Saudi Cultural Missions Theses & Dissertations
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Item Restricted Intensive Care Nurses' Experiences of Burnout During the COVID-19 Pandemic in Saudi Arabia: A Constructivist Grounded Theory Study(King's College London, 2024) Alzailai, Nawal; Xyrichis, Andreas; Barriball, LouiseBackground: Burnout amongst healthcare staff, particularly amongst intensive care unit (ICU) nurses, is a critical issue that intensified during the COVID-19 pandemic. Previous research, especially within the Saudi context, has identified significant levels of burnout in ICU nurses. However, a notable gap exists in the use of qualitative methodologies to deepen our understanding of ICU nurses’ burnout in the Saudi context. Moreover, comprehending the experiences of nurses who suffered from burnout during the pandemic, focusing on the factors that contributed to their stress, has been essential for identifying developmental needs and for shaping interventions aimed at mitigating burnout amongst nurses. Despite this, the existing literature lacks a reliable theory or model that adequately captures the phenomenon of burnout within highly demanding environments like ICUs, particularly under the unpredictable and greatly challenging circumstances of disasters. Aim: To construct a theory grounded in burnout experiences of ICU nurses in Saudi Arabia during the COVID-19 pandemic, intended to act as a foundation for future research that explores burnout in high-stress environments for nurses or other healthcare staff working in similar contexts. Methods: Building from one scoping review and one systematic review, a constructivist grounded theory design was employed for this study, as proposed by Charmaz (2014a). Conducted in four distinct adult ICU departments of a tertiary hospital in Saudi Arabia, the research involved 22 ICU nurses experienced in caring for COVID-19 patients and 10 decision-makers, recruited through initial purposive sampling and subsequent theoretical sampling until theoretical saturation was reached. Data were collected through semi-structured, in-depth interviews. Field notes and a reflexive methodological journal were maintained throughout the research process. Interviews were transcribed verbatim and translated into English where necessary. The analysis followed “Charmazian” principles, which include initial, focused and theoretical coding; constant comparison; theoretical sampling and sensitivity; memo writing; and diagramming. Ethical approval was secured from King’s College London and from the relevant Institutional Review Board in Saudi Arabia. Results: The theory generated by this investigation suggests burnout is a process, resulting from multiple interrelated factors within and beyond an individual’s working environment. This process occurs in three dynamic stages affected by the coping and supportive resources that the nurse has used/received. The core category that emerged, ‘we fought and now we need to be healed’, encapsulates the essence of the nurses’ experiences with perceived burnout and their vital need for recovery and support. This finding led to the development of the BuRN-ICU19 model, a comprehensive framework representing the ICU nurses’ experiences with burnout during the COVID-19 pandemic and informed by results from two fundamental reviews: a scoping review and a systematic review. Conclusion: This thesis offers novel insights into the experiences of burnout among ICU nurses in Saudi Arabia during a disaster situation. It highlights the critical need for targeted interventions and policy reforms to alleviate burnout in, improve the well-being of and effectively support ICU nurses in demanding situations. The BuRN-ICU19 model presents a valuable framework for future research and practical application in ICU nursing, with potential implications extending beyond the Saudi context.45 0Item Restricted A portrait of gamma delta T cell exhaustion: Chronic stimulation models, RNA transcriptomics and CRISPR screens.(University College London, 2024) Alturki, Meshael; Anderson, JohnT cell exhaustion has been identified as a major challenge for T cell therapeutics. In conventional T cells (ab T cells), the study of exhaustion has led to insights into its aetiology, and potential therapeutic approaches to overcome it. Our research focuses on a novel area of study-T cell exhaustion in human γδ T cells, particularly the Vγ9Vδ2 subtype, which is the most prevalent in peripheral blood. These cells hold therapeutic promise due to their broad cytotoxic characteristics and ability to bridge innate and adaptive immunity. However, the understanding of how exhaustion can affect the behaviour and functionality of these cells is yet to be established. Our study involved in vitro chronic stimulation protocols using combinations of zoledronic acid (ZOL) and OKT3 (anti-CD3 monoclonal antibody) or Daudi target cells, both stimulating via the Vγ9Vδ2 T cell receptor. The findings from our ZOL model, which showed a notable decrease in absolute T-cell numbers and significant upregulation of genes associated with T cell exhaustion, could have significant implications for understanding and potentially overcoming T cell exhaustion in Vγ9Vδ2 T cells. Bulk-RNA sequencing of Vγ9Vδ2 T cells identified distinct signatures for the multiple stimulated samples, and a list of highly differentiated genes was selected for further investigation by a pooled CRISPR screen. We optimised and tested a suitable protocol for a CRISPR screen in Vδ2 T cells. Two gRNA hits were enriched in the ZOL and multiple stimulated samples (targets for SLC37A3 and GORASP2 genes). In conclusion, a simple in vitro assay was developed to study hypofunctionaity in Vδ2 T cells, allowing studies to evaluate RNA profiles and regulatory mechanisms of exhaustion induction in this cell type. Finally, selected genes were screened in a CRISPR-based pooled screen and hit gRNAs from stimulated Vδ2 T cells were identified.27 0