Saudi Cultural Missions Theses & Dissertations
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Item Restricted Pain Management in Adult Intensive Care Unit in Saudi Arabia(University of Newcastle, 2024) Alotni, Majid Ali Saleh; Fernandez, Ritin; Guilhermino, MichelleThesis Abstract The prevalence of pain among patients in the intensive care unit (ICU) resulting from invasive procedures and medical interventions remains high. This issue is particularly complex for ICU patients unable to self-report their pain, leading to undetected and untreated pain and affecting quality of life. The specific aims were to: 1. Identify the barriers to nurse-led pain management in adult ICUs through an integrative review. 2. Implement the Critical Care Pain Observation Tool (CPOT) in Saudi Arabia to improve pain assessment in patients unable to self-report pain, with the goal of improving nurse practice and patient outcomes. 3. Develop and investigate the psychometric properties of an instrument designed to measure nurses’ readiness for implementing the CPOT, in ICUs in Saudi Arabia. Method An integrative review was conducted to identify the barriers to nurse-led pain management. Which were mapped to the COM-B model. This model suggested specific strategies to address the barriers. A stepped-wedge trial was conducted to assess the effect of the implementation of the CPOT on pain assessment. Finally, nurses’ readiness to implement was tested using the cross-sectional method with validity and psychometric analysis. Results The integrative review revealed several barriers to nurse-led pain management and informed the intervention. The intervention resulted in a significant increase in the number of pain assessments (Rate Ratio: 1.77, 95% confidence interval [CI]:1.45, 2.16, p < 0.001) and re-assessment (Rate Ratio: 13.99, 95% CI: 8.14, 24.02, p < 0.001) between the intervention and control groups. There was no significant effect on patient outcomes. The content validity of the mAFt. resulted in two factors: acceptability (10 items) and feasibility (five items). Conclusion Identifying barriers to nurse-led pain management in the ICU is crucial. Selecting the most effective interventions is essential to achieving optimal outcomes for both nurses and patients.19 0Item Restricted Nurses’ perspectives on the barriers to and facilitators of effective paediatric pain assessment and management: A systematic review(Saudi Digital Library, 2023-11-21) Gadi, Amirah Dawood M; Wilson, IseultBackground: Children’s pain is a universal problem that has far-reaching negative consequences. Despite the recognition that effective pain management is a fundamental human right, some children are still suffering from unrelieved pain. Nurses have a pivotal role in paediatric pain management; however, they are confronted by many barriers. It is therefore of value to explore the barriers and facilitators that nurses experience when caring for children in pain. Aim: This study aims to explore nurses’ perspectives regarding the barriers and facilitators related to the effective assessment and management of pain in children, infants, and neonates. Methodology: A search strategy was formulated, and five databases were searched for relevant articles including ProQuest, Scopus, CINAHL, PsycINFO and PubMed. Each paper identified by the search underwent a quality assessment using a predetermined tool. Relevant information to the research question was extracted, and the major themes were then identified by thematic analysis. Findings: Eighteen studies were included in this review. Recognised barriers and facilitators were categorised into three main themes related to: (i) healthcare professionals; (ii) the child and their parents; and (iii) the organisation. Prominent barriers included nurses' inadequate knowledge of the uses and side effects of medication, limited pain assessment experience, low prioritisation of pain, time constraints, communication and language difficulties with children, as well as uncooperative children, insufficient parental involvement, lack of guidelines and resources shortages, and nurses’ distrust in pain assessment tools. Key facilitators comprised robust knowledge, adequate experience, higher education, in-service training, parental involvement, effective communication with children and parents, clear guidelines, adequate resources, and nurses’ trust in and utilisation of pain assessment tools. Conclusions: This review provides valuable insights into the barriers and facilitators faced by nurses with respect to the assessment and management of pain in the paediatric population. There is a need for targeted educational interventions and policy changes to support nurses’ ability to deliver high-quality pain care. Further research is needed in order to investigate these factors and to examine any other potentially associated determinants amongst paediatric nurses.23 0Item Restricted Impact of Chronic Pain on Adolescents’ School Functioning and Pain Management Interventions in the School Setting(2023-07-19) Alsaggaf, Fatimah; Coyne, ImeldaBackground: Chronic pain is a widespread issue in children’s health that has a widespread impact on daily activities including participation in school settings. Thus, effective pain management has been emphasised to lessen the impact of adolescents’ chronic pain on school functioning (World Health Organisation 2020). A systematic literature review revealed a need for further research to explore the impact of adolescents’ chronic pain on all aspects of school functioning and the effective school personnel’s responses to managing pain in schools. Furthermore, there was also a deficit of empirical research about adolescents’ experiences of chronic pain in Saudi Arabia. Aim: To explore the impact of chronic pain on adolescents’ school functioning and to identify interventions for managing adolescents’ pain in schools in Saudi Arabia. Methods: A multiple case study design based on Yin’s (2018) methodology was used. Purposeful and theoretical samplings were used to recruit adolescents (n = 10) aged 12 to 18 years who had experienced chronic pain for at least three months, their parents (n = 10), and school personnel (n = 20). Data were collected through semi-structured interviews with participants and through archival hospital and school documents. Data were analysed using constant comparative analysis and cross-case synthesis following Charmaz (2014) and Yin (2018) respectively. Findings: The findings were categorised into three themes: 1) Adolescents’ experiences of chronic pain; 2) Impact of pain on school functioning; and 3) School support and management of adolescents with chronic pain. All adolescents reported that a chronic condition caused their pain and their chronic pain impacted negatively on school functioning, including attendance, performance and competence, physical activity, and social interactions. Adolescents experienced both supportive and non-supportive responses from school personnel, however, when they received school support this helped them to manage their pain in schools and to mitigate their chronic pain’s impact on school functioning. Conclusion: This research provides an insight into adolescents’ experiences of chronic pain, the impact on their school functioning, and how their pain was managed in schools in Saudi Arabia. Chronic pain is a significant health issue that had a detrimental impact on adolescents’ functioning in schools. There is a need for effective communication between parents, healthcare providers, and schools to manage adolescents’ chronic pain effectively. Moreover, a professional development education for school personnel should be provided to enhancing school outcomes and overall health of adolescents with chronic pain.39 0