Predictors of Cardiovascular Morbidity Among Adult Hypertensive Patients: A Cross-Sectional Study from the Kingdom of Saudi Arabia.

Background: Hypertension is a public health issue affecting over a billion people globally. 15% of the adults in the Kingdom of Saudi Arabia (KSA) are thought to have hypertension. A large proportion of them remain undiagnosed or are sub-optimally treated. Those with inadequately treated hypertension have a high risk of life-threatening cardiovascular complications such as ischemic heart disease, left ventricular hypertrophy and heart failure. This study was undertaken to elucidate the cardiovascular morbidity seen in a sample of adult hypertensive patients in Saudi Arabia and identify key demographic and clinical factors associated with cardiovascular morbidity. Methods: A multicentric cross-sectional study was conducted from November 2019 to November 2021 at three hospitals in Al-Kharj KSA. Totally, 105 adult patients with a documented history of primary hypertension for at least 5 years irrespective of treatment status presenting themselves to the study sites were included. Patients with secondary hypertension, and those without confirmed cause and duration of hypertension were excluded. Logistic regression analysis was performed to determine the factors associated with cardiovascular morbidity. Results: The study included 105 participants aged 47.75±13.46 years. 50 (47.6%) were males and 62 (59%) were not Saudis. Left Ventricular Hypertrophy, 64 (61%), diastolic dysfunction, 44 (41.9%), and retinopathy, 33 (31.4%) were the most frequently observed morbidities. Participants aged over 45, those with diabetes, or those with dyslipidemia were more likely to have cardiovascular morbidities (adjusted odds ratio (AOR)): 4.01 (1.29-12.46), p = 0.016, AOR: 6.4 (1.62-25.28), p = 0.008, and AOR: 6.71 (1.46-30.83), p = 0.014, respectively. Conclusion: Older age, the presence of comorbid diabetes mellitus, and dyslipidemia are associated with a higher likelihood of cardiovascular morbidity in hypertensive patients of Saudi Arabia.

The association between nurse managers' transformational leadership and quality of patient care: A systematic review.

AIM: To examine and summarize the reported association of nurse managers' transformational leadership and quality of patient care based on the perceptions of registered nurses. BACKGROUND: Transformational leadership behaviors of nurse managers result in staff nurses' satisfaction and retention and patient satisfaction. Patient safety and quality of care are vital to high-performing healthcare organizations. Perceptions of registered nurses are important because nurses are frontline healthcare providers fundamental to patient safety and quality of care and are considered the final line of defense in preventing adverse events and errors and improving the safety of patients. MATERIALS AND METHODS: We  searched the CINAHL, ProQuest, PubMed, Science Direct, and Web of Science databases for evidence published between 2018 and 2022 in the English language. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in carrying out this meta-analysis. RESULTS: Nine quantitative studies were appraised using the Joanna Briggs Institute checklists and were included in the final review that involved a total sample of 3633 registered nurses. The included studies were reported across Asian, Middle East, and European countries within the past five years. The association between the transformational leadership behaviors of nurse managers and the quality of patient care was found in varying degrees (i.e., insignificant, weak, indirect, and strong direct association) based on the perceptions of registered nurses. CONCLUSIONS: There is a direct and indirect association between the transformational leadership behaviors of nurse managers and the quality of patient care internationally. This association is influenced by confounding and mediating factors, including gender, organizational culture, structural empowerment, and job satisfaction. IMPLICATIONS FOR NURSING AND HEALTH POLICIES: Healthcare organizations need to support nursing leaders to have a stronger transformational leadership style by considering several factors that influence their leadership to improve the quality of patient care their staff nurses provide at the bedside.

Barriers to Implementing Evidence-Based Practice among Primary Healthcare Nurses in Saudi Arabia: A Cross-Sectional Study.

