SACM - United States of America
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Item Restricted Perceived Barriers and Facilitators by Critical Care Nurses and The Impact of Cultural Variations Between Nurses and Patients on End-Of-Life Care at Intensive Care Units(University of Cincinnati, 2024-10-18) Alali, Khairayah; Smith, Carolyn R.Background: Due to the complexity of medical conditions in the intensive care unit (ICU), mortality rates are typically high in most hospitals. End-of-life care (EOLC) begins when curative treatments are no longer beneficial, shifting the focus to comfort and quality of life for patients and families. Despite EOLC being a standard part of ICU management, healthcare professionals encounter complexities and uncertainties when transitioning from life-saving treatments to comfort-focused care. Additionally, EOLC in the ICU is influenced by the cultural backgrounds of both nurses and patients. The nursing culture in Saudi Arabia reflects a diverse workforce, with a significant reliance on expatriate nurses from various countries, leading to cultural and language differences that can influence EOLC. Objectives: To explore the perceived barriers and facilitators of critical care nurses in providing EOLC in intensive care units, how cultural variations between nurses and patients impact care, and how nurses address and meet the cultural needs of dying patients. Method: The study employed a qualitative descriptive method, utilizing semi-structured interviews that were conducted virtually through Zoom. Purposeful sampling techniques and a homogeneous sampling approach were used to recruit participants. Open-ended questions were used from an interview guide to prompt the critical care nurses to share their viewpoints and experiences. Results: The exploration of the perceived barriers and facilitators of critical care nurses during EOLC for terminally ill patients in the ICU revealed three main themes: (a) EOLC barriers, (b) EOLC facilitators, and (c) suggestions to improve the EOLC and overcome barriers. The exploration of how cultural variations between nurses and patients impact care, and how nurses address and meet the cultural needs of dying patients revealed five main themes: (a) cultural practices and traditions of patients & families, (b) cultural competence during EOLC, (c) culturally competent nursing care decisions and actions (d) challenges in providing culturally competent nursing care, and (e) suggestions to improve cultural competence. Conclusion: This study identified barriers to EOLC, including family acceptance, understanding of EOLC, unrealistic expectations, over-involvement, poor policy awareness, staffing shortages, high workloads, care continuity, and insufficient training. Nurses showed a strong commitment to respecting patients' cultural and religious practices but faced challenges in delivering culturally competent care. Recommendations include better family education, clear communication, integrating EOLC training into nursing education, addressing language barriers, implementing advance directives, and fostering a collaborative team environment with adequate resources and flexible visiting hours. These steps can enhance the quality and compassion of EOLC.9 0Item Restricted The Effect of Hot and Cold Debriefing on BLS Competence and Reflection in Undergraduate Nursing Students(University of Cincinnati, 2024-07-10) Alanezi, Fahad; Elaine Miller; Morrison, Caroline F; Benjamin Kelcey; Robin WagnerBackground: Cardiac arrest is one of the leading causes of death globally. Each year, the number of out-of-hospital cardiac arrests in the US exceeds 356,000. Nearly 90% of them are fatal. Basic Life Support (BLS) is an essential element in simulation experiences for nursing students. In simulation training, debriefing is one of the essential tools recommended following cardiopulmonary arrest events. Although AHA recommends debriefing for BLS, debriefing is still delivered in hot format or not delivered at all. In a well-structured simulation experience, debriefing is essential to the learning process. Debriefing improves the performance of individuals, teams, and systems. In the literature, "hot" debriefings occur within minutes to hours of the simulation, whereas "cold" debriefings can occur within days to weeks. There is still a lack of evidence about the best debriefing methods for undergraduate nursing students. Purposes: Manuscript 1 aimed to identify the uses, advantages, and disadvantages of hot and cold debriefing in a nursing context. Guided by Kolb's experiential learning theory (ELT), a two-phase was designed. Phase one (manuscript two) aimed to identify the efficacy of cold versus hot debriefing in Basic Life Support (BLS) training for undergraduate nursing students' BLS competence and to assess the impact of hot versus cold debriefing on undergraduate nursing students' debriefing experience. Phase 2 (manuscript three) explored undergraduate nursing students' experience with cold and hot debriefing styles. Method: The study consisted of two phases. Phase one was a randomized