Saudi Cultural Missions Theses & Dissertations
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Item Restricted EVALUATING THE EFFECT OF NURSE-PATIENT COMMUNICATION ON ANXIETY AMONG PATIENTS WITH IMPLANTABLE CARDIOVERTER DEFIBRILLATORS(UNIVERSITY OF KENTUCKY, 2024) ALTURKI, RAWAN; MOSER, DEBRA; RAYENS, MARY KAYThe implantable cardioverter defibrillator (ICD) is a battery-operated device implanted under the skin to monitor heart rate and rhythm, detecting and correcting dangerous dysrhythmias. It is the preferred choice for preventing both primary and secondary sudden cardiac death (SCD), reducing mortality by 50% compared to patients treated without an ICD. Due to the high prevalence of cardiovascular diseases and associated dysrhythmias, the demand for ICDs is growing each year. In the United States, about 75,000 adults receive an ICD annually. The presence of these devices, along with the uncertainties of living with a heart condition, can significantly affect mental health. About 20% of ICD recipients experience psychological distress and specific concerns related to their ICD. Miscommunication or misunderstandings can lead to fear, panic, and anxiety among ICD patients, with serious negative effects. Over 50% of ICD patients lack a clear understanding of their condition and often express dissatisfaction with the information provided by healthcare professionals regarding their device and treatment. Therefore, it is essential to clearly explain what patients can expect in their lives with an ICD during discussions before and after implantation, including the potential for anxiety symptoms. Effective nurse-patient communication has been shown to improve health outcomes by increasing patient satisfaction, enhancing understanding of health issues, and promoting better adherence to treatment plans through more personalized care. Evaluating nurse-patient communication among ICD recipients will provide an opportunity to identify factors that influence patients' psychological symptoms. Therefore, the purpose of this dissertation was to understand the effect of nurse-patient communication on anxiety symptoms among ICD recipients. The specific aims were: 1) test the psychometric properties of an instrument for assessing ICD device concerns among ICD recipients in the U.S.; 2) evaluate the effect of nurse and patient communication on anxiety among ICD recipients; and 3) synthesize and summarize the current literature about anxiety as a risk factor for mortality in ICD recipients. Aim 1 was achieved by conducting a psychometric analysis of the Implantable Cardioverter Defibrillators Concerns questionnaire in order to assess the extent and severity of ICD recipients’ concerns. We used data from a cross-sectional observational study conducted to test the knowledge, attitudes, and perceptions of adult ICD recipients (N= 240). The tested instrument consisted of 20 items measured on a 5-point Likert-type scale. The items are scored from 0 (I am not worried at all) to 4 (I am very much worried), and there are 20 potential concerns on the scale, corresponding to a maximum potential severity score of 80. The instrument is valid and reliable in multiple populations including, the United Kingdom and Poland, with a Cronbach’s α= 0.94. The factor analysis revealed that a one-component solution was present within the scale, explaining 48% of the variance. In addition, the hypothesis test showed a positive and statistically significant correlation between the Brief Symptoms Inventory (BSI-6) measure of anxiety and the ICDC total score (r = 0.35, p < 0.001). Aim 2 was achieved by conducting a secondary data analysis of a cross-sectional study of (N=200) patients with an ICD in order to evaluate the effect of nurse-patient communication on anxiety among ICD recipients. We have performed a simple logistic regression to distinguish whether nurse-patient communication is a predictor of anxiety among ICD recipients along with the covariates: age, gender, marital status, and health status. Simple logistic regression showed that patients aged 65 years and older are more likely to be anxious than younger patients p= .05 (OR, 2.478; CI, 0.998 – 6.15). In addition, patients who report good or very good health status are more likely to be anxious p= .008 (OR, 0.311; CI, 0.131 – 0.737). No other significant variables were shown, all relationships between discussion, gender, marital status, and anxiety remained not significant. Aim 3 was achieved by conducting a systematic literature review to identify the role of anxiety as a risk factor for mortality among patients with ICDs. Three electronic databases were searched for peer-reviewed articles: (Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, and PsycINFO). Nine studies were found and included. The Socio-Ecological Model guided this