Several studies have been conducted to investigate the barriers to implementing evidence-based practice (EBP) worldwide. In Saudi Arabia, a few studies were conducted in hospital and mental health settings, and no study has explored the topic in primary healthcare settings. This study aimed to examine the barriers perceived by primary healthcare nurses in implementing EBP. This study employed a correlational and cross-sectional design. A total of 284 nurses were surveyed using the BARRIERS scale. Regression analysis was performed to identify the effects of predictor variables on the four subscales. The overall raw score on the BARRIERS scale was 86.21 (standard deviation = 16.15). The highest mean score was reported in the organizational subscale, followed by the innovation and communication subscales, whereas the lowest mean score was reported in the adopter subscale. The findings showed that the three top-ranked barriers were: (1) results of the studies are not generalizable to nurses' setting, (2) facilities are inadequate, and (3) physicians do not cooperate with the implementation. Findings showed that nurses encounter organizational-related barriers to a moderate extent and EBP implementation varies depending on gender, level of education, and job position. There is a need to create and implement educational interventions and programs to overcome the barriers to effective EBP implementation among primary healthcare nurses.

The Prevalence and The Relationship of Workplace Bullying and Nurses Turnover Intentions: A Cross Sectional Study.

Introduction: Sustaining a healthy work environment is a major challenge for health care organizations worldwide. Nursing professionals are often exposed to workplace bullying, which imposes serious challenges to nursing retention. Objectives: To determine the prevalence of workplace bullying and turnover intention among nurses, and to investigate the relationship between workplace bullying and nurse turnover. Methods: A cross-sectional correlational design. Convenience sampling was applied, whereby 347 nurses working in a tertiary medical city in Riyadh, Saudi Arabia, were recruited. Data were collected using the Negative Acts Questionnaire and the Anticipated Turnover Scale. Results: The rate of workplace bullying was high, bullying occurred at a cumulative rate of 33.4% (n = 116). Work related bullying behaviors formed the most common bullying acts with (34.5%) followed by personal bullying with (31.1%) meanwhile physical intimidating accounted by (25.6%). Among the participants, 31.7% exhibited a high turnover intention. The demographic variable age was revealing an inverse correlation with workplace bullying. There was a positive significant correlation between workplace bullying and turnover intentions (r = .24, p < 0.01). Conclusion: The alarming prevalence of both bullying and turnover intention among participants confirms that when nurses are exposed to workplace bullying, they are more likely to demonstrate an increased intention for turnover. Managers are urged to use proper enforcement of anti-bullying policies along with education and training to create a healthy environment and mitigate workplace bullying.

Preparedness assessment for managing disasters among nurses in an international setting: Implications for nurses.

BACKGROUND: The increasing frequency of disastrous incidents emphasizes on the need of an instant and efficient healthcare services. This study assesses the level of preparedness among nurses in Medina regarding the disaster management, with respect to their knowledge. METHODS: Cross-sectional study was conducted among five government hospitals in Medina. A total of 330 (94.3%) full-time nurses participated in this study. Emergency Preparedness Information Questionnaire (EPIQ) was used to collect data. Data was then analyzed through descriptive statistics, Levene's test (an independent sample t-test), and One-way ANOVA. RESULTS: Findings of the study indicated an average level of nurses' preparedness for disaster management (M = 3.37, SD 1.03). The difference found for all the preparedness dimensions with respect to level of nursing education was not significant except for familiarity with ethical issues and triage (p = 0.028), and familiarity with accessing critical resources (p = 0.05). Finally, a statistically significant difference was found in the total mean score of disaster preparedness dimensions between nurses who received training in disaster management and those who did not receive training (p ≤ 0.001). CONCLUSION: Based on the mean score from 10 factors the study concluded that majority of the nurses have an average level of preparedness for managing disaster situations. Therefore, providing proper education with respect to EPIQ dimensions to the nurses is thus suggested to increase their level of preparedness.

Impact of work environment perceptions and communication satisfaction on the intention to quit: an empirical analysis of nurses in Saudi Arabia.

