Background: Nurses play a pivotal role in delivering comprehensive care aimed at enhancing the health and quality of life of individuals, families, and communities throughout the lifespan. Specific Background: The evolving sociocultural landscape has significantly influenced the roles and responsibilities of the nursing workforce. Knowledge Gap: Despite the increasing prevalence of neurodegenerative disorders, limited data exist regarding nurses’ knowledge of Parkinson’s disease, particularly in low-resource settings. Aims: This study aims to assess the level of knowledge about Parkinson’s disease among nurses in Al-Basrah Teaching Hospitals and examine the influence of demographic variables such as gender, age, education, workplace, and experience. Results: A descriptive cross-sectional study was conducted among 75 nurses from three teaching hospitals using a structured questionnaire. Findings revealed that most participants were aged 20–40 years, had less than 20 years of experience, and possessed a school or institute-level education. Notably, the majority demonstrated a poor understanding of Parkinson’s disease. Novelty: This study highlights critical knowledge deficiencies among nurses in a region where Parkinson’s-related care is becoming increasingly relevant. Implications: Addressing this gap through targeted education and training may enhance early detection, management, and patient outcomes in neurodegenerative diseases within clinical settings.
One progressive neurodegenerative illness is Parkinson's disease (PD) [1,27,28]. Nurse training is critical to the efficacy of therapy in the diverse management of chronic illnesses [2, 3]. The patient is directly impacted by nurses' contributions in many areas of progressive PD, including when to take medicine, how long to take it for, how well the patient responds to therapy, and how to monitor motor issues connected to the disease and its treatment.
Few studies have been conducted on nurses' knowledge of Parkinson's disease [4,30,31]. According to these investigations, nurses knew relatively little about Parkinson's disease [5, 6,33,34]. Insufficient general knowledge regarding Parkinson's disease can cause communication issues between nurses, patients, and doctors. Both the disease's therapy and the patient's everyday activities are adversely affected by this condition. There are no statistics on this subject in our nation's literature.
Assessing nurses' attitudes and knowledge regarding Parkinson's disease is the aim of this study. In this manner, what is crucial will be made clear to PD nurses during their education and training. [7.29,32]
Characteristics of Parkinson's disease (PD), a chronic progressive neurodegenerative disorder, include the early and substantial loss of dopaminergic neurones in the substantia nigra pars compacta (SNpc) and the pervasive intracellular protein alpha synuclein (aSyn). [8] When the basal ganglia do not receive enough dopamine, it leads to the classic motor symptoms of Parkinson's disease, including bradykinesia, tremor, stiffness, and eventually postural instability. There is evidence that PD is associated with non-motor symptoms in [9], and these may manifest up to a decade before motor symptoms do. As Parkinson's disease advances, these non-motor symptoms start to cause problems. The current standard of care for Parkinson's disease (PD) management is pharmaceutical therapy; however, there are major downsides to these symptomatic therapies when the condition is severe. Later on in the disease's progression, a variety of incapacitating features manifest, including non-motor symptoms, motor issues caused by long-term dopamine treatment, and dopamine-resistant motor symptoms. [10,35,36] There is still a lack of disease-modifying medicines for Parkinson's disease, even though there have been significant advances in surgical and medicinal therapy. The research community is hopeful, nevertheless, that they will eventually identify potential therapeutic targets. About 1.5 percent of individuals 70 and over and 1 percent of those 50 and up are impacted. While men have a 2.0% lifetime risk of having Parkinson's disease, women have a 1.3% probability. the eleventh
The pathologic diagnosis of Parkinson's disease (PD) requires the loss of DA neurones in the substantia nigra pars compacta (SNpc), a hallmark pathologic indication of the disease. Even mildly affected persons with PD have lost over 60% of their DA neurones due to a combination of factors, including the loss of around 80% of the DA in the corpus striatum at the moment of death and possible dysfunction of the remaining neurones. According to [12,37,38]
