Relationship Between Quality of Sleep and Psychological Well-being Among Frontline Nurses During the COVID-19 Pandemic in Saudi Arabia.

Background: The coronavirus 2019 (COVID-19) pandemic is a world health emergency crisis that challenges the global health system and healthcare providers, especially frontline nurses' physical and mental well-being. Objective: The aim of the study was to examine the association between depression, anxiety, and sleep quality among nurses working in Saudi Arabian hospitals during the COVID-19 pandemic. Methods: This is an quantitative cross-sectional study. An online self-reported data was collected from 187 nurses who were on duty during COVID-19 pandemic. Results: About 87.2% of the nurses were female nurses; not surprising that 88% had poor sleep quality; 44.4% had moderate anxiety, and 44% of the studied nurses had mild to moderate depression. The study revealed that there was an association between level of anxiety and poor sleep quality. Poor sleep quality and emotional stability of nurses play a major role in quality of care and patients' safety. Conclusion: We conclude that healthcare leaders should adopt an occupational wellbeing program for nurses that focuses on their psychological wellbeing and sleep quality.

Outcomes and predictors of seizure recurrence in post-stroke epilepsy, a retrospective hospital-based study.

BACKGROUND: The occurrence of seizures following a stroke is a well-recognized complication associated with a significant increase in morbidity and mortality. Despite the numerous studies examining outcomes and risk factors related to post-stroke seizures (PSS), there remains a lack of clarity regarding the clinical characteristics, treatment, and PSS recurrence (PSSR) rates in patients experiencing their initial episode of PSS. PURPOSE: This study aimed to determine the risk factors for developing recurrent seizures after first PSS and their effects on functional outcomes and mortality. METHODS: All patients underwent an electroencephalography (EEG) and were monitored for a minimum of 24 months following the first PSS. The primary endpoint was the recurrence of seizures. Predictive factors for PSSR were determined by using the Cox-proportional hazards model, and the cumulative latency of recurrence at 90, 180, 360, and 720 days was estimated using Kaplan-Meier analysis. RESULTS: Seizure recurred in 36.8% (39/106). Significant association of PSSR was noted with female gender, use of older anti-seizure medications (ASMs) (p<0.001), EEG findings as focal slow wave activity (p<0.001), Ictal epileptiform abnormalities (p=0.015), status epilepticus (p=0.015), and with severe disability (p=0.008). However, multivariate cox-proportional hazards model showed significant association of female gender (HR=3.28; 95% CI: 1.42-7.58; p=0.006). Hazard ratio (HR) was increased with older ASMs use, focal aware seizure types, Ictal EAs, and periodic discharges on EEG; though, statistically significant. CONCLUSION: Factors such as the type of ASMs, EEG findings, and seizure type were significantly linked to PSSR. Female gender was the only independent predictor established. Additionally, significant functional decline was reported with recurrence.

Sleep quality and fatigue among nurses working in high-acuity clinical settings in Saudi Arabia: a cross-sectional study.

BACKGROUND: Poor sleep quality is prevalent among nurses worldwide. Around two-thirds of nurses doing shift work are known to experience sleep problems and fatigue. Fatigue and sleep problems are linked to poor performance, impaired alertness, injuries, chronic diseases, compromised healthcare quality, and medical errors, all of which detrimentally impact nurses and threaten patients' safety. This area of research has received insufficient attention in Saudi Arabia; therefore, the purpose of this study was to examine the levels of sleep quality and perceived fatigue and their association among nurses working in acute care settings in comprehensive hospitals in Saudi Arabia. METHODS: A descriptive cross-sectional study using the Pittsburgh Sleep Quality Index and Chalder Fatigue Scale. Data was obtained via an online questionnaire that was distributed to nurses using the QuestionPro platform through hospital administrators, social media (WhatsApp), and personal contact. RESULTS: A total of 173 nurses completed the online survey. Most participants reported poor sleep quality (n = 127, 73.4%) and severe perceived fatigue (n = 156, 90.2%). Furthermore, the study revealed a significant correlation between the overall sleep disturbance and fatigue global scores (r = 0.57, P < 0.001), indicating that poor sleep quality was significantly associated with higher fatigue levels among the study sample. CONCLUSIONS: The current study found a significant association between sleep quality and severe fatigue in nurses working in high acute care settings in Saudi Arabia. It is very clear from the results that nurses are experiencing poor sleep and severe fatigue, which in turn, will negatively impact the nurse's quality of life and patient safety.

