Saudi Cultural Missions Theses & Dissertations
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Item Restricted Mental Health of Paramedicine Students in the United Kingdom and the Kingdom of Saudi Arabia(Saudi Digital Library, 2025) Alzahrani, Adnan Atiah; Johnson, Judith; Keyworth, ChrisResearch has shown higher mental health concerns among healthcare students, with paramedicine students experiencing particularly high levels of psychological distress due to exposure to traumatic incidents, high-pressure training environments, and demanding clinical placements. Unlike other healthcare professions, paramedicine students often encounter potentially traumatic events early in their training, yet they frequently suffer in silence without seeking appropriate support. There is limited research on paramedicine student’ mental health, especially from cross-cultural perspectives, and insufficient understanding of how to improve their wellbeing. This thesis aimed to deepen the understanding of mental health challenges faced by paramedicine students. This thesis presents five studies examining paramedicine students from the Kingdom of Saudi Arabia (KSA) and the United Kingdom (UK). The first study was a systematic review and meta-analysis investigating the global prevalence of anxiety, depression, and post-traumatic stress disorder (PTSD) among paramedicine students. Building on these findings, the next two studies used semi-structured interviews to explore the causes of stress and poor wellbeing among paramedicine students (Study 2) and to investigate their preferences, barriers, and facilitators for accessing mental health support (Study 3). To quantify mental health outcomes and their predictors in cross-cultural settings, the fourth study used a cross-sectional survey design investigating burnout and depression rates, along with their associations with clinical experiences and psychosocial factors. The fifth study employed longitudinal survey methods to monitor changes in mental health outcomes over six months, examining how clinical exposure and perceptions of demand, control, and support influence wellbeing trajectories. Key findings This thesis revealed alarmingly high rates of mental health disorders among paramedicine students globally. The systematic review and meta-analysis (Study 1) found pooled prevalence rates of 56.4% for moderate anxiety, 34.7% for depression, and 17,9% for PTSD - all significantly higher than those reported among qualified paramedics and the general population. Regarding factors contributing to poor mental health, the cross-cultural qualitative analysis (Study 2) identified four key themes: exposure to potentially traumatic events during clinical placements; relationship and communication challenges with faculty, peers, and training supervisors; problematic programme atmosphere, including inadequate preparation and support; and career-related concerns about job prospects and professional acceptance. These themes were consistent across both cultural contexts, although with some variation in emphasis. The investigation of support preferences and access barriers (Study 3) revealed that students preferred tailored, culturally sensitive interventions rather than generic student support services. Three main preferences emerged: specialised support addressing paramedicine-specific challenges; privacy protection to safeguard academic and career prospects; and opportunities for peer socialisation and communication. Major barriers included mental health stigma from multiple sources, university environment factors, personal beliefs about help-seeking, operational challenges in accessing services, and concerns regarding professional competency assessments. The cross-sectional survey (Study 4) found significant differences between countries, with students from KSA reporting higher levels of depression but lower burnout scores compared to UK students. Clinical experiences, perceived psychological demands, and lower social support emerged as key predictors of poor mental health outcomes across both cultures. The longitudinal study (Study 5) indicated that mental health outcomes remained relatively stable over six months, with baseline scores being the strongest predictors of follow-up wellbeing. Nevertheless, perceived control and social support showed protective effects against mental health deterioration, while high psychological demands predicted poorer outcomes over time. Implications and conclusions This thesis demonstrates that paramedicine students face significant mental health challenges that exceed those of other healthcare student populations and qualified practitioners. The findings highlight the urgent need for specialised, culturally sensitive mental health interventions integrated into paramedicine curricula. Without targeted support addressing the unique stressors of paramedicine training - including early trauma exposure, demanding clinical environments, and professional identity development - these mental health issues may persist into professional practice, potentially impacting both practitioner wellbeing and patient care quality. The thesis offers the first comprehensive cross-cultural evidence base for developing evidence-informed interventions to support the mental health and wellbeing of this vital healthcare workforce during their formative training years22 