The association between self-reported workload and perceptions of patient safety culture: A study of intensive care unit nurses.

AIM AND OBJECTIVE: This study aimed to examine the association between workload and patient safety culture (PSC) among intensive care unit (ICU) nurses. BACKGROUND: ICU nurses play a vital role in promoting patient safety and are essential indicators in any healthcare system including ICUs. Research studies focusing on the relationship between nursing workload and PSC among ICU nurses are limited. DESIGN: Descriptive correlational design. METHODS: The study participants involved 380 ICU nurses at two hospitals in Riyadh, Saudi Arabia. Data were collected between February 2019-April 2019 and were analysed using SPSS v.22 statistical software. This study was guided by the STROBE checklist. RESULTS: The results showed that ICU nurses have high positive perceptions in the following PSC subscales: teamwork within units, organisational learning-continuous improvement, frequency of events reported, feedback and communication about error, management support for patient safety, teamwork across units, supervisor/manager expectations and actions promoting patient safety, handoffs and transitions, nonpunitive response to errors, staffing and overall perceptions of patient safety. However, the participants collectively considered the overall grade on patient safety as poor. The participants had high mean scores in physical demand, effort, mental demand and overall workload. A statistically significant variability existed in the mean scores of the PSC subscales and workload of ICU nurses. The overall workload was significantly and negatively associated with the PSC perceptions of ICU nurses. CONCLUSION: The ICU nurses experienced high overall workload, physical demand, effort and mental demand which influenced the poor grade of their overall perceived PSC. RELEVANCE TO CLINICAL PRACTICE: Identifying differences and associations with the perceptions of ICU nurses regarding workload and PSC is important because such perceptions may affect their delivery of nursing care. Hospital and nursing administrators must use the study results to find strategies that address workload issues and enhance patient safety.

A descriptive study to analyse the disaster preparedness among Saudi nurses through self-regulation survey.

AIM: The present study aimed to analyse the disaster preparedness among Saudi nurses through self-regulation survey. BACKGROUND: Nurses along with other healthcare professionals face difficulty in terms of management during disastrous condition. Moreover, there is a need to improve the abilities of nurses in managing disaster events by examining the disaster preparedness of nurses. METHODS: It employed quantitative descriptive design by conducting a self-regulation survey among 350 nurses recruited from five government hospitals in Medina, Saudi Arabia. Data related to the motivation, commitment and self-regulation of nurses concerning their participation in disaster preparedness activities were collected. RESULTS: Self-regulation scores were significantly related to the nationality (t [328] 3.95, p < .001), nursing education (t [328] 2.14, p < .05), age group (F [2,327] 4.75, p < .01) and experience (F [3,317] 4.891, p < .01), whereas insignificant association was found with gender (t [328] 1.84, p > .05) and hospitals (F [4,325] 0.925, p > .05). CONCLUSION: The level of knowledge of the healthcare nurses was satisfactory for the disaster preparedness, while there prevails a neutral level of involvement, preparedness and commitment among them. IMPLICATIONS FOR NURSING MANAGEMENT: There is a crucial need for hospital management to arrange disaster preparedness awareness and understanding programs for nurses and hospital staff to be competent for overcoming the risks associated with these events.

Health promoting lifestyle of university students in Saudi Arabia: a cross-sectional assessment.

BACKGROUND: College is a critical time where students are more prone to engage in risky health behaviors known to negatively affect well-being, such as physical inactivity, stress, and poor dietary habits. A health promoting lifestyle is an important determinant of health status and is recognized as a major factor for the maintenance and improvement of health. This study was designed to assess the health-promoting lifestyle of students in health colleges and non-health colleges in Saudi Arabia. METHODS: A total of 1656 students participated in this descriptive cross-sectional study. Data gathering was conducted from November 2016 to February 2017 at King Saud University. Participating students completed a self-reported questionnaire that included questions regarding their demographic characteristics and their health-promoting behaviors. RESULTS: The majority of participants were females (70.4%), 20% of the participants were overweight and 11.3%, were obese. The analysis showed that there was a significant difference between health colleges and non-health colleges with regards to the factor of health responsibility. Students at both schools were found to have an inadequate level of adherence to recommendations regarding physical activity and healthy eating habits. The analysis also found that majority of the students in both colleges do not attend educational programs on health care. The model shows that gender, type of college, year in school, and family structure were significant predictors of the health lifestyle of students in Saudi Arabia. CONCLUSION: The results of the current study indicate that university students are leading unhealthy lives, where the majority of them have unhealthy eating habits and poor physical activity level. Universities are ideal settings for implementing health promotion programs. Therefore, planning and implementing programs to motivate students to be more responsible for their own health, to engage more in physical activity, and to practice healthy eating habits and other forms of wellness are of paramount importance.