review. Studies included in this systematic review concluded that anxiety may be relevant as a risk factor for increasing mortality among patients with an ICD. In conclusion, this study has filled an important gap in the evidence of healthcare communication and psychological outcomes among ICD recipients. This comprehensive approach could lead to better support systems and communication strategies, ultimately improving both mental health and overall outcomes for ICD recipients. The findings emphasize the urgent need for routinely applied and interdisciplinary psychosocial aftercare for ICD patients. Therefore, it is necessary to ensure that ICD recipients receive the required interventions as early as possible in order to prevent any further permanent health issues associated with their devices or overall health. The next step in this area of research would be to conduct a randomized controlled trial with longitudinal follow-up to evaluate the impact of proper one-to-one communication that can help with anxiety symptoms. Additionally, to assess the feasibility of the communication strategies in decreasing anxiety among ICD patients.16 0Item Restricted Student Perceptions of Virtual L2 Learning: Anxiety and Motivation in the COVID-19 Era(University of Reading, 2024-03-25) Alahmadi, Asim Eid; Capstick, TonyThe impacts of virtual education on student levels of motivation and anxiety are explored by the present study, using the qualitative method. Ten students from one Saudi Arabian university were recruited to participate in this study. Thematic Analysis, developed by Braun and Clarke (2006), was used to analyse the data deductively in order to identify those factors influencing students’ anxiety and motivation levels in the virtual environment. The results indicate that the online environment is associated with a higher level of anxiety and a lower level of motivation. The investigation highlighted a number of relevant aspects, including instructors’ teaching styles, lacking student interaction, and online content.10 0Item Restricted The Effectiveness of Virtual Reality Technology for Perioperative Anxiety Among Adults Undergoing Elective Surgery(Queensland University of Technology, 2024-03-11) Asiri, Salihah; Duff, Jed; Currie, Jane; Guilhermino, MichelleBACKGROUND Perioperative anxiety is a common phenomenon that can have a significant impact on a patient's experience and surgical outcomes. Anxiety can manifest in physical symptoms such as increased heart rate, blood pressure, respiratory rate, sweating, and nausea, as well as psychological symptoms such as fear, worry, and panic. Perioperative anxiety can be caused by a variety of factors, including fear of the unknown, fear of pain, fear of the procedure itself, fear of the outcome, and fear of the environment. In addition, perioperative anxiety can lead to postoperative complications such as pain, surgical site infections, and longer hospitalisation. Pharmacological and non-pharmacological interventions have been used to manage anxiety. Pharmacological interventions include medications such as fentanyl, midazolam, morphine, and ketamine. However, side effects can occur from these medicines, such as breathing difficulties, drowsiness, and interactions with other anaesthesia medications. As a result, non-pharmacological interventions, including music, educational videos, psychological counselling, and social support, are becoming more popular. Recently, there has been an increased interest in using virtual reality (VR) to manage perioperative anxiety. The VR technology provides the user with an immersive experience in a three-dimensional simulated environment by allowing them to interact with the virtual environment. This technology is a major area of interest within the field of perioperative anxiety. To date, most studies in the field have focused on the effectiveness of VR on perioperative anxiety among the paediatric population, with limited research on its effectiveness among the adult population. AIMS To evaluate the effectiveness of VR on perioperative anxiety in the adult population undergoing elective surgery. METHODS A systematic review and meta-analysis of the effectiveness of VR in reducing perioperative anxiety for elective adult surgical patients was conducted (Objective 1). Search strategies were employed to identify the literature without language or date restrictions. Searches were completed by July 2023. Two independent reviewers, with a third where consensus was needed, used standardised critical appraisal instruments from the Joanna Briggs Institute, narrative analysis, and meta-analysis using RStudio software. A prospective observational study among 308 adult patients scheduled for elective surgery was conducted to investigate the prevalence of preoperative anxiety at a major metropolitan hospital in