0Item Restricted An exploration of burnout in nurses working in intensive care in Saudi Arabia: An explanatory sequential mixed methods study(Saudi Digital Library, 2025-06-30) Altokhais, Abdulmajeed Saad; Principal supervisor, Professor Melanie Greenwood, and co-supervisor Dr Russell James.Nurses working in highly demanding and challenging environments, such as intensive care units, are prone to experiencing burnout compared to those in less demanding environments. In Saudi Arabia, the large number of nurses from other countries who work in intensive care contributes to the complexity of caring for critically ill people. Cultural complexity, high workloads and low morale may contribute to burnout in nurses, however how these factors affect nurse working in intensive care in Saudi Arabia is not well understood. Understanding these challenges, therefore, can help to mitigate burnout among nurses working in intensive care, improve patient outcomes, and assist recruitment and retention. This study aimed to investigate burnout among nurses working in the intensive care setting and to establish the factors which lead to burnout and which promote well-being and resilience among those nurses in Saudi Arabia. An explanatory sequential mixed methods design was used, and the data collection occurred across two phases. The first phase of the study sought to understand factors that contribute to nurses experiencing burnout. Paper-based questionnaires were distributed to nurses working in intensive care units across four tertiary hospitals in Riyadh, the capital of Saudia Arabia. The questionnaire contained two sections included the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS (MP)) scale used to explore the prevalence of burnout and the factors which contributed to the perception of burnout with the addition of participants’ demographic data and responses to the work characteristics questions. Data from the questionnaires were analysed using SPSS statistical software version 29. In Phase One, a total of 804 (80.4% response rate) nurses completed the questionnaire, with results indicating that more than half of the nurses experienced high levels of emotional exhaustion and depersonalisation, while more than half of those surveyed experienced moderate to low levels of personal accomplishment within the workplace. The analysis of demographic and work characteristic data, along with the MBI-HSS (MP) subscales, indicated that several factors may lead to burnout in nurses working within the intensive care setting. The demographic factors that contributed were gender, age, marital status, living arrangements, number of children, and nationality, while the work characteristics that contributed were work experience, type of intensive care, daily working hours, number of night shifts per month and number of patients per shift, attempts to maintain personal well-being, feeling stressed going to work, access to emotional support, feeling valued at work, salary satisfaction, and intention to leave. The findings from Phase One informed Phase Two, which used semi-structured interviews to delve deeper into and comprehend factors which led to nurses’ feelings of burnout and to identify their personal resilience against burnout. The interviews with consenting participants were undertaken online via Zoom or Microsoft Teams and analysed using a thematic analysis framework. In Phase Two, 20 semi-structured interviews were conducted with nurses who had completed the questionnaire and work in the intensive care setting. Three themes were identified from the thematic analysis: (i) “Being an intensive care nurse is challenging”; (ii) “The impact of the work upon me”; and (iii) “How I cope”. The first theme presented the nature of the work in intensive care settings in Saudi Arabia, highlighting the organisational challenges that participants encountered. The second theme reveals the physical, mental, psychosocial and professional impacts of working in intensive care in Saudi Arabia. The last theme captured the techniques participants used to cope with the challenges in the work environment. A pragmatic approach was used during data integration which influenced how this research was undertaken, presentation of the results and the structure of this thesis. Further, pragmatism helped explain the multiple realities that nurses encountered in their working environment in the intensive care setting in the cultural context of Saudi Arabia. The significant findings in this study are related to the unique cultural environment that exists in the nursing profession in Saudi Arabia and the interplay between the factors that contribute to and are protective against burnout. The contributing factors were the cultural and language challenges, which relied on nurses’ professional experience and adjustments to an altered scope of practice, and the protective factors, which included nurses’ capacity to build resilience, and how support systems created a complex dynamic that affected the participants’ performance and well-being. Whether nurses adapt or the environment adapts will be crucial in determining whether these nurses experience burnout or even leave the profession. Several recommendations stemming from this study are proposed to healthcare organisations, including policymakers, hospital leaders and nurse managers to improve