ENHANCING CULTURALLY COMPETENT NURSING CARE IN SAUDI ARABIA.

This study examined the cultural competence of expatriate nurses using self-reported individual assessment tool, and evaluated if there was an improvement after the educational training provided by nurse educators. Utilizing the Individual Assessment of Cultural Competence tool, questionnaires were administered to nurses (n=584) before the educational training and six months thereafter. A response rate of 90% was obtained. The data revealed that there was no significant difference between pre-test mean score and post-test mean score, (p-value=0.488). However, nurses' self-reported cultural competence was improved, (mean post-test gain = 0.020). Nurses'cultural competence was enhanced through the designed educational training program.

Patients' assessment of quality of care in public tertiary hospitals with and without accreditation: comparative cross-sectional study.

AIM: To compare patients' assessment of quality of care provided by public tertiary hospitals grouped according to accreditation status. BACKGROUND: Healthcare institutions worldwide are increasingly adopting accreditation as continuing initiative aimed at improving structures, processes and outcomes associated with quality of care. Patients being recipients of health care need to participate in assessing the quality of care they experienced while confined for therapeutic management. DESIGN: Comparative, cross-sectional. METHOD: Data were collected from patients confined in public tertiary hospitals (n = 517 in four with accreditation and n = 542 in four without accreditation) in Riyadh, Saudi Arabia between February 2011-June 2011. Patients rated key performance indicators grouped under the dimensions of structure, process and outcome. Mann-Whitney U-test, Spearman Correlation Coefficient and coefficient of determination were used in analysing data. RESULTS: Patients in accredited public tertiary hospitals perceived structure, outcome and overall quality of care statistically higher than patients in non-accredited hospitals. No statistical differences were found in process (access and communication) indicators. Accreditation status is marginally associated with structure; outcome; and overall quality of care. The proportion of variance in the ranks of accreditation status explained the proportion of variance in the ranks of structure; outcome; and overall quality of care. CONCLUSION: The results apparently showed better structure, outcome and overall quality of care in accredited hospitals. Accreditation's association in the overall quality of care apparently remained unclear. Further studies are needed to appreciate the contribution of accreditation.

The work engagement of nurses in multiple hospital sectors in Saudi Arabia: a comparative study.

AIM: To examine the differences in work engagement among nurses in Saudi Arabia and its relationship with personal characteristics across different hospital affiliations. BACKGROUND: Quality care requires an adequate supply of engaged nurses who are dedicated, energised and absorbed in their work. In the nursing profession, work engagement is of considerable importance, owing to the shortage of nurses and the continuing reduction in healthcare costs. METHOD: An analytic comparative cross-sectional design was used. Eight hospitals from three provinces and different affiliation types participated in the study. The Utrecht work engagement scale (UWES) was used to measure 980 nurses' work engagement. RESULTS: The findings indicate that nurses' total engagement scores were closer to the higher end of the Likert scale. The findings indicate generally high levels of work engagement, particularly regarding the element of dedication. Furthermore, the study shows significant differences in nurses' engagement among the various work settings and in nurses' age and experience. CONCLUSIONS: A number of nurses' personal characteristics have independent influences on their work engagement. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse leaders should acknowledge that a statement of professional nursing scope of practice is a necessity to encourage and fulfil engagement.

Nursing work environment in Saudi Arabia.

