Health-Related Quality of Life Among Patients With Stroke: A Cross-Sectional Study.

PURPOSE: To assess levels and predictive factors of health-related quality of life (HRQOL) among stroke patients. METHODS: The study employed a cross-sectional predictive correlational design. Levels of HRQOL were assessed using the Stroke-Specific Quality of Life (SS-QOL) scale, and the Hospital Anxiety and Depression Scale was employed to assess psychological aspects among 209 Saudi stroke patients. The analysis included demographic and medical variables to comprehensively explore influencing factors. RESULTS: A two-step hierarchical multiple regression analysis was performed. The overall SS-QOL summary score (49 items) showed a mean score of 94.4 (SD = 8.1), indicating poor functioning. Nine predictor variables were found to significantly predict HRQOL levels, including age (ß = -0.212, p ≤ .001), female (ß = -5.33, p ≤ .001), unmarried (ß = 2.48, p ≤ .001), low gross monthly income (GMI) (ß = -9.02, p ≤ .001), medium GMI (ß = -8.36, p ≤ .001), having a medical history of hypertension (ß = 2.7, p ≤ .01), time since stroke (ß = 3.26 p ≤ .001), and being a probable case of anxiety (ß = -4.29, p ≤ .001) and/or depression (ß = -2.75, p ≤ .001). These variables collectively explained ~76% of the variance in HRQOL scores (adjusted R2 = .762, F (16,192) = 42.6, p ≤ .001). CONCLUSIONS: Stroke patients exhibited poor HRQOL levels influenced by various factors. Clinicians should consider these predictors and intervene early to enhance HRQOL among patients at risk, emphasizing the importance of optimizing patient outcomes.

Professional autonomy among nurses in Saudi Arabian critical care units.

BACKGROUND: Professional autonomy is essential in expanding the scope of nursing practice and has been recognized as a top nursing priority. OBJECTIVE: This study aims to assess Saudi nurses' autonomy level in critical care settings and examine the influence of sociodemographic and clinical characteristics on their autonomy level. METHODS: A correlational design and a convenience sampling approach were used to recruit 212 staff nurses from five Saudi governmental hospitals in Jouf region of Saudi Arabia. The data were collected through a self-administered questionnaire composed of two sections, including sociodemographic characteristics and the Belgen autonomy scale. The Belgen autonomy scale used in this study measures nurses' autonomy levels and consists of 42 items rated on an ordinal scale. The scale's minimum score of 1 indicates nurses with no authority, while the maximum score of 5 indicates nurses with full authority. RESULTS: Descriptive statistics revealed that nurses in the sample had a moderate overall work autonomy (M = 3.08), with higher autonomy in patient care decisions (M = 3.25) compared to unit operations decisions (M = 2.91). Nurses had the highest level of autonomy in tasks related to preventing patient falls (M = 3.84), preventing skin breakdown (M = 3.69), and promoting health activities (M = 3.62), while they had the lowest level of autonomy in ordering diagnostic tests (M = 2.27), determining the day of discharge (M = 2.61), and planning the unit's annual budget (M = 2.22). The multiple linear regression model (R2 = 0.32, F (16, 195) = 5.87, p < .001) showed that education level and years of experience in critical care settings were significantly related to nurses' work autonomy. CONCLUSION: Saudi nurses in acute care settings have moderate professional autonomy, with higher autonomy in making patient care decisions than unit operations decisions. Investing in nurses' education and training could increase their professional autonomy, leading to improved patient care. Policymakers and nursing administrators can use the study's results to develop strategies that promote nurses' professional development and autonomy.

Health and well-being of refugees, asylum seekers, undocumented migrants, and internally displaced persons under COVID-19: a scoping review.