Another pathologic feature of Parkinson's disease is the Lewy body, which is an eosinophilic inclusion seen in neurones. On histologic stains, Lewy bodies appear as a white halo around the eosinophilic core. Their usual shape is spherical, with a diameter of 5–25 m; nevertheless, they are capable of taking on pleiomorphic forms. The cell soma is a common place to find them, although open space or neurites are other good places to look. Although Lewy bodies can be observed in various brain regions, including the neocortex, diencephalon, spinal cord, and peripheral autonomic ganglia, they are most commonly found in the SN, locus coeruleus, dorsal motor nucleus of the vagus, and nucleus basalis of Meynert—the regions that experience the highest rates of neurone loss in Parkinson's disease (PD). In 1817, Parkinson's disease (PD) was first described by Dr. James Parkinson as a "shaking palsy." There are both motor and non-motor symptoms associated with this neurodegenerative disorder, which is persistent and progresses over time. The condition has a significant clinical impact on patients, families, and carers because to the progressive impairment of muscle function and mobility. The motor symptoms of Parkinson's disease are believed to be caused by the loss of striatal dopaminergic neurones, however non-motor symptoms also indicate neuronal loss in non-dopaminergic locations. Parkinsonism is the collective noun for the motor symptoms of Parkinson's disease (PD), which include bradykinesia, rigidity of the muscles, and resting tremor. The most common secondary cause of parkinsonism is Parkinson's disease (PD), while there are others, including drug-induced causes and illnesses that mimic PD. As mentioned in [14,39,]
Research suggests that the pathophysiological changes associated with Parkinson's disease (PD) may manifest in a variety of non-motor symptoms, such as sleep problems, depression, and cognitive impairments, some of which may manifest prior to the onset of motor symptoms. Research into remedies with the potential to prevent or mitigate harm has piqued attention at this preclinical stage. [15,41,].
Although PD usually strikes the elderly, it has been found in those in their thirties and forties as well. [16,]. Incidence of Parkinson's disease (PD) is three times higher in males than in women, and it starts later in women due to oestrogen's neuroprotective effects on the nigrostriatal dopaminergic system. references [17,18]
Individuals, families, and communities are all impacted by the unpredictable yet apparent progression of Parkinson's disease. In the last stages of a disease, serious complications like pneumonia can develop, and these consequences are often fatal. [18] in Managing symptoms is the focus of present treatment. 20 and 21 Evidence suggests that patients with Parkinson's disease may benefit from a multidisciplinary approach to treatment that incorporates movement specialists, social workers, chemists, and other medicinal specialists. [ 22,40]
When it comes to pharmacologic treatments for Parkinson's disease symptoms, levodopa is by far the most used and effective option. The Parkinson's disease symptoms that levodopa alleviates include bradykinesia, rigidity, and tremor. Patients experience PD symptoms such as bradykinesia, stiffness, and tremor prior to their next levodopa dosage, which means they may need to take more frequent or larger doses in the future due to wearing-off effects and end-of-dose worsening. As the condition advances, the patient has less responsive postural instability and non-motor symptoms. It is harder to treat extrapyramidal symptoms without causing undesired dyskinesia when the treatment window gradually gets smaller over time. [23]
Study design: To evaluate the nurses' understanding of Parkinsonism at Basrah teaching hospitals, a descriptive cross-sectional study design was implemented from February 7, 2021, to June 10, 2021.
Study setting: The current study was conducted at teaching hospitals in Basra.
The study's sample: For the study, a purposive sample of 75 nurses—31 men and 44 women—from teaching hospitals in Basrah were chosen. Al-Fayha Teaching Hospital (21 nurses), Al-Sader Teaching Hospital (25 nurses), and Basrah General Hospital (29 nurses) were the hospitals that were part in the study.