AIM: The purpose of this study was to assess the work environment as perceived by nurses in a large tertiary hospital in Saudi Arabia. BACKGROUND: The quality of patient care services has been associated with the quality of work environment of nurses. It is therefore important to assess the work environment in order to acquire baseline data and enable the institution to benchmark their status from established quality standards. METHOD: This study used a descriptive survey with 1007 staff nurses across service units of a 1000-bed government-operated hospital. The American Association of Critical-Care Nurses (AACN) Healthy Work Environment Assessment Questionnaire was used for data collection. Scores were aggregated and interpreted. RESULT: Effective decision making, authentic leadership, appropriate staffing, true collaboration, skilled communication and meaningful recognition were rated as good (mean range 3.53-3.76). CONCLUSION: Healthy work environments mutually benefit patients, nurses, nurse managers, health care providers, the health team, administration, the institution and the community at large. IMPLICATIONS FOR NURSING MANAGEMENT: Valuable baseline data on the status of the work environment in this setting were generated. This should allow administrators and staff to work together in improving weaknesses and strengthening further whatever gains that are attained to ensure consistent provision of safe and quality patient care.

Actual Scope of Nursing Practice in Saudi Ministry of Health Hospitals.

BACKGROUND: Articulating a clear scope of practice for all nursing categories is essential for improving patient safety, quality of care, and nurse retention. However, this is not the case in many countries, including Saudi Arabia. This study aimed to analyze the actual scope of practice for nursing staff in Saudi Ministry of Health hospitals. METHODS: The study used a cross-sectional exploratory design. The sampling method used in the study was the quota sampling technique. The scale utilized in this study was the Actual Scope of Practice (ASCOP) scale. Data were collected in March 2021 through an electronic form questionnaire completed by 286 nurses in two hospitals in Al-Hasa province in Saudi Arabia. RESULTS: The overall mean score for ASCOP was 4.64 out of 6. When participants were grouped according to select characteristics (various nursing staff categories, educational levels, years of experience, nationality, gender, and type of work setting), the results revealed no statistically significant differences in overall ASCOP mean scores, except for gender and nationality. CONCLUSIONS: The overall mean scores of nursing activities performed in practice do not significantly differ across nurses with different professional categories (health assistant, nursing technician, nursing specialist, and senior nursing specialist), indicating no clear scope of practice for each nursing category, in turn leading to role overlap among them in practice. The current study's findings can guide decision-makers to develop a clear scope of practice for nurses. The findings should also urge the decision-makers to reevaluate the usefulness of having multiple professional categories of nurses who are allowed to carry out almost the same job duties.

Structural Empowerment, Resilience, and Intent to Stay Among Nurses and Midwives in Obstetrics and Gynecology Departments: A Phenomenological Inquiry Study in Saudi Arabia.

Introduction: Staff turnover is a major obstacle to the success of Saudi Arabia's health transformation agenda and the realization of Saudi Vision 2030. Nurses' and midwives' intentions to remain with the organization are heavily influenced by their sense of structural empowerment and resilience. Objectives: To gain insight into the perspectives of nurses and midwives working in the Obstetrics and Gynecology departments of a selection of Saudi Arabian governmental hospitals about structural empowerment, resilience, and intentions to stay in their current positions. Methods: Qualitative Descriptive Phenomenology. Purposive sampling was used to choose eighteen nurses and midwives working in the OB/GYN department in three government hospitals in the Eastern Province of Saudi Arabia. Semi-structured interviews were conducted to gather the participants' perceptions. Colaizzi's steps were used as a data analysis method. Results: The narratives of the selected participants generated five major themes: (a) "nurturing physical and physiological," (b) "developing psychological," (c) "managing financial," (e) "restructuring organizational," and (f) "enriching professional and occupational." Conclusions: The emerging major themes highlighted the perceptive elements of nurses and midwives that keep them empowered, resilient, and determined to stay in their organization. A failure to fulfill any one of these elements will affect the others. To improve organizational outcomes, empowerment and resilience must be obtained.

Patients' satisfaction with the quality of nursing care provided: the Saudi experience.

