Management of acute surgical wounds in Saudi Arabia: nursing staff knowledge and practice.

OBJECTIVE: Nursing staff play a crucial role in postoperative wound care and management; it is therefore imperative that their knowledge is kept up to date to avoid complications. The overarching objective of this study was to assess the knowledge and practice of nursing staff regarding various aspects of the management of acute surgical wounds. METHOD: We conducted a cross-sectional study to assess nurses' clinical knowledge and practices in the management of acute wounds in four large hospitals in Saudi Arabia. The eligible participants included nurses who were working in the medical or surgical departments and those who were employed by the Ministry of Health. We administered a study questionnaire and conducted descriptive analysis to report frequencies and proportions of knowledge and practice aspects. RESULTS: A total of 360 nurses responded to the survey, giving a response rate of 70%. A total of 221 nurses completed all survey questions. Of the participants, 56.56% were ≥30 years old, 95.48% were female, and 50.02% had >6 years' working experience. With regards to nurses' knowledge: 71.9% of the participants had updated their knowledge about wound care in the past two years; 54.3% perceived their knowledge of the availability of wound products as good; 74.66% correctly reported the classic signs of inflammation; 66.97% correctly identified general signs of wound infection; 84.62% of the sample considered surgical site infection as one complication of surgical wound infection. Only 61.09% of the nurses reported following wound care guidelines, 48.42% considered wound appearance as a highly important factor that influences nurses' choice of surgical dressing products, and 41.63% considered hospital policies and practices as important in making evidence-based decisions in wound management. CONCLUSION: This study found that nurses' knowledge about the management of wounds was generally good; however, there were gaps in the practical component which need to be filled to avoid wound complications.

Ethnographic study of the use of interventions during the second stage of labor in Jeddah, Saudi Arabia.

BACKGROUND: Routine use of medical interventions during labor has been identified as a clinical area for concern, since such routinized practice is not consistent with an evidence-based approach to care and continues to increase despite efforts to encourage normal childbirth. Therefore, the aim of our study was to explore maternity health professionals' use of interventions during the second stage of labor in two hospitals in Jeddah, Saudi Arabia, to understand what influences their decision-making and practices. METHODS: This was an exploratory study using an ethnographic approach. Data collection methods included participant observations of 19 labors and births (n = 8 at City Hospital and n = 11 at King's Hospital) and semi-structured interviews with 29 health care professionals. In addition, the hospital labor and delivery ward policies and guidelines from those hospitals were collected. Data were analyzed thematically. RESULTS: Medical interventions were used during the second stage of labor routinely, regardless of clinical indication. Three core influences that shaped the clinical decision-making were identified as follows: (a) organizational culture, (b) a medical concept of birth, and (c) a hierarchical system of control. We suggest that the clinical decision-making and routine practice in this setting arises out of the interface between these three core influences whereby hierarchical control and clinicians' exercise of power and feelings of powerlessness are fundamental drivers for an organizational culture of medicalized childbirth, despite the differing models of childbirth which professionals described. CONCLUSIONS: Clinical decisions relating to the use of interventions during childbirth are both complex and socially negotiated. The findings reflect the complexity of the use of interventions during the second stage of labor and the multiple influences on professionals' practices. We have shown how three key influences interact to shape clinical decision-making during the second stage of labor in this cultural setting and how the use of medical interventions can be analyzed as an illustration of the power dynamic in the maternity health care system. We suggest that written policies are insufficient to bring about evidence-based practice and approaches to change need to take into account these different levels of influence.

Research Priorities of Clinical Nurses and Midwives in the Eastern Mediterranean Region: a Mixed Methods Study.

Effective use of resources in healthcare research is essential in meeting the United Nation's Sustainable Development Goal (SDG) 3 to achieve universal health coverage, increase retention of healthcare workers, and strengthen the capacity of all countries to reduce risk and manage global health risks; the World Health Organization (WHO) also identifies nursing research as an important piece of the framework for improving global healthcare. Determining research priorities to reduce redundancy and ensure a solid evidence base for practice is especially critical in resource-limited countries or those facing healthcare crises such as those in the Middle East. To identify regional research priorities for nursing, focus group discussions composed of hospital-based nurses were conducted in Egypt, Oman, and Saudi Arabia. Forty-eight percent of research priorities were nearly the same as those identified as critical by regional nursing leadership in a previous study, demonstrating consistency between clinician- and administrator-identified research priorities, and suggesting healthcare administrators are well attuned to the research needs of clinicians. Both groups identified critical gaps in population and community health research. Across countries, research priorities identified were related to nursing workforce, health systems research, and quality of care, representing critical issues needing investigation to build a solid evidence base for nursing practice.

