Saudi Cultural Missions Theses & Dissertations
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Item Restricted High-Fidelity Simulation (HFS) Intervention to Increase Advanced Cardiac Life Support (ACLS) Knowledge, Skills Performance and Self- Efficacy (SE) Acquisition and Retention for Saudi Nursing Students: A Feasibility Explanatory Sequential Mixed Method Study(The University of Edinburgh, 2024-08-09) Alshehri, Abdullah Ali; Holloway, AishaBackground As medical technologies advance and patient needs become more complex, care delivery models are undergoing transformation. An essential element for improving the learning experience is the shift from informative to transformative learning. While some countries have incorporated high-fidelity simulation (HFS) into nursing education as a contemporary teaching method, the majority of Saudi nursing schools still adhere to traditional teaching approaches. Aim Using the Medical Research Council (MRC) framework, this study sought to identify and develop a HFS advanced cardiac life support (ACLS)-focused intervention that was piloted among final-year undergraduate Saudi nursing students to investigate the acquisition and retention of ACLS knowledge and skills performance, as well as self-efficacy (SE) gains through HFS compared to traditional teaching methods. Methods This project utilised a sequential explanatory mixed-method design. A two-phased pilot randomised controlled trial (RCT) with embedded qualitative evaluation was conducted. Phase I involved the intervention development and pilot RCT (n= 28), with participants randomly assigned to intervention or control groups. Phase II comprised an embedded qualitative component of semi-structured interviews with a sub-sample of those from the trial (n= 10). The intervention group participants had access to HFS training, whereas the control group learned through traditional teaching methods, such as PowerPoint presentations and demonstrations on a static manikin. The educational content focused on ACLS algorithms. The knowledge variable was measured at three different time points: before the simulation, immediately after, and three months later. Skills performance was assessed twice; the first simulation was conducted at the beginning of the experiment and the second simulation session was three months later. The SE variable scores were obtained at the start of the study and at the end of the quantitative phase after the second simulation session. In the qualitative phase, semi-structured interviews were conducted to ascertain the perceptions of the intervention and control group participants towards the received styles of learning methods at the end of the study. The research was influenced by the effects of the coronavirus disease 2019 (COVID-19). This, in turn, affected the study's sample size due to government restrictions, guidelines, and the personal decisions of the participants. Results The study’s quantitative pilot RCT results showed that the ACLS knowledge exam total scores showed promising increases from baseline to acquisition (p < 0.001) and from baseline to retention (p < 0.004); however, this increase was not evident three months from acquisition for the intervention group (p = 1.000). With regard to skills performance, the intervention group’s ACLS skills acquisition mean score was trending higher (p < 0.001) than that of the control group. After three months, the mean ACLS skills retention score for the intervention group remained higher (p = 0.000) than for the control group. SE scores for the intervention group were moderately higher than for the control group (p < 0.001), showing initial evidence of a positive effect. The SE displayed a strong positive correlation with skills acquisition and a moderate positive correlation with knowledge. In the qualitative phase, students conveyed that HFS offered a more authentic and enjoyable experience, facilitating the application of theoretical knowledge to advanced cases compared to the traditional method, which is more suited to basic skills. The students perceived HFS as a valuable teaching approach that effectively addresses the sensitivity of a mixed-gender working environment and the associated cultural norms in the Kingdom of Saudi Arabia (KSA) context. They confirmed that HFS enhanced their non-technical skills, as well as their SE in handling complex cases upon graduation. The strength of the students’ interest in integrating the HFS into the curriculum further supports the acceptability of the study. Feasibility was confirmed, as the invited students demonstrated a willingness to participate within the nursing school, there was effective communication with the heads of departments in both the nursing school and Simulation and Medical Training Centre, and the setting was prepared to accommodate a substantial number of students for a forthcoming definitive RCT. The availability of diverse materials in the simulation centre and positive perceptions of nursing students regarding the HFS intervention further support the feasibility of the study. Conclusions The HFS intervention was well accepted and feasible with promising results regarding the final year undergraduate Saudi nursing students’ ACLS skills performance and SE. The recruitment methods and data collection procedures used in this study demonstrated feasibility for implementation in a larger, confirmatory RCT in a future definitive RCT. A sample size calculation was conducted to inform a future follow-up definitive RCT, evaluating the HFS intervention over the longer term. A major strength of the study was its adherence to the MRC framework, as well as using the Template for Intervention Description and Replication (TIDieR) checklist to guide detailed reporting of the intervention. A key limitation was the small sample size, constrained by COVID-19 impacts on subject availability and the power to make reliable inferences. More research is required to definitively determine the lasting impacts of high-fidelity ACLS