OBJECTIVE: In consideration of the current nursing shortage in Saudi Arabia, we aimed to investigate the association among perceptions of work environment, communication satisfaction, and intentions to quit nursing profession among nurses. In addition, we aimed to investigate the mediating effect of communication satisfaction on the association between nurses' perception of work environment and their intentions to quit nursing profession. METHODS: This predictive correlational study was conducted at one of the major hospitals in Saudi Arabia from January 2020 to March 2020. It included a convenience sample of 367 full-time registered nurses who completed three types of close-ended questionnaires. We used IBM SPSS version 24.0 to analyze the collected data. Regression analyses were used to test the study's hypotheses. All regression assumptions were assessed and confirmed. Significance for all tests was set at p ≤ .05. RESULTS: The findings indicated an affirmative association between work environment perception and communication satisfaction (b = .764, p < .05) among nurses. In addition, findings showed that work environment perception (b = -.187, p < .05) and communication satisfaction (b = -.226, p < .05) have negative impacts on the nurses' intentions to quit; indicating that as work environment perception or communication satisfaction increases, the intention to quit decreases among nurses. Further, a mediation effect of communication satisfaction on the relationship between work environment perception and intention to quit was confirmed. CONCLUSION: This study presents a novel conceptual framework developed based on the literature about the predisposing factors for nurses' intentions to quit nursing profession. Our results suggest that work environment perception and communication satisfaction among the most contributing factors for nurses resignation. Effective communication was established as a crucial factor for establishing attractive and healthy working environment. Nursing managers can benefit by applying these findings to develop appropriate strategies to inhibit the shortage of nurses in Saudi Arabia.

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.

Identifying the experiences of new graduate nurses during the transition period to practice as a professional nurse.

AIMS AND OBJECTIVES: To assess the impact of orientation programmes on new graduate nurses' transition periods. BACKGROUND: The transition of graduate nurses from students to the practising professional nurse is often found to be stressful. DESIGN: The study has employed a descriptive correlational design. METHODS: The data were collected from 95 participants who were working as registered nurses in public hospitals in Al-Bahah region. Questionnaire was used for collecting data which was based on the Casey-Fink graduate nurse experience survey. SPSS software was used to analyse the results. The methods of this study are in line with the STROBE checklist. RESULTS: The findings indicated statistically significant relationship between preceptor's support and communication leadership, professional satisfaction and job satisfaction, whereas an insignificant relationship was observed between preceptor's support and organising patient safety. The results also indicated that new graduate nurses were uncomfortable while performing different procedures/skills independently. CONCLUSION: The study implied instigation of the structured orientation programme to overcome the challenges faced by the new graduate nurses in their transition period. RELEVANCE TO CLINICAL PRACTICE: The upsurge in the nurses' demand across Saudi Arabia makes this study highly relevant. It helps in optimising the transition experience of the nurses who are required to provide service in the acute sector.

Assessing Building Blocks for Patient Safety Culture-a Quantitative Assessment of Saudi Arabia.

PURPOSE: The study analyzes staffs' perception of a safety culture and their knowledge of safety measures in the hospitals of Saudi Arabia. PATIENTS AND METHODS: A cross-sectional study was conducted by considering six different public hospitals from Arar city, and by recruiting 503 nurses. Building blocks of patient safety culture were measured through survey questions. RESULTS: The highest positive rating (81%) was received by both "people support one another in this unit" and "in this unit, people treat each other with respect." Supervisor/manager expectations and actions promoting patient safety was rated neutrally (n = 283; 56%) with an average mean score of 3.17±0.50, which suggested a neutral response by participants. Organizational learning, along with continuous improvement, was positively rated (n = 406; 81%) with an average mean score of 3.93±0.61. CONCLUSION: It demonstrated that participant nurses neither disagree nor agree on the level of patient safety culture prevailing in their hospital setting.

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.

Stress, Workplace Violence, and Burnout in Nurses Working in King Abdullah Medical City During Al-Hajj Season.