Cut-off scores of the Depression Anxiety Stress Scale-8: Implications for improving the management of chronic pain.

AIM: Mental distress, non-specific symptoms of depression and anxiety, is common in chronic pelvic pain (CPP). It contributes to poor recovery. Women's health nurses operate in multidisciplinary teams to facilitate the assessment and treatment of CPP. However, valid cut-off points for identifying highly distressed patients are lacking, entailing a gap in CPP management. DESIGN: This instrumental cross-sectional study identified a statistically derived cut-off score for the Depression Anxiety Stress Scale-8 (DASS-8) among 214 Australian women with CPP (mean age = 33.3, SD = 12.4, range = 13-71 years). METHODS: Receiver operator characteristic curve, decision trees and K-means clustering techniques were used to examine the predictive capacity of the DASS-8 for psychiatric comorbidity, pain severity, any medication intake, analgesic intake and sexual abuse. The study is prepared according to the STROBE checklist. RESULTS: Cut-off points resulting from the analysis were ordered ascendingly. The median (13.0) was chosen as an optimal cut-off score for predicting key outcomes. Women with DASS-8 scores below 15.5 had higher analgesic intake. CONCLUSION: CPP women with a DASS-8 score above 13.0 express greater pain severity, psychiatric comorbidity and polypharmacy. Thus, they may be a specific target for nursing interventions dedicated to alleviating pain through the management of associated co-morbidities. IMPLICATIONS FOR PATIENT CARE: At a cut-off point of 13.0, the DASS-8 may be a practical instrument for recommending a thorough clinician-based examination for psychiatric comorbidity to facilitate adequate CPP management. It may be useful for evaluating patients' response to nursing pain management efforts. Replications of the study in different populations/countries are warranted.

The Perceptions and Expectations of the Clinical Learning Environment in Saudi Arabia: a Multidisciplinary Study.

Background: The clinical learning environment is a fundamental component of healthcare education. In this setting, students can develop the skills and knowledge necessary to become competent and efficient healthcare practitioners. Due to the importance of clinically based education, it is crucial to have a valid and reliable tool to enable its evaluation. Objective: The aim of this study was to use the Clinical Learning Environment Inventory (CLEI) to examine the perceptions of Saudi undergraduate healthcare students regarding their actual and preferred clinical learning environment and explore the differences between the two viewpoints. Methods: A cross-sectional survey design was utilised with a cohort of Saudi undergraduate healthcare students. Data regarding perceptions of the 'actual' and 'preferred' clinical learning environments were gathered with the Clinical Learning Environment Inventory tool. Results: A total of 194 students participated and nine healthcare disciplines were represented. The highest mean score for both 'actual' and 'preferred' clinical learning environment was for the subscale Task Orientation. Significant differences between 'actual' and 'preferred' environments were demonstrated for Innovation and Individualization, with both subscales scoring higher for the 'preferred' environment. All five subscales-Individualization, Innovation, Involvement, Personalization, and Task Orientation-appear to be important aspects contributing to student satisfaction with their clinical learning environment. Conclusion: Saudi healthcare students demonstrate a preference for a clinical learning environment with the utilization of new and interesting experiences, as well as recognition and accommodation of student individuality. Additionally, student satisfaction appears to be multifactorial in origin. Therefore, there may be many avenues available to enhance the clinical experiences of healthcare students, which is vitally important for the optimization of clinical learning opportunities.

Knowledge and Attitudes of Critical Care Nurses Regarding Pain Management in Saudi Arabia.

