044	.461	2.170
Academic year (fourth year vs first)	.43	.21	.16	2.066	.021	.843	.039	.238	4.203
Type of Study (upgrading vs regular)	−.40	.19	−.09	−2.129	−.760	−.031	.034	.762	1.313
Cumulative Average (low vs very low)	.58	.25	.20	2.360	.098	1.064	0.019	.197	5.069
Cumulative Average (moderate vs very low)	.76	.24	.28	3.163	.290	1.239	0.002	.178	5.622
Cumulative Average (high vs very low)	1.36	.29	.29	4.750	.797	1.920	< 0.001	.367	2.728
Income Level (low vs very low)	−.34	.15	−.11	−2.371	−.692	−.059	.018	.627	1.594
Income Level (moderate vs very low)	−.30	.17	−.08	−1.798	−.627	.028	.073	.692	1.444
Income Level (high vs very low)	.19	.15	.07	1.329	−.092	.478	.184	.583	1.714
Resilience Score	−.33	.13	−.10	−2.466	−.592	−.067	.014	.931	1.074

Note: R = 0.345, R² = 0.119, Adjusted R² = 0.097, F-statistics = 5.337, p < 0.001.

B: unstandardized beta coefficients, Beta: standardized beta coefficients.

Table 4 reports the findings of a multiple linear regression for factors associated with resilience among participants. The model was statistically significant (F = 3.145, p < 0.001); the model was able to predict 6.9% of resilience (R2 = 0.069). Females reported a lower significant resilience level than that of the males (B = −0.14, p < 0.001). Students in the fourth academic year reported significantly higher resilience levels than those of first-year students (B = 0.15, p = 0.016). Students with low and high income levels were reported a lower significant level of resilience than those with a very low income (B = −0.11, p = 0.008; B = −0.10, p = 0.019, respectively).

Table 4.

Predictors of Resilience among Nursing Students (N = 650).

Variable	B	Std. Error	Beta	T	95.0% Confidence Interval for B		Significance	Collinearity Testing
Variable	B	Std. Error	Beta	T	Lower Bound	Upper Bound	Significance	Tolerance	VIF
Sex (female vs male)	−.14	.03	−.18	−4.196	−.211	−.077	< 0.001	.828	1.207
Age (21–23 vs 18–20)	.01	.05	.02	.245	−.090	.116	.806	.335	2.984
Age (24–26 vs 18–20)	−.03	.08	−.02	−.332	−.194	.138	.740	.532	1.881
Age (≥ 27 vs 18–20)	−.14	.09	−.10	−1.510	−.312	.041	.132	.320	3.122
Marital status (married vs single)	.10	.06	.10	1.838	−.007	.208	.066	.521	1.920
Academic year (second year vs first)	.07	.05	.06	1.280	−.035	.168	.201	.590	1.695
Academic year (third year vs first)	.12	.06	.11	1.933	−.002	.234	.054	.463	2.158
Academic year (fourth year vs first)	.15	.06	.20	2.415	.028	.271	.016	.240	4.164
Type of Study (upgrading vs regular)	−.02	.06	−.02	−.421	−.132	.085	.674	.762	1.312
Cumulative Average (low vs very low)	.02	.07	.02	.246	−.126	.162	.806	.197	5.069
Cumulative Average (moderate vs very low)	.03	.07	.04	.450	−.109	.173	.653	.178	5.620
Cumulative Average (high vs very low)	.01	.09	.01	.080	−.160	.174	.936	.367	2.728
Income Level (low vs very low)	−.11	.04	−.13	−2.651	−.198	−.029	.008	.634	1.577
Income Level (moderate vs very low)	−.01	.05	−.011	−.233	−.109	.086	.816	.693	1.444
Income Level (high vs very low)	−.10	.04	−.12	−2.352	−.185	−.017	.019	.589	1.699

Note: R = 0.263, R² = 0.069, Adjusted R² = 0.047, F-statistics = 3.145.

B: unstandardized beta coefficients, Beta: standardized beta coefficients.

Discussion

The present research explored the predictors of both war-related stress and war-related resilience in nursing students who have experienced chronic war exposure in Palestine and found a great deal of psychological stressors experienced by nursing students as a result of being subjected to continuous warfare (war). Resilience varied according to sociodemographic and academic profile differences; thus, findings and consequences indicate nursing students are still very vulnerable to needing to cope with the abrupt nature of their specialty clinical training demands with ongoing exposure to war-related adversity.

War-Related Stress and Resilience among Nursing Students

A large number of students who participated in this study were found to exhibit moderate to high levels of war-related stress, as a result of high prevalence rates of chronic war; further exacerbating the situation, participants were found to be experiencing chronic stress from both the academic demands of college and from clinical practice settings that are emotionally and physically taxing. This study's results correspond with prior documented evidence about increases in stress, anxiety and trauma experienced by university students in war-torn areas, particularly for those who are in health-related fields, as nursing students are at increased risk of experiencing stress due to being in both high-stress academic environments and in high-stress clinical environments.^5,32 Furthermore, studies have identified that chronic stress resulting from armed conflict has similar effects on nursing students as chronic stress resulting from academic factors and clinical factors separately from one another. Compared to younger students, older students reported greater levels of war-related stress.^33,34 This may be the result of having been exposed to more trauma over time and of being under more academic and family responsibilities.³⁵ Also, students enrolled in upgrading programs reported higher levels of stress than did students enrolled in regular programs; the pressure to balance work, family, and school is one contributing factor in this increase in stress.^36,37 These data indicate that non-traditional pathways may add additional psychological risks during long-term crises.

In addition, married students reported less stress than did single students. This suggests that social and emotional support from family can act as a protective factor against war-related stress.³⁸ Therefore, these results support stress-buffering models, which indicate that social support serves to reduce the detrimental psychological effects of chronic stressors.

