Challenges and policy opportunities in nursing in Saudi Arabia.

BACKGROUND: The Kingdom of Saudi Arabia's (KSA) health sector is undergoing rapid reform in line with the National Transformation Program, as part of Saudi's vision for the future, Vision 2030. From a nursing human resources for health (HRH) perspective, there are challenges of low nursing school capacity, high employment of expatriates, labor market fragmentation, shortage of nurses in rural areas, uneven quality, and gender challenges. CASE PRESENTATION: This case study summarizes Saudi Ministry of Health (MOH) and Saudi Health Council's (SHCs) evaluation of the current challenges facing the nursing profession in the KSA. We propose policy interventions to support the transformation of nursing into a profession that contributes to efficient, high-quality healthcare for every Saudi citizen. Key to the success of modernizing the Saudi workforce will be an improved pipeline of nurses that leads from middle and high school to nursing school; followed by a diverse career path that includes postgraduate education. To retain nurses in the profession, there are opportunities to make nursing practice more attractive and family friendly. Interventions include reducing shift length, redesigning the nursing team to add more allied health workers, and introducing locum tenens staffing to balance work-load. There are opportunities to modernize existing nurse postgraduate education, open new postgraduate programs in nursing, and create new positions and career paths for nurses such as telenursing, informatics, and quality. Rural pipelines should be created, with incentives and increased compensation packages for underserved areas. CONCLUSIONS: Critical to these proposed reforms is the collaboration of the MOH with partners across the healthcare system, particularly the private sector. Human resources planning should be sector-wide and nursing leadership should be strengthened at all levels.

Impact of Childhood Cancer on Family Functioning and Family Quality of Life in the Western Region of Saudi Arabia.

Background: Childhood cancer affects families and friends and causes lifestyle changes that become overwhelming for them. Childhood cancer may cause decreased physical, emotional, and social health-related quality of life (QOL). Childhood cancer may cause strain on the financial status of the family and shape their coping strategy to the disease. The extent of the impact of childhood cancer on families is associated with several demographic characteristics of the family such as diagnosis, phase of treatment, and parent's educational level, employment, and marital status of the parents. Objectives: The objective of this study was to explore the impact of childhood cancer on family functioning and family quality of life (QOL) in the Western Region of Saudi Arabia. Methods: This study was a quantitative, randomized, cross-sectional study. 187 participants were randomly selected from the population of parents whose children have cancer and treated at Princess Noorah Oncology Center in King Abdulaziz Medical City, Jeddah. A survey was used to collect data for this study. Healthcare and social systems may have to consider the impact of childhood cancer in the care plans of the patients. Result: Leukemia represents the highest disease prevalence followed by brain tumor. The highest score of the impact on the family survey was familial social concerns domains followed by financial burden with mean scores of 3.59 (98.8%) and 3.56 (98.0%), respectively. Then, mastery domain mean score is 3.43 (85.8%) and finally personal strain with mean score of 3.21 (980.3%). The QOL of the family results indicated that the highest was physical/material well-being with mean score of 3.84 (76.8%) and family interaction with mean score of 3.82 (76.4%), followed by emotional well-being with mean score of 3.54 (70.8%) and parenting with mean score of 3.53 (70.6.%). Significant differences were found between the overall scales of QOL and the scale of impact on the family and some demographic characteristics of children and their parents. Conclusions: Childhood cancer has a substantial effect on family functioning and the family's QOL. In addition, both were significantly associated with some demographic characteristics of the child and his parents.

Compassionate Nursing Care for COVID-19 Patients in the ICU in the Western Region of Saudi Arabia: A Lived Experience Study.