Objectives: The objective of this scoping review was to identify what is known about the impact of COVID-19 on the physical and mental well-being of refugees, asylum seekers, undocumented migrants, and internally displaced persons. The aim was also to identify barriers influencing access to treatment or prevention. Methods: The search was conducted using PubMed/Medline, CINAHL, Scopus, and ScienceDirect. A mixed methods appraisal tool was used to assess methodological rigor. The study findings were synthesized using a thematic analysis approach. Results and Discussion: This review comprised 24 studies and were conducted utilizing a mixed method approach incorporating both quantitative and qualitative methodologies. Two major themes were identified related to the impact of COVID-19 on the health and wellbeing of refugees, asylum seekers, undocumented migrants, and internally displaced persons and the key barriers influencing access to treatment or prevention of COVID-19. They often have barriers to accessing healthcare due to their legal status, language barriers, and limited resources. The pandemic has further strained already limited health resources, making it even more challenging for these populations to receive healthcare. This review reveals that refugees and asylum seekers in receiving facilities face a higher risk of COVID-19 infection than the general population due to their less favorable living conditions. The various health impacts stem from a lack of access to accurate information about the pandemic, misinformation, and the exacerbation of pre-existing mental health issues caused by heightened stress, anxiety, and uncertainty, fear of deportation among undocumented migrants, and overcrowding camps and detention facilities that increase exposure risk. Social distancing measures are difficult to implement in these settings, and inadequate sanitation, hygiene, and a lack of personal protective equipment further compound the problem. Moreover, the pandemic has had significant economic consequences for these populations. Many of them rely on informal or precarious employment, which has been disproportionately affected by the pandemic. Job losses and reduced working hours, and limited access to social protection can lead to increased poverty, and food insecurity. Children faced specific challenges, such as disruptions to education, additionally, interruptions in support services for pregnant women. Some pregnant women have avoided seeking maternity care due to fears of contracting COVID-19, resulting in increased home births and delays in accessing healthcare services. Factors that play a role in vaccination reluctance include uncertainty of undocumented migrants' inclusion in vaccination programs, furthermore, a growing vaccine hesitancy in the population; skepticism about the safety of vaccines, inadequate knowledge/education, a variety of access barriers such as language barriers, and logistical challenges including remote locations, and inaccurate information. Conclusion: This review highlights that the physical health of refugees, asylum seekers, undocumented migrants, and internally displaced persons has been significantly impacted by various barriers to healthcare access during the pandemic. These barriers include legal and administrative challenges, such as a lack of documentation. Additionally, the shift to digital tools has introduced new obstacles, not only due to language barriers or limited technical knowledge but also because of structural barriers, such as the requirement of a bank ID that is often inaccessible to these groups. Other factors contributing to limited healthcare access include financial constraints, language barriers, and discrimination. Additionally, limited access to accurate information about health services, prevention measures, and available resources may hinder them from seeking care or following public health guidelines. Misinformation and lack of trust in healthcare systems can also contribute to a reluctance to access care or vaccination programs. There is concerning evidence regarding vaccine hesitancy that needs to be addressed to reduce any future pandemic outbreak, in addition there is a need to explore the factors that play a role in vaccination reluctance among children in these populations.

Prevalence of depression and its associated factors among stroke survivors in Saudi Arabia.

AIM: The purpose of this study was to investigate the prevalence of poststroke depression (PSD) in Saudi Arabia and its association with socio-demographic and clinical factors. DESIGN: A predictive correlational cross-sectional study. METHODS: The study adopted a non-probability convenience sampling method to recruit 211 stroke survivors between April and October 2021 from the neurology outpatient departments of two main governmental hospitals in Saudi Arabia. PSD was measured using a self-assessment reliable and valid scale (The Hospital Anxiety and Depression Scale [HADS]). RESULTS: More than two-thirds (70.6%) of the study sample (Mean age = 53 years, SD = 8.5, 51.2% were males) experienced some degree of depression (Score ≥8); of these, approximately half (48.8%) were in severe depression. The final prediction model was statistically significant (χ2 [15] = 31.39, p Ë‚ .01). PSD is a statistically significant health issue and requires immediate attention by healthcare providers to improve the health outcomes of stroke survivors.

Medications adherence and associated factors among patients with stroke in the Kingdom of Saudi Arabia

Background: Stroke is one of the most significant neurological problems around the world, and is considered a leading cause of death. Due to polypharmacy and multimorbidity, stroke patients are susceptible to have lower levels of adherence to their medications and self-care activities. Methods: Patients who have suffered a stroke and had recently been admitted to public hospital were approached for recruitment. Patients’ adherence to their medications was examined using a validated questionnaire during an interview between the principal investigator and the patients, where patients’ adherence to their selfcare activities was assessed using a developed, validated and previously published questionnaire as well. Reasons for lack of adherence was explored from the patients. Verification of patient’s details and medications was done via the patient’s hospital file. Results: The mean age of the participants (n=173) was 53.21 (SD= 8.61) years. Assessing patients’ adherence to medications showed that more than half of them stated that they sometimes/often forgot to take their medication/s, while 41.0% sometimes/often stopped their medication/s from time to time. The mean adherence to medications score (out of 28) was 18.39 (SD=2.1), with 83.8% having a low adherence level. It is found that patients who did not take their medications were due to forgetfulness (46.8%) and complications from taking the medications (20.2%). Better adherence was associated with higher educational level, higher number of medical conditions, and higher frequency of glucose monitoring. Adherence to self-care activities showed that majority of patients performed correct self-care activities three times a week. (AU)

Experiences, Perceptions, and Coping Patterns of Emergency Department Nurses with Occupational Stressors in Saudi Arabian Hospitals: Mixed-Method Study.