Background: Approximately five million patients on yearly basis are being admitted to the critical care unit around the world. Around (77%) of these patients suffer from pain during their stay in critical care units. Undertreated pain aggravates anxiety, sleep deprivation, agitation, delirium, and depression that often lead to a chronic condition. There are various barriers toward recognition and proper management of pain such as sedation, the presence of endotracheal tube, healthcare providers lack of knowledge etc. Therefore, it becomes essential for the nurses to have the required knowledge related to pain, valid pain assessment tools, and proper management. Objective: The present study aimed at investigating the critical care nurses' knowledge and attitude towards pain management at a university hospital in Saudi Arabia. Methods: A descriptive cross-sectional design of 112 nurses working at intensive care units and emergency department. The data collected using a knowledge and attitude regarding pain (KASRP) survey. Results: Majority of nurses had inadequate knowledge regarding pain management. Among 112 nurses, only 8 nurses (7.1%) were with good level of knowledge compared by 54 nurses (48.2%) with poor level of knowledge. Results showed significant association between knowledge and attitude and the current position in the ICU (p=0.043). Conclusion: It is mandatory to monitor nurses' pain management knowledge continuously. As well as to emphasis significance of an educational programs that serve nursing practice.

Impact of Educational Program on Critical Care Nurses' Knowledge of ICU Delirium: A Quasi-Experimental Study.

Background: Cat Intensive care unit (ICU) delirium is a significant complication that increases the mortality, morbidity, and length of stay for critically ill patient. Objective: The aim of this study was to assess the critical care nurse's knowledge of ICU delirium and the effectiveness of an educational program about the recognition and assessment of ICU delirium on critical care nurse's knowledge. Methods: A quasi-experimental single group pre-test-post-test design was conducted using delirium knowledge assessment questionnaires. Results: The median post test score of overall nurses' knowledge was 76.2 (range 19.1-95.2) compared to the median pre-test score of 38.1 (range 14.3 - 61.9) indicating a significant change in nurses' knowledge after conducting the educational program (p<0.001). Conclusion: Critical care nurses' knowledge of ICU delirium was low before the intervention and increased significantly after delivering an educational program.

Psychometric evaluation of the depression anxiety stress scale 8-items (DASS-8)/DASS-12/DASS-21 among family caregivers of patients with dementia.

Patients with dementia express a set of problematic and deteriorating symptoms, along with self-care dependency. Over time, the mental health of family caregivers of persons with dementia may be affected, putting them at a high risk for psychopathology, which may be associated with endangered wellbeing of people with dementia. This cross-sectional instrumental design study examined the psychometric properties of the Depression Anxiety Stress Scale 8-items (DASS-8), DASS-12, and DASS-21 in a convenient sample of 571 caregivers from northern Italy and southern Switzerland (mean age = 53 years, SD = 12, range = 24-89 years). A bifactor structure of the three measures had the best fit; some items of the DASS-12/DASS-21 failed to load on their domain-specific factors. The three-factor structure was invariant across various groups (e.g., gender and education), expressed adequate reliability and convergent validity, and had strong positive correlation with the three-item UCLA Loneliness Scale (UCLALS3). Distress scores did not differ among carers of different types of dementia (Alzheimer's disease vs. other types, e.g., vascular dementia). However, distress scores were significantly high among female individuals, adult children caregivers, those caring for dependent patients, and those who received help with care. For 54.9 and 38.8% of the latter, care was provided by relatives and health professionals, respectively. Since the DASS-8 expresses adequate psychometrics comparable with the DASS-21, it may be used as a brief measure of distress in this population.

Assessment of Pain and Anxiety During Arteriovenous Fistula Cannulation Among Hemodialysis Patients: A Cross-Sectional Study in Saudi Arabia.

Background: The number of hemodialysis patients has dramatically increased over the years. The cost of healthcare provision to those patients has been rising as well. In addition, pain management during arteriovenous fistula (AVF) cannulation is an important aspect of nursing care. Patients' outcomes and appropriate pain control are one of the most critical issues in healthcare. Purpose: To measure the level of pain and anxiety associated with arteriovenous fistula cannulation among hemodialysis patients. Methods: A correlational cross-sectional research design was used in this study at the Hemodialysis Unit at King Fahad Hospital of the university, Al-Khobar, in the Eastern region of the Kingdom of Saudi Arabia using a self-administered questionnaire. Ethical approval was obtained. A convenience sample of 117 HD patients from the previous mentioned setting were included in the study. The data were collected using three tools: sociodemographic characteristics, Numerical Analogue Scale (NAS), and Hospital Anxiety and Depression Scale (HADS). Using IBM SPSS software package version 25.0, statistical significance of the obtained results was judged at the 5% level. Results: According to the results, most of the participants experienced a mild to moderate level of pain and anxiety during arteriovenous fistula cannulation. Furthermore, there was a positive association between the level of pain and anxiety, with statistical significance (p<0.001). Conclusion: Based on the results of the study, most of the study participants' level of pain and anxiety during AVF cannulation ranged between mild and moderate.