INTRODUCTION: The rapid spread and the severity of symptoms of COVID-19 led to an increasing number of critical cases that need to be admitted to intensive care units (ICUs) worldwide. Compassion is a principle of nursing practice and indicates the meaning of providing high-quality care in all units, especially in the ICU. It means that nurses know what is important to patients and when they should be there for them when it is needed. There is a paucity of literature from Saudi Arabia that explores how critical care nurses perceive compassionate care during COVID-19. OBJECTIVES: The aim of this study was to investigate the lived experiences of critical care nurses providing compassionate care to COVID-19 patients at King Abdulaziz Medical City, Jeddah, Saudi Arabia. METHODS: A prospective, cross-sectional, descriptive phenomenological approach was utilized in this study. Data were collected from 13 ICU nurses through interviews. Collected data were transcribed and analyzed using Colaizzi's data analysis method. RESULTS:  Eleven out of the 13 ICU nurses hold a Bachelor of Science in Nursing (BSN) and have more than five years of experience. Despite all the challenges surrounding the care for critically ill COVID-19 patients, nurses provide compassion in different ways to show personal interest to the patients. Data analysis revealed five themes: (1) contemporary meaning and competencies for compassionate nursing care, including communication and the inability to freely use touch; (2) physical symptoms, including discomfort, body aches and headaches, and sleep disturbances; (3) emotional turmoil, where three sub-themes emerged, including fear and anxiety, uncertainty, and isolation and loneliness; (4) role changing, including frequent guidelines change, additional roles and responsibilities, and altruism; (5) professionalism, including cultural facets of care, teamwork, and support. DISCUSSION: The COVID-19 pandemic has caused major changes in nurses' working environment and so their experience. The results of this study indicated that nurses working in the ICU experienced remarkable and massive physical, psychological, and emotional symptoms during the COVID-19 pandemic. The nurses extended the relationships to the patients' families as they are at high risk of stress, anxiety, and depression. In addition, they were able to support them in dealing with the fear associated with the uncertainty of COVID-19. Also, results revealed that remote therapeutic relationships and psychotherapy can be credible and trustworthy alternatives to in-person care. CONCLUSIONS: The results of this study indicated that ICU nurses provide compassionate care despite experiencing unprecedented and immense physical, psychological, and emotional symptoms during the COVID-19 pandemic. RECOMMENDATIONS: Further study is recommended using other research methodologies. It is also recommended to conduct the same study in different cities for better generalization.

Telehealth Readiness of Healthcare Providers during COVID-19 Pandemic in Saudi Arabia.

OBJECTIVE: This study aimed to assess and explore the telehealth readiness of healthcare providers in Saudi Arabia. METHODS: This descriptive cross-sectional survey was conducted in a government healthcare facility in Saudi Arabia between August and October 2020. The Telehealth Readiness Assessment (TRA) tool was used. RESULTS: A total of 372 healthcare providers participated in this study. Their mean age was 35.5 years (SD = 10.46). The majority of respondents were female (65.6%), nurses (68.0%), married (60.2%), and non-Saudi nationals (64.2%). The analysis shows that healthcare providers generally had moderate-to-high telehealth readiness. Of the five domains, financial contributions had the lowest rating among nurses and physicians, 63.4% and 66.1%, respectively. Gender (ß = 7.64, p = 0.001), years of experience in the organization (ß = 11.75, p = 0.001), and years of experience in the profession (ß = 10.04, p = 0.023) predicted the telehealth readiness of healthcare providers. CONCLUSION: The telehealth readiness of healthcare providers in Saudi Arabia showed moderate to high levels. The COVID-19 pandemic poses a catastrophic threat to both patients and healthcare providers. Assessing telehealth readiness should include both patients and healthcare provider factors. A better understanding of the factors of organizational readiness, particularly healthcare providers, could help avoid costly implementation errors.

Assessing the Impact of Obesity on Pregnancy and Neonatal Outcomes among Saudi Women.