work conditions in intensive care settings, which could potentially increase the adaptation to the work environment and, therefore, reduce burnout levels among nurses. In addition, it is crucial that stakeholders and hospital management understand the challenges that intensive care nurses encounter every day which impact their well-being as well as the quality of care. Policies and systems in hospitals, therefore, should be changed to help improve work conditions, which could potentially increase nurse retention and improve the quality of patient care.10 0Item Restricted Stress and Burnout in Critical Care Nurses in Saudi Arabia: A Systematic Literature Review(Queen's University Belfast, 2025-03) Aljohani, Abdulelah; Rice, BilliejoanBackground: Burnout is a significant occupational health problem in critical care nurses, particularly working in intensive care units and emergency departments. The intensive work of critical care, involving long shifts, high patient acuity, and emotional stress, is a contributing factor to burnout, impacting job satisfaction, patient care quality, and nursing staff turnover. In Saudi Arabia, regional health disparities, nursing shortages, and reliance on expatriate nurses add to the issue, requiring closer examination. Aim: The aim of this systematic review seeks to synthesise current evidence on risk factors and the prevalence for stress and burnout among critical care nurses in the Kingdom of Saudi Arabia. Methods: Systematic literature search was conducted by utilising PUBMED, CINAHL, and EMBASE databases. Inclusion was rigorous, and studies regarding the prevalence, risk factors, and Saudi Arabian critical care nurses’ exposure to burnout: a total of ten articles were included in the review. Meta-analyses were not feasible; thus, the results were synthesised narratively and categorised into two major categories: Levels of burnout and factors contributing to burnout. Results: There are high to moderate levels of burnout present in Critical care nurses, and there is regional variation between Riyadh, Makkah, and Jazan. Intensive care units’ nurses exhibited more emotional exhaustion, and emergency department nurses exhibited physical exhaustion as a result of workload intensity. There was added stress due to expatriate nurses, including uncertainty in jobs, cultural challenges, and language. Organisational factors, including shortages in staff, shift working, and rigid hospital hierarchies, also contributed to burnout. Conclusion: Burnout among Saudi Arabian critical care nurses’ is a serious workforce issue with direct effects on patient safety, healthcare efficiency, and retention. Addressing burnout requires policy changes, mental health support, and workforce reforms to improve nurse well-being and patient care. Future research should focus on longitudinal studies and intervention-based strategies for sustainable solutions.10 0Item Restricted FACTORS PREDICTING TEACHER BURNOUT: THE MODERATION ROLE OF PERCEIVED SOCIAL SUPPORT(Journal of Special Needs Education (NASE Malaysia), 0019-12-20) ALSAGOOR KHALID; Prof. Dr.Loh Sau CheongThe terminal objectives of this study are to examine: the direct effects of stressors on teacher burnout and the moderation effects of social support on the relation between stressors and teacher burnout. A total sample of 202 special education teachers in the Kingdom of Saudi Arabia completed a 68-item digital countrywide survey questionnaire delivered through email to all special education teachers. For current study, hypotheses were tested based on structural equation modelling (SEM). Results revealed that: (1) role overload had shown significant direct effects on the three dimensions of teacher burnout; (2) role ambiguity had shown significant direct effects on the three dimensions of teacher burnout; (3) role conflict had shown significant direct effects on depersonalization and decreased personal accomplishment; (4) no moderation effect for social support on the relationship between stressors and the three dimensions of teacher burnout.Item Restricted FACTORS PREDICTING BURNOUT OF SPECIAL EDUCATION TEACHERS IN THE KINGDOM OF SAUDI ARABIA(Universiti Malaya, 2024) ALSAGOOR, KHALID; Cheong, Loh SauTeacher burnout affects student achievement and imposes financial burdens on districts and states. This study explores factors predicting burnout, focusing on direct effects of role ambiguity, conflict, and work overload, as well as indirect effects via affective organizational commitment and teaching satisfaction. Additionally, it examines moderating effects of perceived social and supervisor support. A sample of 414 special education teachers in Saudi Arabia completed the Maslach Burnout Inventory and scales for various stressors and supports. Structural Equation Modeling (SEM) using AMOS revealed that: (1) role overload had a significant direct effect on emotional exhaustion (β = 0.389, t = 5.184, P < 0.01), reduced personal accomplishment (β = 0.211, t = 3.797, P < 0.01), depersonalization (β = -0.161, t = -3.392, P < 0.01), and total burnout (β = 0.173, t = 5.828, P < 0.01); (2) role conflict was directly related to decreased accomplishment (β = 0.350, t = 4.194, P < 0.01) and total burnout (β = 0.135, t = 3.465, P < 0.01); (3) role ambiguity affected emotional exhaustion (β = 0.230, t = 4.506, P < 0.01), reduced accomplishment (β = 