Patient's satisfaction has emerged as a central focus of health-care delivery during the last decades, and nursing care became one significant component of patient's satisfaction. The purpose of this study is to examine patients' satisfaction with quality of nursing care provided in Saudi Arabia. Cross-sectional descriptive correctional design was used to recruit 100 patients from one regional hospital in Saudi Arabia. Data collected using structured interview from patients related to six dimensions of nursing care. Patients had a high level of satisfaction with nursing care provided (86% agreement rate). Language (56% disagreement rate), discharge information (56% disagreement rate) and availability (20% disagreement rate) have been identified with the lowest rates of patients satisfaction. Nursing leaders and health-care administrators need to maintain quality nursing care and develop strategies for improving nursing care emphasizing language as barrier and strategies of information dissemination.

Assessment of nurses' perceptions of patient safety culture in a Saudi Arabia hospital.

The purpose of this study was to identify factors that nurses perceive as contributing to the culture of patient safety in a hospital in Saudi Arabia. A total of 498 registered nurses employed in the hospital completed the survey. The majority of nurses perceived a positive patient safety culture. There were significant differences in nurses' perceptions of patient safety culture based on gender, age, years of experience, Arabic versus non-Arabic speaking, and length of shift.

Knowledge, Attitude and Beliefs of Nurses Regarding Antibiotic use and Prevention of Antibiotic Resistance.

Introduction: Resistance to antibiotics is a threat confronting health care system worldwide. Nurses play a significant role in combating this threat. Objectives: The present study examined the knowledge and attitude of nurses towards antibiotic use and prevention of antibiotic resistance. Methods: The research involved a cross-sectional study conducted in a multi-cultural tertiary healthcare setting. The participants were 341 nurses. A structured self-administered questionnaire with a good validity and reliability (α = 0.7) was used. Results: The nurses surveyed showed moderate awareness of antibiotic resistance and a fair attitude towards its prevention. There was no significant correlation of demographic features with their overall knowledge and attitude (p > 0.05). Conclusions: Nurses perform a crucial part in infection control, but often lack knowledge of methods to prevent antibiotic resistance. This paucity highlights the importance of tailored interventions to help nurses improve their awareness of antibiotic resistance and create a favorable attitude towards its prevention.

Nurses' professional values scale‒three: Validation and psychometric appraisal among Saudi undergraduate student nurses.

Objectives: Since the nursing professional values have garnered attention as a principal criterion for safe‒quality nursing practice, it was measured using the Nurses Professional Values Scale‒three. We aimed to validate and ascertain the psychometric indicators of the Arabic version of the Nurses Professional Values Scale-three among Saudi student nurses. Method: This methodological study recruited student nurses using convenience sampling from two nursing colleges at KSA. About 438 valid questionnaires were returned out of 500 questionnaires which were distributed over students in a formal day class time; representing a response rate of 87.6%. A 2‒fold cross‒validation process was adopted. A transcultural process was conducted. Face, content, and construct validity using exploratory and confirmatory factor analyses were used. Convergent and discriminant validity were also assessed. The reliability of the scale was assessed using Cronbach's alpha. Results: Face validity was achieved. The content validity of items ranged from .83 to 1.00, while it was .96 for the overall scale. The exploratory factor analysis yielded a scale containing 28 items with a three‒factor model, explaining 74.5% of the total variance. Confirmatory factor analysis confirmed that three‒factor solution had an adequate model fit (CMIN/df = 1.98; RMSEA = .065; SRMR = .039, CFI = .972, and GFI = .968). Convergent validity and discriminant validity were achieved. Cronbach's alpha values were .89, .90, .90, and .96 for activism, caring, professionalism, and the overall scale, respectively. Conclusion: Adequate levels of reliability and validity of the Arabic version of the Nurses Professional Values Scale-three were established, indicating the appropriateness of using this version to assess the professional values among Saudi and other Arabic‒speaking nurses.

Cultural Competency Among Pediatric Registered Nurses in Saudi Arabia: A Cross-Sectional Design.