Methods: A questionnaire consisting of closed-ended questions was used to collect data for the study. The issue was sent to a scientific committee for their review and recommendations. No less than three parts make up the survey. In the first part of the survey, we enquire about the demographic details of the nurses, including their gender, age, years of experience, level of education, and the name of the hospital where they work. The second part of the questionnaire consists of 34 questions on the disease's characteristics, while the third part has 9 questions regarding nursing interventions. The standardised Likert scale has three options: don't agree (zero mark), agree (one mark), and strongly agree (two marks). Using the usual evaluation form, we added up the results from each form and translated them to percentages. A total of seventy-five nurses were provided with the finalised survey and were asked to fill it out. After collecting all of the completed forms, the researchers scored them according to the correct typical response.
The following form is used to categorise the scoring.
| Level of score | Degree of score |
| Excellent | ( 90_100 ) |
| Very good | ( 80_89 ) |
| Good | ( 70_79 ) |
| Moderate | ( 60_69 ) |
| Acceptable | ( 50_59 ) |
| Poor | ( 49 or loss ) |
Statistical analysis was conducted with SPSS (Statistical Package for the Social Sciences) version 26, with data presented in terms of frequency and percentage. Correlations were employed to investigate the relationship among various variables.
| Gender | Frequency | Percent |
| male | 31 | 41.3 |
| female | 44 | 58.7 |
| total | 75 | 100.0 |
The table showed the distribution of the studied sample (nurses) according to gender , where 41.3 % were males and 58.7 were female.
| Age intervals | Frequency | Percent |
| 20-30 | 32 | 42.7 |
| 30-40 | 15 | 20.0 |
| 40-50 | 12 | 16.0 |
| 50-60 | 16 | 21.3 |
| Total | 75 | 100.0 |
The table showed the distribution of the studied sample according to age intervals, where we found the following: 42.7 % were at age interval from 20 – 30, 20.0% from 30 – 40 age, 16.0 % from 40 – 50, and 21.3% from 50 – 60 age.
| Years of experiences | Frequency | Percent |
| 1-10 | 35 | 46,7 |
| 10-20 | 19 | 25,3 |
| 20-30 | 14 | 18,7 |
| 30-40 | 7 | 9,3 |
| Total | 75 | 100,0 |
The table showed the distribution of the studied sample according to years of experience, where we found the following: 46.7% it was their years of experience from 1 – 10 years, 25.3% from 10 – 20 years, 18.7% from 20 – 30 years, and 9.3% from 30 – 40 years.
| Education levels | Frequency | Percent |
| school of nursing institute nursing college of nursing Total | 35 | 46,6 |
| 28 | 37,3 | |
| 12 | 16,0 | |
| 75 | 100,0 |
The table showed the distribution of the studied sample according to education level, where we found the following: 46.6% from school of nursing, 37.3% from institute nursing, 16.0% from college of nursing.
| Hospital name | Frequency | Percent |
| General Basrah Hospital | 29 | 38,7 |
| Al-Fayha Teaching Hospital | 21 | 28,0 |
| Al-Sadr Teaching Hospital | 25 | 33,3 |
| Total | 75 | 100,0 |
The table showed the distribution of the studied sample according to hospital name, where we found the following: 38.7% from general Basrah hospital,28.0% from Al Fayha Teaching Hospital, 33.3% from Al-Sadr Teaching Hospital.
➢ No significant correlation was found between the scores and the demographic traits of the nurses in the study.