Nurses' Knowledge and Practices Regarding the Prevention of Deep Vein Thrombosis in Saudi Arabia: Descriptive Cross-Sectional Study.

Background: Deep venous thrombosis (DVT) is a prevalent fatal problem and a major cause of avoidable death among morbid hospitalized patients. It is estimated that up to 900,000 people in the United States are affected each year. Additionally, around 60,000 to 100,000 Americans die annually of DVT. Objective: To assess studied nurses' knowledge and practice regarding Deep venous thrombosis prevention. Methods: A descriptive cross-sectional research design was used in this study at King Fahad Hospital of the University in the Kingdom of Saudi Arabia, using a self-administered questionnaire. A total of 67 nurses from medical and surgical units were included in the study. Data were coded and analyzed using SPSS 23.0 version. Results: According to the results, the knowledge and practice of nurses were found to be high. Total knowledge score regarding prevention of deep venous thrombosis (72.8±9.6), regarding studied nurses, score for each subcategory: general knowledge category (70.6±15.5), deep venous thrombosis risk factors category (66.5±13.1), and deep venous thrombosis prevention category (90.1±10.5). in addition, a statically significance association between nurses' years of experience (p=0.026), previous Deep venous thrombosis education (p=0.012), and total knowledge score regarding the prevention of deep venous thrombosis. Concerning the self-reported practice, the majority of the studied nurses have shown a very high practice score. Yet, there was no statically significant association between the sociodemographic characteristic and practice. Furthermore, a positive association between total knowledge and reported practice score but statically insignificant (p=0.075). Conclusion: Based on the result of the study, most of the studied nurses' level of knowledge and practice concerning the prevention of deep vein thrombosis ranged between high and very high.

Saudi Healthcare Students' Perceptions and Beliefs About Immunizations: a Descriptive, Cross-Sectional Study.

Background: Immunization has been one of the most successful public health measures ever undertaken. However, a degree of hesitancy about vaccine use still exists. Healthcare professionals are in a unique position to provide advice and education to the public and may influence the decision to undergo immunization. Objective: The aim of this study was to explore perceptions and beliefs regarding immunizations and immunization-preventable diseases. Methods: A descriptive cross-sectional study was undertaken at the Imam Abdulrahman bin Faisal University, located in Dammam, Saudi Arabia. In the Kingdom of Saudi Arabia, a survey of 564 Saudi undergraduate healthcare students was conducted. 77.8% of participants replied (439). Information was collected regarding perceptions of; severity of immunization-preventable diseases, contracting these diseases, immunization safety, and immunization beliefs. The statistical analysis was performed using the Statistical Package for the Social Sciences (IBM SPSS v25). Non-parametric analyses were utilized. Descriptive data were generated as appropriate, including frequencies, median, and inter-quartile range. Statistical relationships of demographic variables were explored using Kruskal Wallis H-Test and Spearman's Rank-Order Correlation. A p-value < 0.05 was considered statistically significant. Results: Meningitis was perceived as the most severe disease and COVID-19 as having the highest likelihood of infection. Concern regarding vaccine side effects was most evident for the COVID-19 vaccine. Student year level and profession resulted in statistically significant differences for all three assessed perceptions. Substantial differences were also identified regarding views on immunization belief statements. Conclusion: This study identified considerable heterogeneity in Saudi healthcare students' perceptions and beliefs regarding immunization-preventable diseases and vaccination. Further education is required to produce well-informed and confident healthcare professionals around these issues.