Extended working hours, a complicated workplace environment, and engagement in numerous physical and psychological stressors have been associated with the stressful nature of the nursing profession. Only a few studies have provided some insight into workplace stress and coping strategies adopted by nurses in Saudi Arabia and neighboring countries. Therefore, this study utilized a mixed-method design to explore the numerous factors that lead to stress among emergency nurses, their experience and perception of stress, and the coping mechanisms they find useful. A survey containing four domains and 86 items was adapted, pilot tested, and validated. The quantitative phase recruited 296 nurses who returned completed questionnaires, and then 21 nurses were interviewed for the qualitative phase. In total, 89.5% (n = 265) of the participants were female, 51% (n = 151) were aged 20-29 years, 83% (n = 246) were non-Saudi nationals, 49% (n = 145) were married, and 82% (n = 245) had a bachelor's degree. The most common causes of occupational stress were work overload, personnel shortages, and inadequate pay. The qualitative phase data revealed five primary themes, including increased workload, rising living costs despite equal compensation, and staff shortages as main stressors. In addition, the study found that praying and spending quality time with friends are the primary coping techniques among nurses. The study results contribute to a better understanding of nurses' working conditions in the emergency department. Additionally, they may contribute to the development of policies and practice reforms to improve Saudi nurses' well-being, health, and overall work experience.

Predictors of Colorectal Cancer Screening among Average and High-Risk Saudis Population.

Colorectal cancer (CRC) screening intention is one of the most important elements influencing the longstanding effectiveness of community-based CRC screening programs. The primary purpose of this study is to generate and validate a predictive screening model that investigates the influence of Saudis' demographics, CRC knowledge, and beliefs on intention to undergo CRC screening via fecal occult blood test (FOBT). Convenience sampling was used to recruit 600 average and high-risk participants from multiple primary health care centers in three major Saudi provinces. A valid and reliable self-administered online survey was used to collect data from March 2021 to October 2021. The final modified screening prediction model explained 57.35% of the variance in screening intention. Intention to screen was significantly influenced by seven factors in which the perceived barriers factor (ß = −0.55, p < 0.001) was the strongest predictor. Those who had lower perceived barriers and greater levels of knowledge (ß = 0.36, p < 0.001), health motivation (ß = 0.35, p < 0.001), perceived benefits of screening (ß = 0.35, p < 0.001), severity (ß = 0.29, p < 0.001), and susceptibility (ß = 0.28, p < 0.001) were more likely to become involved in screening practices. Health care practitioners and various media forms could benefit from the prediction model playing a significant role in raising awareness, reducing perceived barriers, and enhancing Saudi screening rates.

Effectiveness of pain management among trauma patients in the emergency department, a systematic review.

OBJECTIVE: To systematically review the available data and scientific literature and to compile all evidence-related studies of the effectiveness of pain management for traumatic patients in the emergency department. METHODS: The present study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RESULTS: A total of 777 articles were retrieved, and eighteen were selected according to the inclusion criteria in this systemic review. These studies were published from 2004 to 2020 and reported from all around the world. Seventeen studies were based on pharmacological intervention, and one study was based on nonpharmacological intervention. Analgesics and methoxyflurane administration were the most adapted interventions for pain management in traumatic patients among the selected studies. Other reported interventions were fixed nitrous oxide/oxygen mixture, sufentanil, and professional practice assessment. CONCLUSION: This systemic review provides an overview of the effectiveness of pharmacological and nonpharmacological pain management in trauma patients in the emergency department. Analgesic treatment is an effective and ancient management strategy with drawbacks of associated side effects and intravenous administration. New strategies reported and applied by oral or nasal route administration with similar and better efficacies. However, large-scale studies are crucial for better implementation and outcome. Nonpharmacological interventions may also contribute to pain relief.

Medications adherence and associated factors among patients with stroke in the Kingdom of Saudi Arabia.