controlled trial. The students were randomly assigned to a control or experimental debriefing condition. A total of 44 students participated in phase one. Twenty-two students were in the experimental group (Cold), and 22 were in the control group (Hot). Phase two involved collecting qualitative data through two focus group interviews. Twelve students participated in phase two, six in each group. Results: In manuscript one, twenty articles met the inclusion criteria. Due to heterogenicity in the studies' design, debriefing tools, methods, and intervention fidelity across the reviewed studies, it was difficult to draw a strong conclusion on the effect of hot versus cold debriefing. The result of this integrative review formed the scientific basis of the next two manuscripts. In manuscript two, both the hot and the cold debriefing groups significantly improved their BLS competence scores from the pre- to the post-test. The results revealed no statistical differences between the two debriefing methods regarding BLS competence scores and debriefing experience scale scores between the hot and cold debriefing groups. Qualitatively (manuscript three), Five main categories emerged from students' perceptions related to simulation and debriefing experiences: Simulation Experience, Debriefing Experience, Reflection, Debriefing Impact on Learning, and Advice for Educators. Conclusions: It is recommended that simulation followed by debriefing be integrated into the nursing curriculum, especially for teaching BLS. The study emphasizes the value of debriefing in simulation-based education and offers insights into optimizing debriefing strategies to improve nursing experiences and competence. Although there was no statistically significant difference between the two debriefing methods, it was evident that simulation with both debriefing approaches were beneficial. There are advantages and disadvantages to each type of debriefing, and the choice may need to be tailored based on the specific situation.17 0Item Restricted DEVELOPING A THEORETICAL FRAMEWORK FOR THE SOCIO-EMOTIONAL WELL-BEING OF SAUDI GRADUATE STUDENTS IN THE UNITED STATES.A QUALITATIVE ANALYSIS USING GROUNDED THEORY(The University of Alabama at Birmingham, 2024) Alshehri, Najlaa; Evans, RettaThe purpose of this study is to develop a theoretical model that expands the understanding of socio-emotional well-being among Saudi graduate students studying in the United States. This research addresses a significant gap in the literature, as little empirical attention has been given to the socio-emotional challenges these students face, particularly regarding how cultural, religious, and educational factors shape their experiences. Saudi students face unique pressures, including navigating cultural differences, overcoming language barriers, and adapting to the academic demands of United States universities. The central research question guiding this study is: How can current theoretical frameworks be expanded to explain how socio-emotional well-being is shaped for Saudi graduate students studying in the U.S.? A qualitative, grounded theory approach was employed, with data collected through semi-structured interviews with 14 Saudi graduate students from various academic disciplines and universities across the United States. There was no need to recruit past this number due to the repetition of codes and themes that were overwhelmingly present within these 14 participants’ responses. The data was analyzed using thematic analysis, which led to the identification of five provisional themes: 1) Education and Academic Experience, 2) Cultural Adjustment and Social Integration, 3) Personal and Emotional Well-being, 4) iv Language and Communication, and 5) Time Management and Personal Development. These themes provide insights into the complexity of the students’ experiences and their strategies for navigating socio-emotional challenges. This study introduces the Saudi Collective Ecological Model of Socio-Emotional Well-being, which highlights the complex interaction of cultural, social, and academic factors that shape the well-being of Saudi students studying in the U.S. This model emphasizes the importance of understanding the influence of collectivist cultural values, such as family support, religious practices, and community ties, which significantly affect the students' emotional resilience and adaptation. This study contributes to expanding theoretical frameworks on socio-emotional well-being by creating a culturally informed model that addresses the unique challenges faced by Saudi students. Specifically, the study developed the Saudi Collective Ecological Model of Socio-Emotional Well-Being, offering new insights into the experiences of Saudi graduate students in the United States. Additionally, this model provides practical recommendations for educators and policymakers, equipping them with the knowledge needed to better support international students from collectivist societies, like Saudi Arabia, in U.S. educational institutions.5 0Item Restricted SAUDI ARABIA’S TRANSFORMATION AND ITS GLOBAL IMPACT