Background: The rising prevalence of obesity has a significant impact on obstetrics practice regarding maternal and perinatal complications includes recurrent miscarriage, pregnancy-induced hypertension, preeclampsia, gestational diabetes, and prolonged labor. Objective: To assess the impact of obesity on pregnancy and neonatal outcomes among Saudi women. Methods: The study was conducted at King Abdul-Aziz Medical City, Jeddah. Design: A cross-sectional retrospective design. A total number of 186 participants were recruited from July to December 2018 according to eligibility criteria. The data were collected retrospectively by a review of the chart records of the labor and delivery department. Results: The mean (SD) age of participants was 31.94 (5.67) years old; two-thirds were in obesity class I. There was a significant association between obesity and pre-existing thyroid disease and induced hypertension class III. However, episiotomy showed that obesity class III was significantly different from obesity class II. Conclusion: This study concludes obesity affects the outcomes of pregnant Saudi associations between obesity and preeclampsia, perineal tears, and episiotomy variables, and other variables reflect no associations. Recommendations: Further studies are needed to generalize the results. This study endorses the pregnant women start the antenatal follow-up from 1st trimester so, the data will be available on the system for research.

Fear of Nurses During COVID-19 Pandemic in Saudi Arabia: A Cross-Sectional Assessment.

Objective: We aimed to assess the level of fear among nurses in Saudi Arabia during the COVID-19 outbreak. Methods: A cross-sectional survey-based study was conducted from June to August 2020. All nurses currently working in public and private hospitals in Saudi Arabia during the COVID-19 pandemic were invited to complete an online survey. We used the 7-item unidimensional Fear of COVID-19 Scale (FCV-19S) to assess the level of fear of COVID-19. Multiple regression analysis was used to identify predictors associated with fear of COVID-19. Results: A total of 969 nurses participated in this study. The participants were relatively young with a mean age of 35.5 ± 10.46 years. About two-thirds of the participants were women (65.9%), married (57.2%), and were non-Saudi nationals (67%). The total mean score for the FCV-19S was 19.7 SD 7.03 (range 7-35), which is near the mid-point, indicating a moderate level of fear of COVID-19. Out of the eight variables measured in the analysis, three variables emerged as a significant predictor (i.e., gender, marital status, and age). A higher level of fear (FCV-19S) was associated with being a woman, married, and older age (p ≤ 0.05). Conclusion: This study demonstrated the level of fear of COVID-19 among nurses in Saudi Arabia. Overall, nurses in Saudi reported moderate levels of fear of COVID-19. Assessing the level of fear of nurses who work during the COVID-19 pandemic should be a priority to health care administrators to prevent mental health difficulties or psychological injury.

Association of Fear of COVID-19 and Health Literacy Among the General Public in Saudi Arabia: A Cross-Sectional Assessment.

Objective: This study aims to determine the level of fear of coronavirus disease-2019 (COVID-19) among the general public in Saudi Arabia and the association of its scores with their level of health literacy. Methods: A descriptive cross-sectional study was conducted among the general population in Saudi Arabia from April 2020 to May 2020. A three-part online self-reported survey was used to assess the participants' demographic characteristics, fear of COVID-19 of the participants, and levels of health literacy. Results: Of the 848 participants, 56.8% were in the age group of 25-34, 45.6% were females, and 57.1% had a bachelor's degree. The total mean score of the fear of COVID-19 scale of the participants was FCoV-19: mean ± SD = 19.60 ± 7.33 and the health literacy was HL index: mean ± SD = 27.57 ± 11.05. There was a significant difference in the scores of fear of COVID-19 scale in terms of age (F = 2.442, p = 0.050), representing that those aged 45 and above had higher mean fear scores than the younger participants. The analysis revealed that an increased level of fear of COVID-19 was associated with older age (B = 1.87; p = 0.020), being unemployed (B = 0.76; p = 0.023), with no formal education (B = 0.89; p = 0.001), and low level of health literacy (B = 0.02; p = 0.021). Conclusion: The study shows an above-average level of fear of COVID-19 of the general public in Saudi Arabia and its association with a low level of functional health literacy. Timely and comprehensive health interventions should be promoted to enhance the level of health literacy and further reduce the level of fear of COVID-19 in the community.