INTRODUCTION: Saudi Arabia's culturally diverse population is growing rapidly. The need for cultural competence is greatest in pediatric units where nurses provide care to children in collaboration with their parents. METHOD: Nonprobability sampling of 394 nurses and cross-sectional descriptive design was used to investigate nurses' cultural competence, and to examine the relationships between the variables and participants' demographic data in pediatric units across five hospitals in Riyadh, Saudi Arabia, by asking nurses to complete a self-report questionnaire. RESULTS: The results suggest a high degree of cultural competency. Participants' scores indicated high levels of perceived cultural awareness, sensitivity, and cultural competence behavior for performance. DISCUSSION: This study supports the 3-D Puzzle Model of culturally congruent care for cultural competence, which assumes that cultural competence is deeply influenced by one's experiences. The findings revealed a high level of cultural competence despite a lack of information with respect to patient views.

Mental Health Outcomes of Healthcare Providers During COVID-19 Pandemic in Saudi Arabia: A Cross-Sectional Study.

Objective: In this descriptive cross-sectional study we aimed, to assess the level of depression, anxiety, insomnia and distress symptoms experienced by healthcare providers during the COVID-19 pandemic in Saudi Arabia. Methods: All healthcare providers currently working in different hospitals were invited to participate in this study. Data gathering started in March 2020 to May 2020. The participants answered a five-part questionnaire which includes demographic data, a 9-item Patient Health Questionnaire, a 7-item Generalized Anxiety Disorder, a 7-item Insomnia Severity Index, and a 22-item Impact of Event Scale-Revised, which assess the level of depression, anxiety, insomnia, and distress. Results: Out of 200 healthcare providers, 40% were males. 52% were aged 31-40 years old, 61% were married. The majority of the participants were Saudi nationals (84%), 74% were nurses, 11% were physicians and 15% were other healthcare providers. More than half of the participants worked as front-liners (57%). Overall, 73, 69, 62, and 83% of all healthcare providers reported symptoms of depression, anxiety, insomnia, and distress, respectively. The analysis showed severe symptoms level of depression for physicians and nurses was 35% and 20% (p < 0.05), respectively. Only three of the independent variables made a unique contribution to the model (gender, profession, and working position) (p < 0.05). Conclusion: COVID-19 pandemic has a significant impact on the mental health of healthcare providers in Saudi Arabia. Female nurses and healthcare providers working in the frontline who were directly treating patients with COVID-19 are at increased risk of severe depression, anxiety and distress.

Using action research to evaluate a nursing orientation program in a multicultural acute healthcare setting.

OBJECTIVES: Competence motivates newly employed nurses to provide high-quality care, which leads to appropriate patient care and satisfaction. A nursing orientation program can have a positive impact on new nurses who are joining healthcare organizations. The research examined the orientation program for new nurses in a multicultural setting to redesign the program. METHODS: The study was carried out in a multicultural tertiary setting. Action research was used as a research strategy with qualitative content analysis and quantitative evaluation. Seventy nurses were part of the orientation program. The competence of the nurses was assessed using the Nurse Competence Scale. Focus-group discussions were also conducted to find the views of the beneficiaries about the program. RESULTS: The study revealed that the overall competence was high, and there was an overall gain in the competence score (5.48%) among the nurses. Among their competence in different dimensions, new nurses had a maximum gain in competence for the dimension of ensuring quality. However, they showed low competence gain in teaching coaching. The results show that the difference in the overall pre- and post-test scores was statistically significant (P < 0.05) in all dimensions except teaching coaching and managing situations, and the program was effective. However, a few challenges were identified in the program. CONCLUSIONS: New nurses were found to be competent, and the orientation program had a significant impact on the competence of the nurses. The findings emphasized the need for modification of some content and strategy for future programs. The strategies developed from the findings were presented. This helps hospitals to consider examining specific aspects of the orientation program and redesigning it so it can enrich the experiences of new nurses.

Determining the effects of traditional learning approach and interactive learning activities on personal and professional factors among Saudi intern nurses.

Aim: This study determines the impact of traditional and interactive learning activities on personal and professional development among Saudi intern nurses. Design: A comparative research design was adopted by recruiting 48 intern nurses, who were divided into two equal groups. Methods: Data were collected through the clinical assessment tool for nursing education. Results: Enthusiasm (p < .0001), initiative (p < .0001), realistic self-confidence (p < .0001), competent cooperation with staff (p < .0001) and competent cooperation with patients (p < .0001) were significantly higher among the interactive learning activity group compared with traditional group. The interactive learning activity showed better attitude of Saudi intern nurses in terms of caring, respect and sensitivity towards the needs and well-being of their patients, while considering personal factors.