0.305, t = 3.862, P < 0.01), depersonalization (β = 0.137, t = 2.738, P < 0.01), and total burnout (β = 0.271, t = 7.045, P < 0.01); (4) teacher satisfaction mediated the impact of role overload on emotional exhaustion (β = 0.103, t = 2.573, p < 0.05); (5) affective organizational commitment facilitated the effects of role overload on emotional exhaustion (β = 0.143, t = 2.367, p < 0.05), role conflict on burnout (β = 0.204, t = 6.811, p < 0.05), and role ambiguity on total burnout (β = 0.316, t = 2.715, p < 0.05); (6) perceived social support moderated the effects of stressors on burnout components, such as reducing role overload’s impact on emotional exhaustion (β = -0.226, t = -7.500, p < 0.01); and (7) supervisor support moderated effects of role overload on burnout components, like reducing its impact on emotional exhaustion (β = -0.256, t = -8.868, p < 0.01). These findings suggest that enhancing teaching satisfaction and commitment could mitigate burnout, adding theoretical insights into stressors–burnout relationships among special education teachers in Saudi Arabia.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.50 0Item Restricted Work Productivity among Australian Palliative Care Nurses during the COVID-19 Pandemic: The Role of Compassion Fatigue and Compassion Satisfaction(La Trobe University, 2024-07) Baqeas, Manal; Copnell, BevSimilar to their counterparts worldwide, Australian palliative care nurses played a significant role in responding to the COVID-19 pandemic and reported feeling overwhelmed. This research focused on the work productivity of palliative care nurses in Australia during the pandemic and associations between work productivity and professional quality of life, including compassion fatigue (CF), comprising burnout (BO) and secondary traumatic stress (STS), and compassion satisfaction (CS). A scoping review was first conducted on CF and CS among palliative care providers (nurses and other professionals). A correlational, cross-sectional research design was employed. Measures were collected in 2021 using an online survey with a sample of 208 nurses working in a range of palliative care settings. Participants demonstrated moderate levels of BO, STS, and CS. Work productivity was negatively associated with burnout but positively associated with CS and with STS in a nonlinear manner. Following identification of potential confounding variables and moderators of the relationships between work productivity and measures of professional quality of life, a regression model was developed to maximise the prediction of work productivity. As well as burnout, STS and CF, this model included nurses’ gender, work setting, and religiosity, and whether they had been diagnosed with COVID-19. During the pandemic, participants reported various challenges and difficulties. Fear of being infected contributed to the pressures they felt. However, they also acquired new skills, were given new responsibilities, implemented new work practices, and paid better attention to infection prevention. The work productivity of palliative care nurses can be enhanced by improving their professional quality of life. Evidence-based policy and practices are needed to address heavy workloads, staffing shortages, inadequate staff training, and risk of infection, along with improving leadership and providing better access to professional psychological support. Such changes would help optimise the quality of care provided for patients at end of life.16 0Item Restricted Burnout in mental health nurses in Saudi Arabia: A mixed method study.(Newcastle University, 2024-02-27) Faisal Al-Dhafeeri; McColl, Elaine; Chaddock, Anna; Ahmad, Balsam; Teare, DawnIntroduction: Workplace burnout is a social phenomenon that affects healthcare professionals and patient care. It is a response to workplace stressors and is characterised by high emotional exhaustion (EE), high depersonalisation (DP), and low personal accomplishment (PA). Aim: The aim of this research was to explore workplace burnout and associated factors among mental health nurses in Saudi Arabia and to identify potential solutions to minimise burnout and its impact. Method: A mixed methods design was employed, comprising an umbrella review of predictors of burnout in mental health nurses (MHNs), a survey of MHNs from three Saudi Arabian hospitals, using validated measures of burnout, workplace stressors and social support, and in-depth interviews and a focus group with a subset of respondents to this survey. Findings: The umbrella review identified a range of predictors of burnout which could be grouped as intrapersonal (e,g, age, gender), interpersonal (e,g. social support, aggression at work) and extrapersonal (e.g. lack of training, high workload). Cluster analysis showed that more than half of the sample (56%) were Engaged (high EE, high DP, high PA), with approximately 20% in each of Ineffective (PA only reduced) and Burnt-out (EE and DP reduced) profiles. Social support came most often from friends/family, least often from colleagues. Hospital base, number of years’ experience, time to travel to work, Workload, Client Related Difficulties and Organisational Structure and Process and Colleague Support were statistically significantly associated with profile type. Three themes were identified from qualitative data analysis: the experience of burnout