BACKGROUND: The Hajj pilgrimage to Mecca, one of the largest mass gatherings in the world, is associated with various challenges for nurses. One of these challenges is increased levels of workplace violence. Therefore, handling and mitigating workplace violence against nurses during Hajj, when nurses face a higher risk of violence and most experience stress and burnout, is of particular importance. PURPOSE: The aims of this study were to identify the types and sources of workplace violence, examine the relationship between burnout in nurses and the variables of stress and workplace violence, and identify from the perspective of nurses measures to effectively handle and mitigate these issues during Hajj season. METHODS: This study used a descriptive correlational design. A convenience sample of 118 nurses completed the Perceived Stress Scale, the Maslach Burnout Inventory, and the modified version of the Joint Programme on Workplace Violence in the Health Sector published by the International Labour Office in Geneva. Data analysis was done using an independent samples t test and Pearson product-moment correlation. RESULTS: One hundred eighteen nurses completed the study. Over two thirds (65%) were female, and 56% reported experiencing at least one type of violence, of which bullying/mobbing, racial harassment, threats, and physical violence accounted for 61%, 15%, 12%, and 12%, respectively. Nurse managers displayed violent behaviors against 54% of the participants. Participants reported high levels of stress and burnout. A positive relationship was found between stress and emotional exhaustion (r = .387, p < .01). Providing effective security measures and staff training regarding how to deal with violence at the workplace were the main measures identified to help reduce workplace violence. CONCLUSIONS: Providing effective security measures and tailored intervention programs addressing how to deal with violence in the workplace may enable nurses to handle violent behaviors more effectively.

Work-related stress among nursing staff working in government hospitals and primary health care centres.

AIM: Work-related stress (WRS) in the nursing working environment is prevalent and significantly affects the performance of nurses and organizations. Poor nursing and administrative performance affects the delivery of safety and quality patient care. Thus, this study aims to compare the sources and factors of stress among nurses from hospitals and primary health care centres. METHODS: A cross-sectional study was conducted in five government hospitals and four sectors of primary health care centres in Saudi Arabia. Through a survey, the Nursing Stress Scale was completed by 347 nurses from February to March 2016. RESULTS: Workload is perceived as the most common source of WRS, whereas inadequate preparation is regarded as the least. Other major sources are conflicts with physicians and nurses in primary centres and the lack of support and uncertainty concerning treatment in hospitals. The nurses' age, marital status, nationality, and job position are the significantly identified factors that contribute to stress. CONCLUSION: Overall, the sources and factors of WRS significantly vary with nurses' working environment. Hence, understanding the perception of nurses towards their working environment can be a strategic basis in modifying policies in occupational stress management.

Spectrum of Gastrointestinal Manifestations in Joint Hypermobility Syndromes.

Joint hypermobility is a common, primarily benign finding in the general population. However, in a subset of individuals joint hypermobility causes a range of clinical problems mainly affecting the musculoskeletal system and, to a lesser extent, extra-articular disorders. Joint hypermobility often appears as a familial trait and is shared by several inherited connective tissue disorders, including the hypermobility subtype of Ehlers-Danlos syndrome (hEDS) and benign joint hypermobility syndrome (BJHS/JHS). Although joint hypermobility has primarily been thought of as a rheumatological disorder, increasing evidence shows significant associations between both hEDS and BJHS with specific extra-articular disorders. To date, the strongest associations of these 2 conditions are with anxiety disorders, orthostatic tachycardia, various functional gastrointestinal (GI) disorders and pelvic and bladder dysfunction. This review article focuses on GI disorders associated with both hEDS and BJHS. The aim of this review is to evaluate existing research and literature regarding associations between JHS (hEDS/BJHS) and GI disorders. Our goal is to raise awareness of BJHS/JHS and hEDS as an explanation for chronic unexplained symptoms and functional GI disorders as well as to review the current standard tests available for proper evaluation of GI symptoms in these patients.

Attitudes and practices of nurses toward oral care of hospitalized patients - A cross-sectional survey in Riyadh, Saudi Arabia.