Background: Stroke is one of the most significant neurological problems around the world, and is considered a leading cause of death. Due to polypharmacy and multimorbidity, stroke patients are susceptible to have lower levels of adherence to their medications and self-care activities. Methods: Patients who have suffered a stroke and had recently been admitted to public hospital were approached for recruitment. Patients' adherence to their medications was examined using a validated questionnaire during an interview between the principal investigator and the patients, where patients' adherence to their self-care activities was assessed using a developed, validated and previously published questionnaire as well. Reasons for lack of adherence was explored from the patients. Verification of patient's details and medications was done via the patient's hospital file. Results: The mean age of the participants (n=173) was 53.21 (SD= 8.61) years. Assessing patients' adherence to medications showed that more than half of them stated that they sometimes/often forgot to take their medication/s, while 41.0% sometimes/often stopped their medication/s from time to time. The mean adherence to medications score (out of 28) was 18.39 (SD=2.1), with 83.8% having a low adherence level. It is found that patients who did not take their medications were due to forgetfulness (46.8%) and complications from taking the medications (20.2%). Better adherence was associated with higher educational level, higher number of medical conditions, and higher frequency of glucose monitoring. Adherence to self-care activities showed that majority of patients performed correct self-care activities three times a week. Conclusion: Post-stroke patients in Saudi Arabia have indicated low levels of medication adherence, while reporting good adherence to their self-care activities. Better adherence was associated with certain patient characteristics such as higher educational level. These findings can help in focusing the efforts to improve adherence and health outcomes for stroke patients in the future.

Workplace violence towards emergency nurses: A cross-sectional multicenter study.

BACKGROUND: Workplace violence (WPV) against nurses continues to be a challenge within healthcare systems worldwide. Quantifying the burden of WPV in emergency departments will inform the design of appropriate interventions. This study aimed to determine the prevalence, pattern and factors associated with WPV among emergency nurses working in Saudi Arabia. METHODS: A multicenter descriptive online survey was conducted using a standardized self-administered questionnaire. Emergency nurses working in public hospitals in the country were invited to participate. Data were analyzed with descriptive statistics and multivariate logistic regression. RESULTS: The study recruited 849 emergency nurses, most (73.7%) had experienced WPV in the past two years; 47.4% experienced physical violence and 94.3% experienced non-physical violence. Most exposures to WPV occurred during the afternoon shifts (70.8%), and mainly perpetrated by family members or relatives of the patients (88.3%). CONCLUSION: WPV encountered by emergency nurses in Saudi Arabia is alarmingly high, and underreported by the affected nurses. Increased workload, inadequate staffing levels, poorly enforced visitor policy, unmet expectations, and a lack of clarity in reporting were the most frequent causes of WPV. There is a need to reassess the current occupational safety measures in the emergency departments in the country.

Impact of night shift rotations on nursing performance and patient safety: A cross-sectional study.

AIM: Hospitals operate on a 24-hr basis, with shiftwork being unavoidable for most nurses. This study aims to explore the impact of night shiftwork rotations on nurses' physiological status, work performance and patient safety concerns among nurses in public hospitals. DESIGN: A descriptive predictive correlational design using a self-administered questionnaire. METHODS: Electronic and printable survey questionnaires were distrusted among nurses working in public hospitals in multiple regions of Saudi Arabia. The study recruited 1,256 nurses from different nationalities, hospital work units and work experience. RESULTS: A large proportion of nurses on night shiftwork encountered patient safety issues (85.7%) and physiological consequences (93.6%). Counselling sessions and programmes to support at-risk nurses are recommended.

The Effect of a Health Education Intervention on Jordanian Participants' Colorectal Cancer Knowledge, Health Perceptions, and Screening Practices.

BACKGROUND: Globally, colorectal cancer (CRC) is the second and third most commonly diagnosed cancer in women and men, respectively. OBJECTIVES: The aim of this study is to test the effectiveness of a health education intervention on the current level of Jordanians' CRC knowledge, health perceptions, and screening practices. METHODS: A convenience sampling method was used to recruit a sample of 197 average-risk Jordanian adults aged 50 to 75 years. The sample was collected from outpatient departments of Jordan University and Al-Basheer Hospitals in Amman. This study used quasi-experimental design, and a rolling enrollment method was implemented to randomly assign the participants into intervention and control groups. RESULTS: Baseline results indicated that Jordanian average-risk participants were not well informed about CRC and screening recommendations. One-fourth perceived themselves to be susceptible to CRC. About one-third comprehended the seriousness of CRC, most recognized the benefits of CRC screening, and fewer than half believed there were barriers preventing them from participating in CRC screening. Four weeks after intervention implementation, there was a significantly higher level of knowledge, as well as increased susceptibility and severity perceptions, screening via fecal occult blood test, and intentions to undergo screening via colonoscopy or sigmoidoscopy. CONCLUSION: The findings support the implementation of a health education intervention as an effective way to enhance levels of knowledge and promote positive health perceptions regarding CRC and screening recommendations. IMPLICATIONS FOR PRACTICE: This study may provide Jordanian and other nurses with a theory-based educational intervention to improve the quality of nursing care and reduce costs.