among mental health nurses in Saudi Arabia; how nurses deal with the challenges of burnout; changes on the horizon in Saudi Arabia from the perspective of mental health nurses. Conclusions and recommendations: One in five nurses in my sample could be characterised as Burnt-out. Recommendations to reduce workplace stress and ameliorate burnout included: improved staff: patient ratios, more opportunities for training and development, and ensuring nurses feel valued.53 0Item Restricted The Prevalence Of Burnout In Saudi Arabia Dental Hygienists(Old Dominion University, 2024-01-18) Aldayel, Nouf; Ludwig, Emily; Suedbeck, Jessica; Hunt, AmberPurpose: The purpose of this pilot study was to assess the prevalence of burnout in Saudi Arabian dental hygienists and identify risk factors associated with burnout. Methods: A descriptive survey design using the Copenhagen Burnout Inventory (CBI) assessed burnout among a convenience sample of n=123 Saudi dental hygienists. The survey was disseminated electronically to 1,000 Saudi Arabian dental hygienists. The CBI measures three subscales: personal, work-related, and client/patient-related burnout on a five-point Likert-type scale. The survey also included six demographic questions, two Likert-type, one “yes/no,” and one open- ended question, related to burnout. Descriptive statistics, one-way between subject’s ANOVA, independent samples t-test, and chi-square test were used to analyze the data. Results: One hundred and twenty-three Saudi Arabian dental hygienists completed the survey with a 12% response rate. Participants indicated overall moderate burnout (M=53.54), with personal (M=60.84) and work-related (M=54.70) burnout also in the moderate range. Participants working in government facilities had significantly higher personal (p < .001), work-related (p < .001), and client/patient-related (p = .026) burnout than those in the “Other” practice category. Female Saudi hygienists had significantly higher overall (p = .007), personal (p < .001), and work-related (p = .008) burnout scores compared to male Saudi dental hygienists. Conclusions: Results from this study suggest Saudi Arabian dental hygienists display moderate levels of workplace burnout, with the highest prevalence rate in personal burnout. Findings underscore the need for further research with an expanded sample size to identify stressors that lead to burnout and identify mitigation strategies to promote a healthier working climate for practicing Saudi dental hygienists.44 0Item Restricted The Impact of Burnout Prevention Programs on Reducing Burnout Among Paediatric Nurses: qualitative Systematic Review(Saudi Digital Library, 2023-11-09) Aloufi, Khlood; Ritchie, DawnBackground: Paediatric nursing plays a pivotal role in delivering healthcare services to children, and the well-being of paediatric nurses directly influence the standard of care given. This systematic review aimed to comprehensively investigate the When compared to paediatric nurses who don't receive any treatment, the installation of burnout prevention programs might reduce burnout among them. Inclusion Criteria: To conduct this review, an exhaustive reliable database, such as PubMed, Google Scholar, and Cochrane, were searched. Ten relevant studies, published between 2013 and 2023, were meticulously selected based on stringent inclusion criteria. These criteria were shaped by the integration of the PRISMA flowchart and the PICOT framework. The inclusion criteria emphasized studies that specifically targeted intervention programs designed to reduce burnout among pediatric nurses. To ensure the methodological rigor of the selected studies, the Cochrane Risk of Bias Tool (RoB 2) was applied as a guiding framework. Search Strategy: The literature search strategy was executed with utmost precision, employing carefully chosen keywords related to burnout, pediatric nursing, and intervention programs. Furthermore, the search prioritized studies conducted and published in the English language, thereby ensuring a comprehensive yet linguistically focused approach. Methodological Quality: Each of the ten selected studies underwent a rigorous evaluation for methodological quality. This process involved the extraction of a diverse set of study attributes, including participant demographics, details of the interventions employed, outcome measures, and significant findings. The methodological quality assessment was conducted with meticulous attention to detail, further confirming the accuracy and validity of the results. Results: Results of this comprehensive review provided compelling evidence supporting the implementation of burnout prevention programs among pediatric nurses. The selected studies consistently demonstrated that these programs had a substantial positive impact. They were associated with a notable reduction in burnout rates among pediatric nurses, resulting in tangible improvements in patient care outcomes (HK and Leiter, 2006). Additionally, the programs contributed to elevated job satisfaction and an overall enhancement of the well-being of healthcare professionals in the pediatric nursing field. Conclusion: The findings underscore the significance of prioritizing the well-being of healthcare professionals, as it directly translates into improved patient outcomes and increased overall efficiency within the healthcare system.10 0