simulation training on nursing education outcomes. Large-scale RCTs with larger samples, longitudinal examinations of skill translation into clinical environments, and multi-site tracking of trained nursing cohorts are recommended to further strengthen the evidence supporting wider curricular integration of simulations.19 0Item Restricted Pressure Injury Prevention in Critical Care Settings in Saudi Arabian Hospitals(University of Wollongong, Australia, 2024-01) Alshahrani, Bassam Dhafer S; Sim, Jenny; Middleton, Rebekkah; Rolls, KayeBackground Critically ill patients are more susceptible to pressure injuries. Despite established prevention methods, pressure injuries remain common in Saudi Arabia, particularly in critical care units. A systematic review was conducted to synthesise evidence on the most effective nursing interventions for preventing pressure injuries in critical care settings. The four key intervention categories identified showed considerable effectiveness in pressure injury prevention during gap analysis. These categories are 1) pressure injury prevention bundles, 2) repositioning and the use of surface support, 3) prevention of medical device–related pressure injuries and 4) access to expertise. This review highlights the importance of nurse competency and advanced education, emphasising the need for consistent implementation of fundamental strategies to enhance mobility and redistribute pressure. Aim This doctoral study investigated pressure injury prevalence rates, care processes and nurses’ knowledge and attitudes towards prevention practices in Saudi Arabian critical care units. The overall aim was to reduce pressure injuries and assess the impact of an educational intervention on prevention practices. Methods The study was conducted in critical care units in three hospitals in different geographical regions in Saudi Arabia. A pre- and post-intervention approach with a qualitative evaluation was conducted. The study was guided by the Knowledge-to- Action framework and included four phases. In Phase 1, pressure injury prevalence rates and prevention care processes were observed. The Pressure Ulcer Knowledge Assessment Tool, version 2.0 and the Attitude towards Pressure Ulcer Prevention tool were used to examine critical care nurses’ knowledge about and attitudes towards pressure injury prevention. In Phase 2, a tailored educational intervention was developed to include theory, case studies and hands-on sessions and was implemented at the participating sites. Phase 3 involved evaluating pressure injury prevalence rates and nurses’ knowledge and attitudes towards pressure injury prevention using the methods from Phase 1. Phase 4 used interviews with nurses to evaluate the project’s impact, gathering feedback and assessing perceptions about the intervention and barriers and facilitators faced in preventing pressure injuries. Quantitative data was analysed using the Statistical Package for the Social Sciences, and qualitative data was analysed using Braun and Clarke’s thematic analysis. Findings Pre-intervention data was collected from 87 patients and 190 nurses. The initial pressure injury prevalence was 60.9% (n = 53). In the observed cohort, a total of 96 pressure injuries were identified among 53 patients. Of these individual pressure injuries, 52.9% (n = 46) were classified as hospital-acquired pressure injuries and 37.9% (n = 33) were developed in the intensive care unit and were therefore classified as unit acquired pressure injuries. Additionally, 23.0% (n = 20) were associated with medical devices. Nurses’ average knowledge and attitude scores were 43.22% and 74.77%, respectively. The tailored educational intervention was delivered to 91.8% (n = 294) of nurses in the research sites between December 2021 and March 2022. Post-intervention data was gathered from 94 patients and 195 nurses. The pressure injury prevalence rates decreased significantly to 28.7% of patients (n = 27, p < 0.001). A total of 49 pressure injuries were identified, of which 21.3% (n = 20) were hospital acquired, 14.9% (n = 14) unit-acquired and 8.5% (n = 8) medical device–related. Most pressure injuries were observed in the sacral region, head and heels and were predominantly Stages I and II. Nurses’ knowledge and attitude scores increased to 51.22% and 79.02%, respectively (p < 0.001). This research identified a positive association between greater pressure injury prevention knowledge and positive attitudes towards pressure injury prevention. Nurses’ age, overall nursing experience and ICU experience correlated with better knowledge about pressure injury prevention. Nurses with a bachelor’s degree or higher demonstrated better knowledge about and attitudes towards pressure injury prevention. Patients’ age, length of stay in the ICU, haemoglobin levels, Braden scores and the post intervention period were significantly associated with pressure injury–related outcomes. Patients’ age and ICU stays were predictors of pressure injury onset and progression, while the Braden score predicted only the development of severe injury. Nine participants were involved in the qualitative evaluation of the project. Three themes related to the barriers and facilitators that nurses experience when providing pressure injury prevention were identified. The themes included ‘workforce and resource issues’, ‘training and preparedness’ and ‘handling complex conditions’. The project evaluation was positive, with three key themes pinpointed as drivers of its success: ‘adaptable and personalised’, ‘attention to detail’ and ‘making a difference’. Conclusions This doctoral study has highlighted the pivotal role of nurses in preventing pressure injuries in critical care units, particularly in Saudi Arabia. Grounded in the Knowledge-to-Action framework, the project demonstrated the significant impact of tailored educational interventions in reducing pressure injury rates. It not only enhanced knowledge and attitudes through evidence-based learning but also addressed barriers