Saudi Cultural Missions Theses & Dissertations
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Item Restricted An Exploration of Parents' and Healthcare Professionals' Experiences and Perceptions of Family-Centred Care (FCC) for Children in the PICU in Saudi Arabia: A Sequential Explanatory Mixed-Methods Study(Saudi Digital Library, 2025) Althomali, Saud; Byole, Breidge; Clarke, SonyaThis thesis investigates the experiences and perceptions of parents and healthcare professionals regarding family centred care (FCC) for children admitted to paediatric intensive care units (PICUs) in Saudi Arabia, employing a sequential explanatory mixed-methods approach. Quantitative data from healthcare staff surveys assessed current FCC practices and identified key gaps, while qualitative interviews with parents and focus groups with professionals explored lived experiences and institutional barriers. The findings reveal systemic challenges such as hierarchical communication, restricted parental involvement, and environmental factors, language barriers and heavy workloads that inhibit effective FCC implementation. Although healthcare professionals conceptually support FCC, its practical application is often undermined by institutional policies and perceived parental knowledge limitations. Parents expressed trust in professionals yet reported exclusion from decision-making and care routines, resulting in feelings of helplessness and disenfranchisement. Structural and cultural factors, including restrictive visiting policies and inadequate family facilities, further hinder meaningful family participation. The study’s integrative analysis demonstrates the critical need for culturally adapted, policy supported FCC models in Saudi PICUs, highlighting the importance of infrastructure improvements, educational interventions for both staff and families, and the development of collaborative care frameworks. These recommendations are informed by both local context and international best practices, aiming to foster family engagement, improve communication, and enhance patient outcomes. This work provides new insights into FCC within the Saudi context and offers actionable strategies for reforming paediatric critical care environments to better support families and children. The thesis contributes to the growing body of evidence advocating for holistic, culturally sensitive approaches to FCC in diverse healthcare settings.41 0Item Restricted The Role of Analyst Coverage on Earnings Management, Firm Outcomes, and Environmental, Social, and Governance (ESG) Performance(Saudi Digital Library, 2025) Alanazi, Bandar; Abdul Wahab, Effiezal; Haider, ImranThe purpose of this thesis is to investigate the influence of analyst coverage on member countries of the Gulf Cooperation Council (GCC). The investigation includes earnings management, firm outcomes, and environmental, social, and governance (ESG) performance as dependent variables for the empirical studies. In addition, this thesis examines the moderating influence of political connections on the relationship between analyst coverage and those variables among GCC stock exchanges. This thesis contributes to the literature by providing empirical insights on various aspects of earnings management, firm outcomes and ESG performance in GCC countries. The first chapter presents the background of the economy and accounting information in the GCC region. Due to their focus on a more sustainable and diversified economy by moving away from a dependence on oil and gas, GCC countries are undergoing a pivotal phase of economic and social transformation. The chapter also provides the motivation for the empirical studies and summarises the findings and contributions to the existing literature. The second chapter presents a comprehensive literature review exploring analyst coverage across global markets. It discusses the methodology and findings, explains how analysts influence firm characteristics and decision-making, and identifies the factors that determine the extent of analyst coverage. The third chapter of this thesis, entitled “Analyst Coverage and Earnings Management”, aims to investigate the effect of analyst coverage on earnings management among GCC firms. The study also explores the relationship between analyst coverage and earnings management, taking into consideration the impact of the royal family in the region. This paper’s methodology employs panel data to investigate analyst coverage and its influence on two measures of earnings management decisions – accrual and real earnings management – as well as whether the royal family moderates the relationship between analyst coverage and earnings management. The analysis covers non-financial firms listed on six emerging capital markets in the GCC over a nine-year period from 2013 to 2021. The premise is that higher levels of analyst following can mitigate agency problems between shareholders and management by providing an information intermediary and ensuring interests are aligned. Based on 991 firm-year observations for non-financial firms listed on GCC stock exchanges, this study finds a negative relationship between analyst coverage, accruals and real earnings management. A more negative relationship between analyst coverage and earnings management is found in the extended analysis focusing on royal family affiliation. The results of tests of potential endogeneity bias remain consistent with the main findings. The fourth chapter of this thesis, entitled “Analyst Coverage and Firm Outcomes”, investigates how analyst coverage affects GCC firms. The findings reveal a significant association between analyst coverage and firm outcomes in GCC firms. It also explores how royal family affiliations affect this relationship in the region by using public non-financial firms listed in the GCC from 2013 to 2021, which constitutes a sample of 992 firm-year observations. The study finds that analyst following has a significant impact on firm outcomes. A higher level of analyst coverage of the firm leads to improved firm outcomes, which mitigates the agency problem between shareholders and management. This supports the argument that the role played by analysts is crucial to reducing information asymmetry. In addition, royal families positively (negatively) moderate the association between analyst coverage and firm outcomes. Furthermore, the findings remain robust after endogeneity tests. The fifth chapter of this thesis, entitled “Analyst Coverage and ESG Performance”, examines the relationship between analyst coverage and environmental, social, and governance (ESG) performance in GCC firms. Using a sample of public non-financial firms listed on GCC stock exchanges from 2012 to 2023, this study finds a significantly positive association between analyst coverage and ESG performance. Further, the findings indicate that analyst affiliation affects the relationship: international analysts exhibit a more pronounced positive relationship than other analysts. The results are qualitatively similar after controlling for endogeneity. Finally, the last chapter provides the conclusion to the thesis and outlines directions for future research.11 0Item Restricted The Psychosocial Impact on Families of Paediatric LT-MCS Patients During In- Hospital Bridge to Transplant: A Modified Systematic Review(University of Nottingham, 2024-09) Alawami, Sakinah; Hemingway, PippaIntroduction: End-stage heart failure children waiting for heart transplants have better survival rates with long-term mechanical circulatory support (LT-MCS). However, the shortage of donor hearts prolongs the transplant bridging period, extending hospitalisation, disrupting family life, and adding uncertainty. While a previous mixed-method systematic review has explored the home experience of these families, understanding their in-hospital experiences remains limited. Therefore, this review aims to examine the psychosocial impact on these families during their LT-MCS children’s in-hospital bridged to transplant, illuminating their challenges and resilience. Methods: This review employed the SPIDER framework searching for PubMed, CINAHL, ASSIA, Embase, and ProQuest (dissertations and theses) for English-published and non-published qualitative studies according to the pre-defined inclusion criteria. Findings: Six qualitative studies matched the pre-defined inclusion criteria. The review synthesised four themes using Braun and Clarke reflexive thematic analysis: (1) Commencing the families' journey with LT-MCS discussing the diagnosis and LT-MCS implantation’s impact. (2) Navigating the LT-MCS paediatric patients’ families through Bridging: addressing LT-MCS children-mother role changes, caregiver's daily life, complications, and grief. (3) Crossroads of blessings and challenges: LT-MCS children's families await a new heart, highlighting donor heart uncertainty. (4) The power stations of LT-MCS children’s families focus on supporting systems. After synthesising themes, findings were examined through Dr. Mishel’s Uncertainty in Illness Theory, Theor yielding recommendations aligned with Advanced Nursing Practice's pillars. Conclusion: This systematic review highlights the profound psychosocial impact and uncertain experience on LT-MCS children’s families during diagnosis, hospitalisation, complications, grieving, and the waiting period for a new heart. It calls for urgent tailored educational and supportive interventions by clinicians for sudden and previously diagnosed heart failure children's families, robust policy initiatives, and innovative research. Additionally, it points out the role and potential needs of healthcare providers in helping families mitigate the stresses associated with the in-hospital bridging period.23 0