Australia from November 2021 to July 2022 (Objective 2). A self- administered questionnaire was used to measure anxiety levels, and other variables, including age, sex, and type of surgery, were collected from the patient's records. Data analysis included univariate logistic regression to evaluate the significance of independent variables , including age, gender, and surgical type. A two-group, parallel, single-centre, superiority, randomised controlled trial (RCT) of the effectiveness of VR in perioperative anxiety for adult elective surgical patients was conducted (Objective 3) based upon a published protocol. The study was conducted from November 2021 to July 2022 in 95 patients who experienced moderate to high levels of preoperative anxiety. Computer-generated randomisation was used to allocate participants to either the control group or the intervention group, who received 10 minutes of a VR session for relaxation purposes. The primary outcome was perioperative anxiety measured using the Visual Analogue Scale for Anxiety (VAS-A). Secondary outcomes included stress levels as measured by saliva cortisol level and heart rate, postoperative pain, patient satisfaction with perioperative care, hospital length of stay, and VR-associated adverse events. Data was analysed using R and RStudio software. RESULTS A systematic review identified that there was support for the effectiveness of VR in alleviating anxiety and enhancing patient satisfaction. Additionally, a meta-analysis of four studies revealed a small, non-significant reduction in preoperative anxiety based on subjective measurements, favouring VR (SMD -0.29, 95% CI -0.83 to 0.24), with moderate heterogeneity (I2 = 47%). The results of a prospective observational study identified that almost one-third (32.4%, n=100/308) of adult elective surgical patients had significant preoperative anxiety, identified as an Amsterdam Preoperative Anxiety and Information Scale (APAIS) score 11 or higher. Women were three times more likely to experience anxiety than men (OR=3.39, 95% CI 1.97-5.82).Older patients were less likely to experience anxiety, with a reduction in anxiety of 2% for each year above 18 years (OR=0.98, 95% CI 0.97-0.99). In addition, patients were more anxious about the surgery than the anaesthesia, with mean scores of 5.04 (± 2.48) and 3.65 (± 2.07) out of 10, respectively. Over half of the patients (54.9%) reported needing more information about the anaesthesia and surgery. The results of the RCT showed a statistically significant difference in preoperative anxiety levels between the intervention and control groups after the intervention (MD -17% points, 95% CI -23.0 to -11.7). However, there was no statistically significant difference in postoperative anxiety levels between the two groups (MD -7.2% points, 95% CI -17.9 to 3.5). Drowsiness and tired eyes were reported as VR side effects. CONCLUSION Perioperative anxiety among adult surgical patients is often overlooked. Findings suggest that adult surgical patients should be screened for preoperative anxiety, taking into account gender differences, and provide appropriate interventions for those with significant anxiety levels. VR interventions could be considered as a potential treatment option due to their efficacy in the adult population.35 0Item Restricted “What is the impact of gardening on the psychological health of adults? A scoping review.”(Exeter University, 2024-03-06) Alomiri, Abeer; Garsid, RuthRecently, there have been concerns that the prevalence of mental disorders has increased significantly, threatening the mental health of a large segment of the population. Therefore, there has been a call to improve the psychological health of the general population using non-pharmacological interventions (e.g., gardening and green spaces). Although several scoping reviews have examined the psychological outcomes of green spaces, there is a lack of scoping reviews that examine the psychological outcomes of gardening. Scoping reviews in this research area can be valuable because they identify potential methodological limitations, informing future research. Further, they can explore the scope of evidence, which can identify unanswered research questions. Therefore, this scoping review aimed to explore the scope of evidence as well as identify the methodological limitations in this research area in order to inform future research. The scoping review was guided by a framework developed by Arksey and O'Malley (2005). Different databases were used to access relevant studies, including Scopus, Medline, and the Web of Science Core Collection (WSCC). The search yielded 26 studies. Gardening can lead to a wide range of psychological outcomes, including a reduced risk of depression, with a higher effectiveness of community gardening in decreasing depression compared