Nurse-Delivered Brief Behavioral Treatment for Insomnia in Lung Cancer Survivors: A Pilot RCT.

Objective/Background: Insomnia occurs in 50 to 80% of lung cancer survivors. Cognitive behavioral therapy is the standard treatment for insomnia (CBTI); however, treatment length and lack of psychologists trained in CBTI limits access. Brief Behavioral Treatment for Insomnia (BBTI), a nurse-delivered modified CBTI, is proposed. This feasibility pilot study sought to compare the BBTI intervention to attention control Healthy Eating Program (HEP) for insomnia in lung cancer survivors. Participants: The participants comprised adults, 21 years of age or older with insomnia and stage I/II non-small cell lung cancer, more than 6 weeks from surgery and living in Western NY. Methods: Participants (n = 40) were randomly assigned to an experimental (BBTI) or attention control condition (Healthy Eating Program). Thirty participants completed the study. Results: Participants were 66 years of age (± 7.6; range 53-82), 40% (n = 16) male, 87.5% (n = 35) Caucasian, 50% (n = 20) married, BMI 27.7 (± 5.8), and 12% (n = 5) never smokers. Baseline sleep diary sleep efficiency, ISI and other baseline covariates were balanced between the groups. Sleep efficiency improved ≥85% in BBTI group (p = .02), but not in HEP control group (p = 1.00). Mean ISI for BBTI and attention control were 6.40 ± 4.98 and 14.10 ± 4.48 (p = .001) respectively. In addition, BBTI group mean total FACT-L score improved by 6.66 points from baseline while HEP group score worsened (p = .049). Conclusions: BBTI is a practical, evidence-based, clinically relevant intervention that improved sleep and quality of life in lung cancer survivors with insomnia. Additional research to evaluate efficacy, duration, and implementation strategies are essential.

Efficacy of Precise Foot Massage Therapy on Pain and Anxiety Following Cardiac Surgery: Pilot Study.

BACKGROUND: Pain is the most pervasive distressing symptom following cardiac surgery. Forty percent of postoperative cardiac patients report inadequate pain management. Undertreated acute pain results in increased anxiety, delayed wound healing, and increased chance of persistent chronic pain. Foot massage is a safe, visible complementary approach to manage acute pain following surgery. AIM: The aim of this study is to evaluate the efficacy of integrating foot massage therapy for managing postcardiac pain. METHOD: A randomized placebo controlled single blinded trial comparing foot massage to placebo was conducted at a large hospital in Saudi Arabia. Thirty-one patients who had undergone cardiac surgery (16 in experimental and 15 in placebo group) participated in the study. Ten-minute foot massage was delivered to the experimental group by a nurse researcher, twice during one day, within 30 minutes after receiving an opioid pain medication. RESULTS: The findings of this study indicate that foot massage significantly (p < .05) decreases pain intensity and anxiety in patients who have undergone cardiac surgery compared with a placebo control group. CONCLUSION: Providing non-pharmacologic interventions for pain is the responsibility of the nursing staff. Foot massage is within the scope of nursing practice and is a safe and effective manner of improving patient care. Foot massage in conjunction with pharmacological interventions is effective in improving pain and anxiety. Future studies should consider focusing on frequency, dose, feasibility, acceptability, and participants' satisfaction.

Feasibility Testing of a Self-Management Program Book to Improve Adherence to PAP in Persons Newly Diagnosed With Sleep Apnea.

OBJECTIVES: To obtain feasibility data on a self-management program to improve adherence with positive airway pressure (PAP) in individuals with newly diagnosed obstructive sleep apnea. METHODS: A mixed-methods design assessed program effectiveness and participants' opinions on program ease-of-use. Structured interviews with the treatment group occurred one week and one month after initiation of PAP therapy. RESULTS: Participants (n = 14) completing the study demonstrated 64% adherence versus 58% of the controls. Ease of use was demonstrated. CONCLUSIONS: The PAP self-management program demonstrated ease of use and was found somewhat effective in improving PAP adherence. PRACTICE IMPLICATIONS: The book was useful in assisting participants by validating information obtained from their providers and developing an understanding of the consequences of not using PAP.