Moreover, students who earned an academic average were under greater amounts of war-related stress than those who earned a very low average. This might suggest that high-achieving students experience greater internalized stress due to increased pressure to perform academically and fear of disruption of academic performance, coupled with uncertainty regarding future careers in an unstable environment.^39,40

High-stress levels were linked to lower household incomes, and students from very low-income homes displayed the highest levels of total stress. Financial stresses caused increased concern about education-related expenses and access to basic needs, thus increasing the overall effects of war-related disruptions on students’ emotional well-being.⁴¹

The majority of nursing student participants scored within an expected normal range of resiliency, indicating an adaptive nature among this group. However, this resiliency varied with females scoring significantly lower than did males. These results are consistent with findings of other studies that show females in areas affected by conflict, such as refugees, experience more depression and have fewer resources to recover due to gender-based social roles and expectations.⁴²

Fourth-year nursing students reported higher resiliency levels than first-year nursing students, indicating resiliency could increase through time spent in school and through exposure to patients. As nursing students continue through their education they develop improved coping skills, professional identity, and emotional regulation, which will ultimately help them manage difficult situations created by both wartime and nursing school.⁴³

Resilience outcomes were significantly impacted by income level as evidenced by students in both low and high-income households reporting lower levels of resilience than those in very low-income households. This could be due to adaptive resilience due to the fact that these students have always lived with the burden of economic hardship and perpetual adversity, supporting the idea of “stress inoculation” that has been seen in long-standing crisis areas.⁴⁴ Furthermore, students who have become accustomed to adversity may develop coping methods that more efficiently buffer against psychological tolls than students who experience temporary or irregular economic stressors.

The regression analyses yielded statistically significant results; however, they only explained a modest proportion of the observed variance for both the war-related stress and resilience (11.9% and 6.9%, respectively). This indicates that nursing students’ level of stress and resilience is influenced by additional factors beyond those investigated in this study (ie, sociodemographic and academic variables).⁵ This could potentially include variables that were not measured in this study such as the level and distance of exposure to war (ie, direct trauma, displacement, and loss of someone), perceived social support from family, friends, and others; coping strategies utilized; history of mental health issues, sleep difficulties, and whether or not they have had access (ie, general psychological services or institutional supports) to psychological resources.^45,46 Due to the multifactorial and complex nature of psychological responses in a conflict environment, future research needs to include these contextual and psychosocial factors to create more comprehensive explanatory models.

Implications for Nursing Education and Policy

This research study has pertinent implications for nursing education and mental health support in war-affected regions. Academic institutions should integrate structured, evidence-based resilience-building programs within their nursing curriculums particularly for early-year female students and those in upgrading programs. Gender-sensitive mental health services, peer support programs, and trauma informed academic policies would all serve to minimize the long-term psychological ramifications of prolonged exposure to war.

In addition, universities and policymakers need to recognize that academic performance does not equal psychological wellness. High academic achievers may require targeted psychological care in order to avoid burnout and attrition. Financial assistance programs and institutional flexibility during times of escalation may further support academic success and professional achievement.

Strengths and Limitations

The present study has several strengths, including a large sample size and highlights the importance of examining both stress and resilience outcomes in order to obtain a fuller understanding of psychological functioning of Palestinian nursing students living in an environment that has experienced war and continuing conflict. One limitation of the study is the inability to make causal conclusions, as it was conducted using a cross-sectional design and data were collected using self-reported measures, which may have resulted in bias. Another limitation of this study is that it only included nursing students from one university, which may limit the ability to generalize these findings to other universities or regions.

Conclusions

Palestinian nursing students endure significant psychological distress due to war-related stress and chronic conflict and demonstrate varying levels of resilience based on such factors as gender, academic standing, and socio-economic status. Although many students demonstrate resilience, those at-risk continue to face elevated levels of distress. To ensure continued participation in nursing education and to promote resilience in future healthcare providers working in conflict-affected areas, nursing students’ mental health problems must be treated through context-specific, targeted interventions.

Footnotes

ORCID iDs

Rabia H. Haddad

Ahmad M. Al-Bashaireh

Razan Haddad

Ashraf J. Abuejheisheh

Ethics Approval and Consent to Participate

The Scientific and Ethical Research Board at Al-Quds University approved this project (RESC/2024-38A), and all participants were guaranteed that their involvement in this study was voluntary. Data collection began after ethical approval had already been provided to conduct the study, and therefore, all activities performed complied with legally applicable standards, including the Declaration of Helsinki.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability

The data sets created and used (analyzed) in the conduct of this project can be made available from the corresponding author upon reasonable request.

Authors Bibliographies

Rabia H. Haddad, RN, MSN, CNS, PhD: Assistant Professor of Psychiatric and Mental Health Nursing. His research interests are stress caused by psychological trauma, psychological deterioration, Adverse life experiences, and the psychological impact of natural and man-made disasters, such as the impact of psychological warfare among the most vulnerable populations.

Ahmad M. Al-Bashaireh, RN, MSC, PhD: Assistant Professor of Critical and Acute Care Nursing. His research interests are biobehavioral nursing studies with an emphasis on acute care, heart failure, atrial fibrillation, atherosclerotic cardiovascular diseases, smoking, and tobacco research.

Razan Haddad: Assistant Professor of Pharmaceutical Technology, concentrating on developing pharmaceutical nanoparticles and methods for drug delivery.

Ashraf J. Abuejheisheh, RN, MSN, CNS, PhD: Assistant Professor of Critical Care Nursing. His area of research is Psychosocial Interventions, particularly in education for healthcare professionals, and AI integration in healthcare delivery.

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