Sarah's birth. How the medicalisation of childbirth may be shaped in different settings: Vignette from a study of routine intervention in Jeddah, Saudi Arabia.

BACKGROUND: The expansion of the medicalisation of childbirth has been described in the literature as being a global phenomenon. The vignette described in this paper, selected from an ethnographic study of routine intervention in Saudi Arabian hospitals illustrates how the worldwide spread of the bio-medical model does not take place within a cultural vacuum. AIM: To illuminate the ways in which the medicalisation of birth may be understood and practised in different cultural settings, through a vignette of a specific birth, drawn as a typical case from an ethnographic study that investigated clinical decision-making in the second stage of labour in Saudi Arabia. METHODS: Ethnographic data collection methods, including participant observation and interviews. The data presented in this paper are drawn from ethnographic field notes collected during field work in Saudi Arabia, and informed by analysis of a wider set of field notes and interviews with professionals working in this context. FINDINGS: While the medicalisation of care is a universal phenomenon, the ways in which the care of women is managed using routine medical intervention are framed by the local cultural context in which these practices take place. DISCUSSION: The ethnographic data presented in this paper shows the medicalisation of birth thesis to be incomplete. The evidence presented in this paper illustrates how local belief systems are not so much subsumed by the expansion of the bio-medical model of childbirth, rather they may actively facilitate a process of localised reinterpretation of such universalised and standardised practices. In this case, aspects of the social and cultural context of Jeddah operates to intensify the biomedical model at the expense of respectful maternity care. CONCLUSION: In this article, field note data on the birth of one Saudi Arabian woman is used as an illustration of how the medicalisation of childbirth has been appropriated and reinterpreted in Jeddah, Saudi Arabia.

Childbirth care practices in public sector facilities in Jeddah, Saudi Arabia: a descriptive study.

OBJECTIVES: to explore reported hospital policies and practices during normal childbirth in maternity wards in Jeddah, Saudi Arabia, to assess and verify whether these practices are evidence-based. DESIGN: quantitative design, in the form of a descriptive questionnaire, based on a tool extracted from the literature. SETTING: nine government hospitals in Jeddah, Saudi Arabia. These hospitals have varied ownership, including Ministry of Health (MOH), military, teaching and other government hospitals. PARTICIPANTS: key individuals responsible for the day-to-day running of the maternity ward. MEASUREMENTS: nine interviews using descriptive structured questionnaire were conducted. Data were analysed using SPSS for Windows (version 16.0). FINDINGS: the surveyed hospitals were found to be well equipped to deal with obstetric emergencies, and many follow evidence-based procedures. On average, the caesarean section rate was found to be 22.4%, but with considerable variances between hospitals. Some unnecessary procedures that are known to be ineffective or harmful and that are not recommended for routine use, including pubic shaving, enemas, episiotomy, electronic fetal monitoring (EFM) and intravenous (IV) infusion, were found to be frequently practiced. Only 22% of the hospitals sampled reported allowing a companion to attend labour and childbirth. KEY CONCLUSIONS: many aspects of recommended EBP were used in the hospitals studied. However, the results of this study clearly indicate that there is wide variation between hospitals in Jeddah, Saudi Arabia in some obstetric practices. Furthermore, the findings suggest that some practices at these hospitals are not supported by evidence as being beneficial for mothers or infants and are positively discouraged under international guidelines. IMPLICATIONS FOR PRACTICE: this study has specific implications for obstetricians, midwives and nurses working in maternity units. It gives an overview of current hospital policies and practices during normal childbirth. It is likely to contribute to improving the health and well-being of women, and have implications for service provision. It could also help in the development of technical information for policy-makers, and health care professionals for normal childbirth care.