to individual/home gardening, a decrease in anxiety, mental resilience and relief from stress, escape, enjoyment, and relaxation, better cognitive performance, a sense of community and social relationships, and a greater sense of meaning of life, although there is a greater effect size in individualistic than collectivist cultures and an overly simplistic approach to the association between gardening and psychological outcomes. Further, there were several methodological limitations, such as limited use of objective measures (e.g., salivary cortisol levels, fMRI), a lack of use of the Core Outcome Sets (COS), a lack of studies with long-term follow-up, a lack of studies that examined the difference between doing the gardening activity and the mere presence of being at the gardening site, and a lack of studies from different countries (Africa, Asia, and South America). Limited studies examined the impact of mediators and moderators. Further, known facts were usually not taken into account. Researchers are advised to address these methodological gaps, as this will improve the quality of evidence in this emerging research area. Moreover, policymakers are advised to provide the required financial support to urban planners to increase the presence of gardens, as they can encourage local people to engage in gardening activities. Further, initiatives that introduce community gardening in public gardens can be adopted by local governments worldwide. Keywords: gardening, green spaces, psychological health, depression, anxiety, stress12 0Item Restricted The Level and Factors of Foreign Language Speaking Anxiety Among Female Saudi EFL University Students(University of Leicester, 2024-01-18) Alsaiari, Nawal; Jim, KingAnxiety is a prominent affective factor that exerts a substantial impact on the emotional state, cognitive processes, and basic abilities of individuals. Foreign language speaking anxiety (FLSA) is a prominent issue that has a significant impact on students who are actively involved in the process of language acquisition. The apprehension associated with speaking a foreign language can be a significant obstacle, impeding the ability to communicate effectively and achieve a high level of linguistic competence. The objective of this study is to measure the level of foreign language speaking anxiety among female Saudi English as a Foreign Language (EFL) university students and identify the primary elements that contribute to this phenomenon. In order to accomplish this objective, a research methodology that included both qualitative and quantitative methodologies was utilised. 53 females Saudi EFL university students were involved in the questionnaire. However, five of the most anxious Participants participated in the interview. Regarding the result and discussion of this research, it has been evident that female Saudi EFL university students encounter a high level of foreign language speaking anxiety, which subsequently results in their hesitancy, avoidance, and impeded progress in language acquisition. Several causes were ascribed to this outcome, including the learners themselves, the instructor, and the nature of the assignment.61 0Item Restricted Prevalence of Anxiety and Depression Among Respiratory Therapy Professionals in The Western Region of Saudi Arabia(Saudi Digital Library, 2023-11-08) AlQahtani S, Ali; Zimmerman, RalphBackground: Anxiety and depression are prevalent concerns among psychologists, psychiatric professionals, and behavioral scientists across the world. Anxiety is defined as worry-filled thoughts and a pervasive sense of impending doom. It is a broad concern about what will or might occur in the future. Depression is a debilitating disorder, leading to higher death rates and a significant decline in the quality of life. It is characterized by persistent feelings of sadness, emptiness, and lack of happiness. Therefore, anxiety and depression could have a detrimental effect on the well-being and productivity of respiratory therapists. Purpose: The purpose of this study is to investigate the prevalence and severity of anxiety and depression among respiratory therapists employed by public and private hospitals in the western region of Saudi Arabia. Methods: A cross-sectional study was conducted between September 5 and October 7, 2023. The Hospital Anxiety and Depression Scale (HADS) was distributed electronically to respiratory therapists' email addresses through direct collaboration with RT department heads. Data were collected from RT professionals in both public and private hospitals by using a non-probability convenience sampling technique. The data analysis and statistical description provided by the participants were displayed as means, standard deviations, frequencies, and percentages. A one-way ANOVA test was used to determine the significant