ON LINGUISTIC AND DISCOURSE-PRAGMATICS(Indiana University, Bloomington, 2024-12) Althuwaini, Anas; Obeng, Samuel GyasiThis dissertation examines the evolving Western perceptions of Saudi Arabia under HRH Crown Prince Mohammed bin Salman’s (MBS) leadership, focusing on U.S. online discourse and MBS’ communication strategies. Employing a multi-perspective analysis, the study investigates how MBS’ leadership has affected Western, particularly American, views of Saudi Arabia as reflected in media discourse and public opinion. The research is structured around three interconnected studies. The first study examines MBS’ hedging strategies in his 2023 Fox News interview with Bret Baier, highlighting how linguistic devices are employed to navigate sensitive topics, manage ambiguity, and maintain public image. The analysis reveals that MBS strategically uses hedges, such as modal verbs and approximators, to convey pragmatic functions such as caution and avoidance of firm commitments on controversial issues. It demonstrates that his use of hedging is comparable to that of other politicians, such as President Barack Obama (of the United States) and King Abdullah II (of Jordan). The second study employs Conversation Analysis (CA) methodology to subject YouTube comments on MBS’ 2023 Fox News interview to empirical inspection, focusing on adjacency pairs (AP) with the view to synthesizing and analyzing the interactional patterns and thematic content of the interview. This study reveals varied comments showing strong feelings about MBS’ leadership, vision for Saudi Arabia, and handling of international issues. User interactions demonstrate the negotiation of meaning, highlighting the contentious nature of MBS’ public image. The third study is a longitudinal analysis of Reddit users’ discourse from primarily US-focused subreddits about the political image of the Kingdom of Saudi Arabia from 2015 to 2023, utilizing computer-mediated discourse analysis (CMDA) and the Linguistic Inquiry and Word Count (LIWC) tool. The study finds increased analytical thinking over time, particularly following major political events. Clout, authenticity, and emotional tone fluctuated, with clout peaking during significant events like the 2020 U.S. presidential election. The discourse generally maintained a negative emotional tone, with a slight positive trend in later years. By integrating pragmatic, conversational, and computational methodologies, this dissertation provides a nuanced understanding of how MBS’ leadership and Saudi Arabia’s reforms have been portrayed and debated in digital spaces. It contributes to discourse analysis, media studies, and international relations by offering insights into the interplay between leadership rhetoric, media representation, and public opinion in the digital age.9 0Item Restricted LIQUID CRYSTALS NUCLEI COEXISTING WITH AN ISOTROPIC PHASE(Kent State University, 2022-08) Alqarni, Ali; Lavrentovich, OlegThe morphology of finite-size condensed materials is influenced by surface tension. To reduce surface area, tiny droplets of water in the air have spherical shapes, but solid crystals have facetted shapes defined by the orientation dependency of surface tension. Bulk interactions are unimportant in these two examples because they are either too weak to overcome surface tension in the first case or too powerful to enable internal curvatures in the second case. In liquid crystal droplets, the bulk and surface energies are more closely balanced, resulting in a more diversified morphology of structures such as smectic "batonnets", nematic spindle-like tactoids, and even the possibility for droplet division . Liquid crystals are well-known examples of ordered materials whose nuclei emerge from an isotropic state and have a shape topologically equivalent to a sphere. In the first part of the thesis, we explore experimentally and theoretically the nuclei of columnar lyotropic chromonic liquid crystal coexisting with the isotropic phase that is toroidal in shape. We study the lyotropic chromonic liquid crystal (LCLC) composed by plank-like molecules of disodium chromoglycate (DSCG) with hydrophobic polyaromatic cores and hydrophilic peripheries. The goal is to establish the physical mechanisms in the balance of elasticity and anisotropic surface tension that produce toroidal shapes and establish how these shapes depend on parameters such as molecular concentrations and the presence of a crowding agents. The second part of the thesis will focus on the droplets of chiral and ferroelectric liquid crystal materials.12 0Item Restricted ASSOCIATION BETWEEN MANDIBULAR ANTERIOR CROWDING AND PREVALENCE OF GINGIVAL RECESSION IN ORTHODONTICS PATIENTS(University of Oklahoma, 2024) Fita, Sarah; Whitley, Tracey; Henderson, Robin; Kadioglu, OnurPurpose: The aims of this study were 1) to determine if there is an association between the degree of mandibular anterior teeth crowding prior to orthodontic treatment and the development/progression of gingival recession during treatment and measured at the completion of orthodontic treatment; 2) to explore mucogingival