| NO | ITEM | IDA | AG | SAG | MS | Sig |
| 1 | Parkinson’s disease is cell damage | 4 | 55 | 16 | 2.16 | SIGNF |
| 2 | Neuronal damage affects the release of dopamine a neurotransmitter responsible for coordinating movement commands | 2 | 63 | 10 | 1.94 | |
| 3 | brain call damage begins about 5-10 years before symptoms appear | 30 | 39 | 6 | 1.68 | |
| 4 | most people who develop Parkinson’s disease are 50 years old or older ,but young adults also be affected | 6 | 51 | 18 | 2.16 | SIGNF |
| 5 | men are more likely to have Parkinson’s disease than women | 18 | 47 | 10 | 1.89 | |
| 6 | -parkinson’s disease may be caused by bacteria in the intestine | 56 | 13 | 6 | 1.3 | |
| 7 | heredity plays an important role in the development of Parkinson’s disease | 23 | 37 | 15 | 1.89 | |
| 8 | Exposure to environmental toxicants and pesticides increases the risk factor | 24 | 39 | 12 | 1.84 | |
| 9 | Symptoms associated with the disease: tremor, muscle stiffness, and slow movement | 11 | 43 | 21 | 1.13 | SIGNF |
| 10 | Symptoms begin to appear on one side of the body | 12 | 39 | 10 | 1.6 | |
| 11 | Tremors often occur during rest and disappear completely during sleep | 16 | 47 | 12 | 1.94 | |
| 12 | Muscle stiffness often appears in the extremities | 8 | 48 | 19 | 2.14 | SIGNF |
| 13 | -Walking in short steps with dragging the feet and sudden immobility of movement are symptoms of the disease | 11 | 44 | 20 | 2.12 | SIGNF |
| 14 | Difficulty turning around and getting up from complications of muscle stiffness | 9 | 52 | 14 | 2.06 | SIGNF |
| 15 | The patient with Parkinson's disease suffers from rigidity of facial expressions, drooling and difficulty swallowing | 17 | 39 | 19 | 2.06 | SIGNF |
| 16 | Parkinson's disease is often accompanied by depression | 14 | 45 | 16 | 2.06 | SIGNF |
| 17 | Severe headaches are one of the main symptoms of Parkinson's disease | 26 | 43 | 6 | 1.73 | |
| 18 | Severe constipation and difficulty initiating urination are major complications of Parkinson's disease | 22 | 42 | 11 | 1.85 | |
| 19 | Symptoms of Alzheimer's disease appear in the advanced stages of the disease | 22 | 42 | 11 | 1.85 | |
| 20 | Sudden drop in blood pressure upon standing | 19 | 50 | 6 | 2.26 | SIGNF |
| 21 | The prevalence of vision problems in patients with Parkinson's disease | 33 | 32 | 10 | 1.69 | |
| 22 | Impaired sense of smell and taste | 39 | 31 | 5 | 1.54 | |
| 23 | The severity of symptoms varies from person to person | 8 | 49 | 18 | 2.13 | SIGNF |
| 24 | It is not necessary for all people with Parkinson's disease to have the same group of diseases | 7 | 49 | 19 | 2.16 | SIGNF |
| 25 | Possible death from Parkinson's disease | 24 | 34 | 17 | 1.9 | |
| 26 | No blood or laboratory tests are available to diagnose the disease | 22 | 40 | 13 | 1.88 | |
| 27 | The disease is diagnosed clinically by observing the characteristic symptoms of the disease | 13 | 45 | 17 | 2.05 | SIGNF |
| 28 | There is no complete cure for Parkinson's disease at present | 11 | 48 | 16 | 2.06 | SIGNF |
| 29 | Pharmacotherapy can help to overcome the problems of the three main symptoms | 4 | 57 | 14 | 2.13 | SIGNF |
| 30 | The most common drug used to treat Parkinson's disease is levodopa | 12 | 45 | 18 | 2.08 | SIGNF |
| 31 | Delirium, hallucinations, and excessive sleepiness are the most important side effects of levodopa | 16 | 42 | 17 | 2.01 | SIGNF |
| 32 | Use of dopamine agonists in the early stages of the disease | 6 | 61 | 8 | 2.02 | SIGNF |
| 33 | The use of deep brain stimulation (DBS) as a therapeutic surgical intervention in the advanced stages of the disease | 16 | 47 | 12 | 1.94 | |
| 34 | Adopting physical therapy and physical activity to control the complications of muscle stiffness | 4 | 49 | 22 | 2.24 | SIGNF |