differences in HADS scores among categorical groups. Results: A total of 307 responses were received from RTs working in the western region of Saudi Arabia. The majority of them were from public hospitals (74.3%) and (25.7%) from private hospitals. The study findings showed that the prevalence of anxiety and depression among RT professionals in the western of SA were found to be 38.8% and 37.5%, respectively. In addition, HADS scores were significantly higher among RT professionals who were female, current smokers, divorced, or widowed. However, HADS showed that anxiety was significantly higher among RT professionals with clinical experience between 1-4 years as well. Conclusion: Anxiety and depression were common psychological disorders among respiratory therapists in the western region of Saudi Arabia. Higher odds of anxiety and depression were significantly found among females, staff with clinical experience between 1 and 4 years, smokers, and divorced/widowed staff. Further studies are required to investigate the prevalence of depression and anxiety among RTs in all regions of Saudi Arabia.29 0Item Restricted Substance Use and Mental Health Conditions Among US Active Duty Military Personnel: Prevalence and Associated Factors(2023-04-13) Alulaiyan, Mohammed; Alqaderi, Hend; Tavares, Mary; Vardavas, Constantine; Alhazmi, HeshamObjective: To assess the relationship between three mental health conditions (post-traumatic stress disorder [PTSD], generalized anxiety disorder [GAD], and depressive symptoms), and cigarette smoking or marijuana use. We also explored this relationship when adding sleep duration (as a mediator variable). Methods: This was a cross-sectional study and secondary data analysis of the 2015 Department of Defense (DoD) Health Related Behaviors Survey (HRBS). Prevalence and 95% Confidence Interval (CI) of PTSD, GAD, and depressive symptoms with the sociodemographic characteristics of the United States (US) active service duty members were measured. Weighted multivariable logistic regression analyses were conducted to estimate the adjusted Odds Ratios (aOR) and 95% CI of the associations between PTSD, GAD, depressive symptoms and cigarette smoking or marijuana use. Mediation analysis was conducted to examine the role of sleep duration in the relationship between the exposures and outcomes mentioned. Results: Our study population includes 3372 service members that had at least one mental health disorder. The data showed that the prevalence of PTSD, GAD and depressive symptoms were higher among individuals who work in the Army (47.07%, 42.45%, 44.43% respectively) followed by the Navy (26.20%, 26.36%, 24.50%), Marines (15.11%, 18.90%, 20.09%), Air Force (10.08%, 10.44%, 9.52%) and lastly the Coast Guard (1.54%, 1.84%, 1.47%). The regression analyses showed that among those who did not receive mental health therapy, the estimated aOR of PTSD is 2.33 times higher for cigarette smokers compared to non-smokers [95% CI= 1.45, 3.74]. Additionally, the estimated aOR of GAD is 1.76 times higher for marijuana users compared to non-users [95% CI= 1.23, 2.51] and 2.26 times higher for cigarette smokers compared to non-smokers [95% CI= 1.60, 3.20]. Regarding depressive symptoms, the estimated aOR were higher for both marijuana users and cigarette smokers compared to non-users and non-smokers respectively. Specifically, the estimated aOR for marijuana users was 1.67 [95% CI= 1.05, 2.63], and for cigarette smokers it was 2.09 [95% CI= 1.35, 3.22]. When the association was investigated among different military branches, we found a statistically significant association between PTSD and both marijuana use and cigarette smoking among the Marines [aOR= 2.20, 95% CI= (1.18, 4.10), and aOR= 3.36, 95% CI= (1.73, 6.53)] respectively, when compared to individuals who did not use marijuana or smoke cigarettes. Among the Air Force, only marijuana use was statistically significantly associated with PTSD [aOR= 1.81, 95% CI= (1.02, 3.23)] when compared to non-users, and finally, cigarette smoking was statistically significantly associated with PTSD among Coast Guard members [aOR= 1.80, 95% CI= (1.22, 2.66)], when compared to non-smokers. For the mediation analysis, sleep duration was found to be a partial mediator in the relationship between smoking or marijuana use and mental health. Conclusion: Our study found that marijuana and cigarette use were associated with higher odds of GAD and depressive symptoms among military personnel who did not receive mental health therapy. Our findings indicated an interplay between mental health conditions, cigarette smoking, marijuana use, and sleep, and that sleep duration partially mediated the relationship, which suggest that improving sleep behavior could potentially improve mental health among individuals who smoke or use marijuana.20 0