abnormalities and conditions in relation to the severity of crowding and its effect on recession development during orthodontic treatment. Method: Four hundred sixty-nine subjects with pretreatment dental casts, pretreatment and post-treatment clinical photographs, and one hundred sixty-nine of those subjects with cone beam computed Tomography (CBCT) were retrospectively evaluated from the existing database at the University of Oklahoma Health Science Center (OUHSC) College of Dentistry, taken between 2007-2022. Little’s Irregularity index was measured on pre-treatment dental casts. Clinical photographs before and after orthodontic treatment were calibrated and analyzed for recession, keratinized tissue (KT) width, and oral hygiene (OH) at the mandibular six anterior teeth. Bone height and bone thickness at three points apicocoronally were measured on the same teeth in a convenience sample of CBCTs. Results: There was no significant association between the degree of crowding prior to orthodontic treatment and recession at the end of orthodontic treatment (P >0.05). Subjects with premolar extraction are less likely to develop recession (P = 0.005) as are subjects with good oral hygiene prior to orthodontic treatment (P = 0.015) Conclusion: The degree of crowding is not associated with recession development or progression after orthodontic treatment. Other factors not associated with recession include class of malocclusion, gender, age, buccal bone height and width, and lack of KT. Factors significantly associated are premolar extraction and oral hygiene prior to orthodontic treatment.10 0Item Restricted REIMAGINING THE ORIENT: REVISITING THE ONTOLOGICAL REPRESENTATIONS OF THE MIDDLE EAST IN POST 9/11 AMERICAN LITERATURE(Morgan State University, 2024-11-17) Aljuaid, Sara Saleh; Newson-Horst, AdeleAfter the attacks on September 11, 2001, the Arab and Middle Eastern American communities gained a new social status as hypervisible and hyphenated citizens. Sensationalized stories about the Middle East as a terrorism and violence hub prevail in American television. Hollywood broadcasts films and T.V. shows that exhibit stereotypical representations of the Middle East and Muslim women, mirroring the Orientalist legacy in the colonies dating back to the eighteenth and nineteenth centuries. Before 9/11, the American perception of the Middle East was inherited from the European fascination and romanticization of the Orient, causing to reproduce Orientalism aesthetics to contribute to the proliferation of capitalism and the amplification of consumerist culture in America. Since the attacks, a new rhetoric has emerged pertaining to the portrayals of Muslim women in primetime American T.V. The optics of Muslim women as exotic, hypersexualized, and oppressed have been broadcasted to provoke sentiments of sympathy and fear. The dehumanization of the Middle East by adopting the rhetoric of Muslim women’s victimhood has been utilized as a soft weapon to promote the War on Terror and the US expansionist projects in the Middle East. Arab American literature post-9/11 attempts to demystify the vagueness of conflicting identities and the emergence of discourse that focuses on the depiction of Muslim women. Arab American fiction authors internalize the Orientalist discourse, implement the Arabesque narration style, and reproduce dichotomies to create subdivisions within the Orient to appeal to Western sensibilities and to mediate finding common ground with the dominant culture.16 0Item Restricted Optimizing Construction Productivity Through Climate-Specific Heat Stress Management(Purdue University, 2024-12) Alreshoodi, Majed; Hastak, MakarandThis research investigates the combined impact of heat stress and fatigue on construction worker productivity in two climatically distinct regions: a humid coastal area and a dry inland region. Using Wet Bulb Globe Temperature (WBGT) as a measure of heat stress and incorporating working hours to account for fatigue, the research employs Monte Carlo simulations to model productivity variations across different work shift configurations and environmental conditions. The research focuses on two high-intensity construction tasks, with baseline productivities established through field observations. Simulation results reveal significant differences in optimal work strategies between the two regions, considering both heat stress and cumulative fatigue effects. In the humid coastal region, shifts starting between 12:00 AM and 4:00 AM showed the highest productivity, with the most effective work ban period from 10:00 AM to 1:00 PM. In contrast, the dry climate allowed for a wider window of productive hours, with the current 12:00 PM to 3:00 PM ban proving most effective. The research also explored the impact of breaks, indoor versus outdoor work, and various shift lengths on productivity, taking into account how fatigue accumulates under different environmental conditions. Model validation against field data demonstrated high accuracy, with mean productivity differences of -4.00% for Jubail and 1.19% for Qassim. The findings