and facilitators in prevention. The findings strongly support individualised, patient specific care and a nurse-centric approach to pressure injury prevention, emphasising both fundamental and advanced prevention practices.50 0Item Restricted MAJOR ADVERSE EVENTS IN CRITICALLY ILL PATIENTS WITH ACUTE RESPIRATORY DISTRESS SYNDROME(Saudi Digital Library, 2021) Alenezi, Faraj; Thickett, David; Parekh, Dhruv; Mahida, Rahul; Patel, JaiminAcute kidney injury (AKI) is common among patients with COVID-19 or sepsis. The incidence of AKI may increase when these patients develop acute respiratory distress syndrome (ARDS), which is often associated with poorer patient outcomes and higher mortality rates. Major adverse kidney events (MAKEs) - a composite of the need for renal replacement therapy (RRT), a decline in eGFR of <75% from baseline, or all- cause mortality - are considered a reliable long-term measure of AKI's impact on patient outcomes. This thesis aimed to evaluate the existing evidence regarding the incidence and risk factors of AKI in COVID-19 patients with ARDS. Additionally, it sought to determine the incidence and clinical risk factors of MAKE-365 in patients with AKI, both with and without COVID-19 ARDS. The thesis also examined the associations between novel kidney biomarkers (including plasma Cystatin C, urinary NGAL, urinary [TIMP- 2]*[IGFBP-7], and urinary CCL-14) and MAKE-365 in ICU patients with sepsis and AKI. Lastly, it evaluated the predictive capabilities of these kidney biomarkers in combination with clinical predictive models for MAKE-365. Firstly, a systematic review and meta-analysis were conducted to examine the incidence and risk factors of AKI in COVID-19 patients with ARDS. This review, which included 31 studies, found a higher incidence of AKI in COVID-19 patients with ARDS compared to those without. The study identified several risk factors associated with worse outcomes, including advanced age, male gender, and pre-existing conditions such as hypertension, diabetes, obesity, and CKD. Secondly, a retrospective cohort study was carried out on ARDS patients to assess the occurrence of MAKEs up to 365 days post-ICU admission in both non-COVID-19 and COVID-19 cohorts. The incidence of MAKE-365 was more common in the non- COVID-19 cohort. CKD and high bilirubin levels were identified as predictors for MAKE-365 in both cohorts, with additional risk factors such as older age and diabetes in the COVID-19 cohort and lower albumin levels in the non-COVID-19 cohort. Finally, another retrospective cohort study was conducted to assess MAKE-365 development and evaluate the predictive ability of kidney biomarkers for MAKE-365 in septic patients, regardless of ARDS status. The prevalence of MAKE-365 was higher in septic patients with AKI, irrespective of ARDS status. Among the evaluated biomarkers, urinary [TIMP-2]*[IGFBP-7] showed the most promise for predicting MAKE-365, particularly when combined with the clinical prediction model. Overall, this thesis underscores the importance of identifying patients at risk of MAKE- 365 development in critically ill patients using clinical predictors in conjunction with kidney biomarkers. However, the utility of these biomarker combinations must be confirmed in larger, external prospective cohorts to ensure the findings' generalizability and specificity to the patient population used in this study.15 0Item Restricted Intensive care nurses' knowledge, perceptions, and experiences about noise exposure in the intensive care unit.(Saudi Digital Library, 2023-11-03) Athuwaybi, Sami; McKinney, AidinBackground: Intensive care unit (ICU) noise can have significant impacts on patients and nurses. Ultimately, it directly influences patient outcomes, nurse well-being, and overall quality of care. Understanding how nurses view noise in intensive care is essential in order to explore and build helpful noise control strategies. Comprehending the subjective perceptions of noise among nursing professionals in the ICU is of paramount importance, as it serves as a foundational step in elucidating, formulating, and implementing effective noise mitigation strategies. Aim: This systematic review aims to identify intensive care nurses' knowledge and perceptions about noise exposure in the intensive care unit. Methodology: For this systematic review, a comprehensive search spanning the years 2003 to 2023 was conducted across three prominent databases: CINAHL, MEDLINE, and Embase. The researcher incorporated studies with different research methods including qualitative, quantitative, and mixed methods studies. They employed the Mixed Methods Appraisal Tool (MMAT) to assess the quality of the included studies, while the synthesis and analysis of the findings were conducted using thematic analysis. Results: The review included 7 studies that revealed variations in nurses' knowledge and perceptions of ICU noise. While some were aware of elevated noise levels exceeding recommended limits, others had low levels of knowledge. Noise sources, including human-related activities and medical devices, were recognised, but overall knowledge varied. Furthermore, nurses had varying degrees of understanding of the physiological and psychological effects of noise on patients and staff, with some demonstrating limited understanding of the chronic physiological changes that could arise in patients exposed to excessive noise. Strategies for noise control, such as improving ICU design and addressing human factors, were also proposed, but awareness and implementation varied. 8 Conclusion: Nurses' knowledge and perceptions of ICU noise vary, with some staff members indicating limited understanding of acceptable noise levels, sources and impacts of noise, and strategies to reduce noise levels. This highlights the need for targeted interventions to improve nurses’ knowledge and implement more effective noise control measures. Addressing ICU noise could enhance patient outcomes and create a more conducive working environment for nurses.57 0