Breast Cancer Patients' Perceptions of Their Experience With Chemotherapy-Induced Nausea and Vomiting and Its Impact on Quality of Life in Jeddah, Saudi Arabia.

Background Breast cancer accounts for 11.6% of all neoplasms worldwide and is the commonest cancer among Saudi females (29.7%). Chemotherapy-induced nausea and vomiting (CINV) is a very common side effect of chemotherapy that has a great impact on the quality of life (QoL) of patients. Literature is still scarce about this effect on the Saudi population. This study aims to explore breast cancer patients' perception of their experience with CINV and its impact on QoL. Methods This is a cross-sectional retrospective study conducted on Saudi adult female breast cancer patients who underwent chemotherapy at King Abdulaziz Medical City, Jeddah, Saudi Arabia. Data collected through patients' records review, face-to-face and telephone structured interviews using a questionnaire composed of four parts: sociodemographic characteristics, nature of acute CINV (within 24 hours) and delayed CINV (after 24 hours), impact on QoL, and general information on their experience. Results Out of a total population of 173, 98 (56.65%) patients participated in the study. The main findings show that 78.6% experienced nausea, whereas 35.7% experienced vomiting. Most participants had a moderate-to-extreme impact on their QoL due to nausea (74.0%) and vomiting (62.9%). Overall, 57.5% rated anti-emetics as excellent for controlling CINV, whereas 22.9% rated them as moderate to good; 83.5% were completely compliant on anti-emetics and 71.1% reported that they received completely comprehensive education about CINV. Religious practices (74.4%), diet (57.7%), and relaxation techniques (44.9%) were found to be the most common non-pharmacological methods used to control CINV. No significant correlation was found between the effect of CINV on QoL and sociodemographic characteristics (p > 0.05). Conclusions CINV is very common among Saudi adult female breast cancer patients; despite being completely compliant and receiving comprehensive education and effective anti-emetics; CINV still had a high impact on different aspects of QoL. Health care professionals should consider CINV as an issue and should find effective strategies for alleviating patients' suffering.

Roles and responsibilities of nurse preceptors: Perception of preceptors and preceptees.

In this study setting, preceptors, who were clinical teaching assistants and hospital employed nurses assist through an interactive process preceptees, who were nursing students, in developing clinical skills and integration into the culture of the clinical area. Therefore, roles and responsibilities of preceptors should be clear and meet the expectations of preceptors and preceptees. This study aimed at comparing similarities and differences of perception to roles and responsibilities as held by nurse preceptors and their preceptees in relation to how important such roles and responsibilities are, and how frequently preceptors attend to the role. A self-administered questionnaire using Boyer's (2008) roles and responsibilities was completed by a convenience sample of 87 preceptee and 62 preceptors amounting to 66.9% and 77.5% response rate respectively. The questionnaire included 43 items and two 4-points Likert-type scales: "Importance of", and "frequency of attendance to roles". Two versions were developed: one for preceptors and the other for preceptees. The reliability (Alpha values) was .944 for the importance and .973 for the frequency of attendance scales. Mean scores indicated agreement among the two groups in relation to importance of, but to disagreement in relation to frequency of attendance to certain roles and responsibilities. Both groups perceived roles and responsibilities as important but varied with significant difference in rating preceptors' frequency of attendance to their roles as educators and facilitators.

Perception of nursing students to two models of preceptorship in clinical training.