Predictors of Palliative Care Knowledge Among Nursing Students in Saudi Arabia: A Cross-Sectional Study.

BACKGROUND: Societal aging, a concern in many countries worldwide, is increasing the demand for quality palliative care in Saudi Arabia. Nursing education is responsible for providing nursing students with high levels of knowledge and competency related to palliative care. PURPOSE: The aim of this study was to investigate the predictors of palliative care knowledge among nursing students in Saudi Arabia. METHODS: A convenience sample of 409 nursing students from one public academic institution and one private academic institution in Saudi Arabia was surveyed from November to December 2017 in this descriptive, cross-sectional study. The 20-item Palliative Care Quiz for Nursing was used to collect the data. Descriptive statistics were used to fully describe the demographic characteristics and palliative care knowledge of the participants. One-way analysis of variance and t test were used to examine the associations between palliative care knowledge and the demographic characteristics. Multiple regression analysis was conducted to identify the significant demographic predictors of this knowledge. RESULTS: The mean score of the participants was 5.23 (SD = 3.24, range = 0-12), indicating poor palliative care knowledge. The participants lacked palliative care knowledge in terms of palliative care principles and philosophy, management of pain and other symptoms, and psychosocial and spiritual care. Being enrolled in a private university, being in the second year of a nursing program, having attended palliative care education sessions outside a university setting, and attending a palliative care course in the nursing program were identified as significant predictors of higher palliative care knowledge. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: This study may be used as a basis for formulating education policies and interventions to enhance palliative care education and clinical training among nursing students and ensure the quality of palliative care not only in Saudi Arabia but also in other countries.

Assessing Palliative Care Knowledge Among Nurses in 2 Hospitals in Saudi Arabia.

The aims of this study were to assess the palliative care knowledge among nurses in Saudi Arabia and to identify the demographic factors influencing such knowledge. A convenience sample of 365 nurses working in 2 hospitals in Saudi Arabia was surveyed using the Palliative Care Quiz for Nursing in this cross-sectional study. The mean score of the respondents in the Palliative Care Quiz for Nursing was 8.88 (SD, 1.75), which is interpreted as low knowledge. In terms of the theoretical categories of the scale, 9 of the 13 items in the category pain and symptom management were answered correctly by the majority of the respondents, whereas all the items in the psychosocial and spiritual care category were answered incorrectly by the majority of the respondents. Type of hospital, age, and attendance to palliative care education in the last 6 months were revealed as significant factors that influence the nurses' palliative care knowledge. Continuing education on palliative care should be implemented by hospital administrations, and palliative care education should target the weakness of the nurses, especially those revealed in the study, such as on the psychosocial and spiritual care, some aspects of pain and symptom management, and philosophy and principles of palliative care.

Quality of Life and Its Predictors Among Nursing Students in Saudi Arabia.

PURPOSE: This study investigated the quality of life (QOL) and its predictors among nursing students in a university in Saudi Arabia. DESIGN: A descriptive, cross-sectional design. METHOD: A convenience sample of 175 baccalaureate nursing students from a university in Saudi Arabia was surveyed in this study. Using the WHOQOL-BREF and a sociodemographic sheet, the QOL and its predictors among Saudi nursing students were investigated. FINDINGS: The respondents reported a mean score of 4.09 ( SD = 0.71) and 4.02 ( SD = 0.87) for their overall perceptions of QOL and health, respectively. The psychological and physical health of these students had the highest and poorest QOL perception, respectively. Gender, academic year level, community type, and monthly family income exerted a multivariate effect on the four domains of QOL. CONCLUSION: The study underscores the need to ensure the highest level of health and well-being among nursing students while they are undergoing training for their professional roles as nurses. The findings should be utilized by policymakers in nursing institutions in Saudi Arabia in creating policies centered on the holistic development of nursing students in the country.