highlight the need for climate-specific work strategies and policies that address both heat stress and fatigue to optimize construction productivity while ensuring worker safety. The research provides valuable insights for industry practitioners and policymakers, suggesting that tailored approaches to managing both environmental stress and worker fatigue can significantly improve productivity and well-being in challenging climatic conditions.17 0Item Restricted EFFECTS OF A REPEATED READING INTERVENTION ON IMPROVING ARABIC READING COMPREHENSION AND FLUENCY IN FEMALE FIFTH GRADERS WITH LEARNING DISABILITIES IN SAUDI ARABIA(Duquesne University, 2024-08) Aljuwayhir, Jawaher; Huang, AnnHaving the ability to read is an essential skill for an individual. However, comprehension, the aim of reading, is a complex cognitive process that involves constructing meaning through deliberate thinking. Unfortunately, students with learning disabilities (LD) often struggle with reading, which impairs their comprehension abilities. Repeated Reading (RR) interventions, focusing on fluency and automaticity, have shown promise in enhancing comprehension. Although research supports the effectiveness of RR interventions among students with LD, limited studies have explored their efficacy in improving Arabic comprehension among Saudi fifth-grade students with LD. This dissertation aims to evaluate the potential benefits of RR interventions on Arabic reading comprehension in Saudi fifth-grade students with LD. Utilizing a multiple baseline across participants design, the study involves three participants diagnosed with LD. The intervention consists of RR sessions where students repeatedly read grade-level Arabic passages to enhance their reading fluency and comprehension. The dependent variables measured include oral reading fluency (ORF) and reading comprehension, assessed through words read correct per minute (WCPM) and Maze assessments, respectively. The findings revealed significant improvements in both ORF and reading comprehension among the participants, indicating that RR is an effective intervention for enhancing the academic development of Saudi students with LD. These results provide valuable insights for educators, policymakers, and stakeholders, contributing to evidence-based practices aimed at improving educational outcomes and opportunities for success among students with LD in Saudi Arabia3 0Item Restricted Development, Cross-Cultural Adaptation, and Psychometric Testing of the Child and Adolescent Activity Card Sort (CA-ACS)-Arabic version of the Adolescent and Young Adult-ACS (AYA-ACS)(University of Wisconsin Madison, 2024-12-16) Alkhamees, Abdullah; Larson, ElizabethOccupational therapy (OT) takes a client-centered approach in which OT practitioners work with clients to create and meet goals; this is a valued approach in the United States (U.S.) However, In Saudi Arabia, children with NDDs are rarely asked to select their therapy goals, likely due to a lack of instruments that support the child's participation in the process. In the U.S., activity card sorts are increasingly being used in pediatrics to include children in goal setting. This dissertation presents three studies focused on developing and validating a school-aged Activity Card Sort (ACS) for Saudi children and adolescents. Study 1 aimed to develop a comprehensive occupation-based, culturally tailored tool adapted from the U.S.-developed Adolescent and Young Adult-Activity Card Sort (AYA-ACS) (Berg et al., 2015). Following Beaton and colleagues’ cultural tailoring and translation process, forty-six percent were retained or modified from the AYA-ACS, and 54% were unique to the Saudi culture. This resulted in an 83-activity card sort, Child Adolescent-Activity Card Sort-Arabic version (CA-ACS). The activity cards were sorted into nine domains, including ADLs, obligatory chores, leisure, social, health and wellness, education and learning, caring for other children, religion, and sports. Study 2 aimed to pilot-test the newly developed CA-ACS-Arabic version and establish its face and content validity. The results showed that parents and children rated the activities of the CA-ACS-Arabic version as frequently culturally appropriate activities. There was good face validity as parents rated the activity cards as clearly demonstrating the captioned activity. Study 3 examined the psychometric testing of the CA-ACS-Arabic version, which showed excellent reliability (Cronbach’s alpha = 0.893). Two analyses were conducted to assess convergent and discriminate validity to establish construct validity. There was a significant positive relationship between the CA-ACS-Arabic version and the Arabic CAPE (r = 0.72, P <0.001), demonstrating good convergent validity. Lastly, there was a significant difference between the NT and NDD groups’ scores on the CA-ACS-Arabic version (P=<0.05), suggesting good discriminative validity. Future research is needed to examine the usefulness of the CA-ACS-Arabic version for NDD populations in developing occupational profiles and identifying goals in Saudi Arabia.9 0