PURPOSE: This descriptive survey aimed at exploring nursing students' perception of two models of preceptorship: Model A requires intensive mentorship while Model B requires increasing students' independence and self directed learning. METHODS: Convenience sample of 110 nursing students were recruited for this study. Fifty seven who were in courses of adult I and adult II were engaged in Preceptorship Model A, while 53 who were in courses of maternity and pediatric nursing were engaged in Preceptorship model B. Moore's (2009) reliable "Preceptorship Evaluation Survey" was used for data collection. It consists of three dimensions: preceptor's performance, preceptorship support at the practice site, and preceptee satisfaction with the clinical training experience. t-test, independent samples, was used for data analysis. RESULTS: The findings showed that participants' mean scores on each dimension: preceptee satisfaction, program support, as well as preceptor's performance domains (teacher, facilitator, role model, provider of feedback, adept with adult learning, advocate, and socializer) were significantly (p < .05) in favor of Model A. CONCLUSIONS: Participants perceived the preceptorship model which incorporates intensive mentoring as more satisfactory than the preceptorship model where increasing students' independence and self directed learning is required.

Research utilization in a multicultural nursing setting in Saudi Arabia: barriers and facilitators.

BACKGROUND: Clinical decision making is most effective when guided by the latest evidence-based methods. Although policies governing modern nursing clinical practice advocate the need for evidence-based practice (EBP) to maximize quality and contain costs, the literature indicates a persistently low utilization of research findings in nursing. The gap between available research evidence and the use of this evidence in practice is an issue that requires attention. PURPOSE: This study explored barriers to and facilitators of research finding utilization in nursing practice and examined the associations between these barriers and nurse demographic characteristics. METHODS: This study employed a quantitative, nonexperimental, descriptive, and correlational design. Researchers used the Barriers to Research Utilization Scale, which contains quantitative and some qualitative structured questions, and recruited a convenience sample of nurses working in Saudi National Guard hospitals in the three cities of Riyadh, Jeddah, and Al-Ahsa. RESULTS: Participants rated nearly two thirds of the Barriers to Research Utilization Scale items as moderate to strong barriers to utilizing research in practice. Organization factors had the highest perceived barrier scores, followed by communication, adopter, and innovation factors, respectively. Themes emerging from the qualitative data indicated the presence of other barriers such as lack of time, lack of authority, lack of physician cooperation, and lack of EBP-related education. Participants suggested the importance of increasing organizational support and creating an organizational culture based on EBP to further promote utilization of research findings in nursing practice. CONCLUSIONS: Policymaker and administrator support is necessary to promote the utilization of research findings in nursing practice. Further initiatives are needed to raise awareness of the importance of using the best scientific evidence in practice.

Applying Watson's nursing theory to assess patient perceptions of being cared for in a multicultural environment.

BACKGROUND: J. Watson's (2002) caring theory addresses caring relationships among humans and the deep experiences of life itself. M. Leininger (1988) noted that caring is a universal phenomenon, which is likely to be perceived differently by patients and nurses if they come from different cultural backgrounds. Little is known about the patients' perception of "being cared for" in the Kingdom of Saudi Arabia, where most nurses in the workforce come from cultural backgrounds different from their patients. PURPOSE: This study was designed to explore Saudi patient perceptions of important caring behaviors and those most frequently attended to by staff nurses in a multicultural environment. METHODS: A questionnaire survey was used to explore discrepancies between the perceived importance of caring behaviors and how frequently those caring behaviors were attended to by staff nurses. A probability sample of 393 patients was drawn from three hospitals in three different regions of Saudi Arabia. The Caring Behaviors Assessment instrument of S. N. Cronin and B. Harrison (1988) was used in data collection. RESULTS: Patients rated overall caring behaviors as important (97.2%) and frequently experienced (73.7%). The discrepancy between the importance of and frequency of attendance to caring behaviors by nurses was statistically significant (t = -4.689, p = .001). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The caring behaviors based upon Jean Watson's theory were valued by Saudi patients irrespective of their cultural differences with the caregiver. However, the frequency of caring attended to by nurses in teaching/learning and helping/trust behavior subcategories were rated lower. Such is most likely the result of culture differences and language barriers existing between patients and nurses in Saudi Arabia. Results showed that the carative factors in Jean Watson's theory were also applicable to patients in Saudi Arabia and that nursing professionals should base their care on such theory to meet patient needs.