| 35 | Neurological assessment and observation of physical and behavioral changes (how the patient moves, walks, writes, talks and eats) | 8 | 49 | 18 | 2.13 | SIGNF |
| 36 | Make sure that the patient eats high-protein, high-fiber foods and plenty of water | 8 | 50 | 17 | 2.12 | SIGNF |
| 37 | Directing the patient to raise his feet when walking and avoid sitting for long periods | 9 | 50 | 16 | 2.09 | SIGNF |
| 38 | Strengthening physical therapy and rehabilitation | 3 | 49 | 23 | 2.26 | SIGNF |
| 39 | Directing the patient to use anti-disease drugs to increase the level of dopamine in the nervous system | 8 | 52 | 15 | 2.09 | SIGNF |
| 40 | Instruct the patient to limit the intake of foods rich in vitamin B6 | 25 | 37 | 13 | 1.84 | |
| 41 | Avoid taking dopamine blockers used to treat depression because it causes high blood pressure | 14 | 34 | 18 | 1.81 | |
| 42 | Assessment of family support and access to social services | 6 | 41 | 28 | 2.29 | SIGNF |
| 43 | Assessment of the patient's vital signs | 7 | 25 | 43 | 2.48 | SIGNF |
| 1.99 |
IDA : I DON’T AGREE .AG : AGREE . SAG: STRONGLY AGREE , MS : MEAN OF SCORE , Sig : SIGNIFICANT
The overall estimated mean of scores is not significant, indicating that there were low level of knowledge regarding Parkinsonism by the assessed nurses.
| Scoring | Frequency | Percentage |
| Excellent ( 90_100 ) | 0 | 0 |
| Very good ( 80_89 ) | 0 | 0 |
| Good ( 70_79 ) | 1 | 1.3 |
| Moderate ( 60_69 ) | 11 | 14.6 |
| Acceptable ( 50_59 ) | 22 | 29.3 |
| Poor ( 49 or loss ) | 41 | 54.6 |
| Total | 75 | 100 |
The table showed that there were no excellent and very good scores for answering the questionnaire forma, good scores were 1.3 %, moderate score were 14.6 %, acceptable (low level) scores 29.3 % and poor scores were 54.6 %.
| Scoring | Frequency | Percentage |
| Excellent ( 90_100 ) | 1 | 1.3 |
| Very good ( 80_89 ) | 3 | 4 |
| Good ( 70_79 ) | 16 | 21.3 |
| Moderate ( 60_69 ) | 22 | 29.3 |
| Acceptable ( 50_59 ) | 17 | 22.6 |
| Poor ( 49 or loss ) | 16 | 21.3 |
| Total | 75 | 100 |
The table showed that were excellent score were 1.3%, very good score were 4%, good score were 21.3%, moderate score were 29.3%, acceptable (low level) score were 22.6% and poor score 21.3%.
Our study was a cross sectional study, to assess nurses’ knowledge about Parkinson disease.
Our study showed that the nurses had low level of knowledge about Parkinson disease for the disease knowledge and for intervention steps In a study done in Turkey [7], Their result were similar to our study.
A study conducted in northern India, which differs from our research, indicated a high degree of expertise among nurses. A study in England indicated that a survey of 35 nurses, done by the Parkinson’s Disease Society, found a considerable deficiency in understanding of the mental health difficulties linked with Parkinson’s among nurses in England. Fewer than one third of the questioned nurses had received training pertinent to Parkinson's in the past two years, and the majority expressed a desire for further understanding regarding dementia and depression. The survey indicated that nurses had the lowest confidence levels compared to other professional groups, with about fifty percent lacking confidence in their capacity to recognise the mental health or non-motor symptoms related to the disorder. [25] Our investigation concurs with this research.
A research in the USA indicated that nurses' knowledge scores varied from 0.70 to 0.95, surpassing 0.90 for the global parkinsonian sign score. [26] Our analysis revealed a limited degree of knowledge.
1.High percent of the sample age were from 20 to 40 years.
2.High percent of the sample were had years of experiences less than twenty.
3.Most of the sample is either having school or institute level of education.
4.Most of the nurses had low level of knowledge about Parkinson disease.