BACKGROUND: Oral care of hospitalized patients is an important measure that aims to maintain and promote the health of oral and dental tissues. This study aimed to investigate nurses' attitudes and practices regarding oral care of hospitalized patients in Riyadh, Saudi Arabia. MATERIALS AND METHODS: A cross-sectional, descriptive design was implemented. The research instrument was a self-administered questionnaire that was designed and distributed among 300 nurses working at five hospitals located in Riyadh. RESULTS: Totally, 226 questionnaires were completed (response rate: 75%). Almost all participants (97.8%) think that providing oral hygiene is an important element of patient care and 90.7% think that nurses need to update their oral care knowledge and skills. Only 46% of the nurses reported the presence of a policy for oral care at their hospital unit and 55.3% indicated that patients are assessed for oral health at their department. About 56.2% of participants did not receive training on oral assessment and provision of oral care and a few nurses (2%) received training on oral care at their current job place. A large proportion of nurses (44%) expressed a desire to undergo training on oral care of hospitalized patients. Gender, nationality, and previous training were the most important predicators of a positive attitude. CONCLUSIONS: The outcome of this study indicates a positive attitude among the surveyed nurses toward provision of oral care for hospitalized patients. Current oral care practice in Saudi hospitals is suboptimal. Saudi hospitals need to pay more efforts to train their nursing staff and issue clear policies and guidelines regarding oral care of hospitalized patients.

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.

Relative Bioavailability of an Emulsion Formulation for Omega-3-Acid Ethyl Esters Compared to the Commercially Available Formulation: A Randomized, Parallel-Group, Single-Dose Study Followed by Repeat Dosing in Healthy Volunteers.

LOVAZA (omega-3-acid ethyl esters; eicosapentaenoic acid [EPA]/docosahexaenoic acid [DHA]), with diet, lowers very high triglycerides (≥500 mg/dL) in adults. This study evaluated whether an emulsion formulation (LEM) increases the bioavailability of EPA/DHA compared to the reference formulation (RF) in healthy volunteers. Following relative bioavailability assessment, LEM, RF, and placebo were dosed for 2 weeks. Exposure measurements included plasma-free and total fatty acid (EPA/DHA) concentrations and phospholipid and red blood cell (RBC) incorporation. Following single doses, the dose-normalized EPA plasma-corrected AUCs were 14-fold (total) and 12-fold (free) higher and DHA plasma-corrected AUCs were 10-fold (total) and 13-fold (free) higher for LEM compared to RF. EPA and DHA incorporation into phospholipids increased for all active treatments; the increase was dose dependent for EPA. An 8-fold increase over baseline was observed in EPA incorporation for LEM (4-capsule dose) compared to a 4-fold increase for RF 4 g. DHA incorporation increased to a lesser degree, and RBC incorporation also increased. Pharmacodynamic evaluations revealed slight decreases (-8% to -25%) in the mean fasting triglyceride concentrations in all groups, including placebo, compared to baseline. Following a high-fat meal, no consistent treatment-related effect on the triglyceride profiles was observed. Study treatments were safe and tolerated. In conclusion, LEM improves the oral bioavailability of EPA and DHA.

Comparison of personal characteristics, tobacco use, and health states in Chaldean, Arab American, and non-Middle Eastern White adults.

This study compared and contrasted personal characteristics, tobacco use (cigarette and water pipe smoking), and health states in Chaldean, Arab American and non-Middle Eastern White adults attending an urban community service center. The average age was 39.4 (SD = 14.2). The three groups differed significantly (P < .006) on ethnicity, age, gender distribution, marital status, language spoken, education, employment, and annual income. Current cigarette smoking was highest for non-Middle Eastern White adults (35.4%) and current water pipe smoking was highest for Arab Americans (3.6%). Arab Americans were more likely to smoke both cigarettes and the narghile (4.3%). Health problems were highest among former smokers in all three ethnic groups. Being male, older, unmarried, and non-Middle Eastern White predicted current cigarette smoking; being Arab or Chaldean and having less formal education predicted current water pipe use.

Predictors of narghile (water-pipe) smoking in a sample of American Arab Yemeni adolescents.

To explore the predictors of water-pipe smoking among American Arab Yemeni adolescents, a descriptive correlational design was used, and regression models representing the proposed relationships in the study were tested from a convenience sample of 297 adolescents who attended a teen health clinic and two high schools. The participants completed five measures. Fourteen hypotheses were tested. Experimentation with tobacco was found to be significant in predicting narghile smoking. Tobacco use prevention and cessation interventions for this population can be focused on targeting the family and peer units, from which their identity is likely derived.