Saudi Cultural Missions Theses & Dissertations
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Item Restricted Enhancing Patient Care in Nursing: Evidence-Based Approaches to Managing Chronic Obstructive Pulmonary Disease(Saudi Digital Library, 2026) sayed, majidah; dornan, markBackground: Chronic obstructive pulmonary disease (COPD) remains a leading cause of preventable morbidity and mortality globally. In the United Kingdom alone, COPD accounts for approximately one million hospital bed days and over £3 billion in annual healthcare costs. Despite established guidelines from GOLD, NICE, and the British Thoracic Society, a persistent gap remains between evidence-based recommendations and frontline medical-surgical nursing practice. Medical-surgical nurses are well positioned to deliver structured COPD interventions, yet their contributions remain underutilised due to inadequate respiratory training, role ambiguity, and fragmented care systems. Aim: This study aimed to evaluate evidence-based nurse-led interventions for COPD management within medical-surgical settings and assess their impact on patient outcomes. Method: A systematic review was conducted in accordance with PRISMA guidelines. Five electronic databases (MEDLINE, CINAHL, PsycINFO, Embase, and Cochrane Library) were searched, yielding seven primary studies for inclusion after rigorous screening. Studies were critically appraised and synthesised using an analytical framework integrating the Chronic Care Model, GOLD guidelines, and the Social-Ecological Model. Findings: Structured nurse-led interventions – including self-management education, pulmonary rehabilitation, advance care planning, and psychosocial support – demonstrated meaningful improvements in quality of life, reduced hospital admissions, enhanced exercise capacity, and, in some cases, reduced mortality. Multicomponent programmes sustained beyond twelve months yielded the most pronounced and durable benefits, while six-year follow-up data provided compelling evidence of long-term reductions in mortality and cardiovascular complications. However, socio-demographic factors such as income, health literacy, geographic location, and the quality of nurse–patient relationships significantly moderated intervention effectiveness, with social determinants capable of undermining even well-designed programmes. Conclusion: Nurse-led, evidence-based COPD interventions can substantially improve patient outcomes when adequately resourced and sustained. Realising this potential requires investment in respiratory-specific nursing education, standardised discharge pathways, routine psychosocial screening, digital health infrastructure, and policy frameworks that formally recognise and support the contribution of nursing in chronic disease management. Keywords: COPD, nurse-led interventions, evidence-based practice, medical-surgical nursing, self-management, systematic review33 0Item Restricted Acceptance and Feasibility of Delivering an Evidence Based Digital Intervention for Palliative Care Education: A Mixed Method Study(Saudi Digital Library, 2026) Alosimi, Areej; Alosimi, AreejBackground: There is a growing need for palliative care as a result of a rise in the number of people diagnosed with non-communicable diseases. Palliative care is based on multidisciplinary teamwork, and the provision of care is significantly aided by the work of nurses. Therefore, education is an essential element in elevating the standard of palliative care in general. The subject of palliative care has not yet been introduced into nursing curricula in Saudi Arabia. Undergraduate students' understanding of palliative care may be improved via the use of digital learning, which is not only an effective method of education but also a persuasive one. Objectives: The primary aim of this study was to evaluate the feasibility of delivering palliative care education to nursing students via digital learning in Saudi Arabia. Primary Objectives: 1: To present initial findings on the feasibility and acceptance of implementing a digital palliative care educational intervention for undergraduate nursing students in Saudi Arabia, specifically to assess engagement, attrition, recruitment, and adherence to the intervention. 2: To evaluate participants’ perceptions and satisfaction with the intervention. Secondary Objectives: to determine whether specific outcomes change following the intervention, particularly to assess the impact on participants' confidence and knowledge levels before and after the intervention. Methods: This study employed a convergent parallel mixed-methods research (MMR) design using a single-group feasibility approach. Participants were undergraduate nursing students from Shaqra University, Saudi Arabia. The palliative care digital intervention contains 4 modules, and the program duration was 4 weeks. The study's primary outcomes focused on feasibility indicators, including recruitment rate, attrition rate, intervention adherence, outcome measure feasibility, and overall program experience. The secondary outcomes explored changes in palliative care-related knowledge and confidence levels by using the palliative care nursing quiz and the palliative care self-efficacy scale. Quantitative data on primary and secondary outcomes were collected before and after the intervention. Qualitative data were gathered through semi-structured interviews to explore participants' experiences and perceptions of the intervention. Key findings: A total of 52 nursing students were recruited. The conclusions from quantitative data demonstrated the feasibility of the major outcomes. Participants showed improvements in secondary outcome measures following the intervention: Knowledge (M=8, SD 4.30) and Confidence (M=24, SD 7.26). Thematic analysis of interviews from 13 participants identified four key themes (Students’ perceptions of intervention usability, Usefulness of the intervention, Levels of engagement and Suggestions for future improvement). The data were assessed and compared to predefined feasibility and success criteria following quantitative and qualitative data analysis. The study procedures, data collection methods, and feasibility indicators—including recruitment rate, attrition rate, intervention adherence, and outcome measure feasibility—were feasible and effective. Implications This is the first research in Saudi Arabia looking into the feasibility and acceptability of a digital palliative care curriculum for undergraduate nursing students. This thesis tackles the need for increased palliative care education in Saudi Arabia by creating a theory-based online education module tailored to the needs of the target participants. This educational intervention is an important step toward addressing a shortage of resources in Saudi palliative care education, as instructional opportunities on this issue are currently unavailable in educational institutions. The findings, based on quantitative and qualitative data, provide convincing evidence for the feasibility and applicability of digital palliative care teaching for enhancing undergraduate students' knowledge and confidence. This feasibility study revealed the potential of digital education in this sector and laid the groundwork for a large randomised controlled trial (RCT) through the use of an innovative approach. The findings suggest that the digital palliative care education intervention is feasible, practical, and well-received among undergraduate nursing students. This study highlights promising opportunities for future research, particularly a definitive trial to assess the program’s long-term effectiveness and impact within the Saudi Arabian context.29 0Item Restricted A Cross-Sectional Study of Fatigue and Burnout Predictors among Shift-Working Nurses in Saudi Arabia(Saudi Digital Library, 2025) Alanazi, Salman Alhumaidi; Trainor, Lisa HannaA literature review on shift work's impact on nurses' health linked night shifts, rotating schedules with a high frequency of nights and long hours or overtime with fatigue, burnout, and poor mental health. The review identified significant inconsistencies in the literature regarding which specific shift patterns (e.g., 12-hour vs. 8-hour, rotating vs. fixed nights) had the most critical risk for burnout. It also highlighted a research gap concerning the role of occupational fatigue as a direct mechanism linking shift type to burnout and a scarcity of quantitative data from Saudi Arabia and the larger Middle East and North Africa (MENA) region. This gap provided the rationale for the accompanying journal paper, which aimed to investigate these relationships within a Saudi Arabian context. A cross-sectional quantitative design was employed. Data was collected using an online self-administered questionnaire that was designed to collect social demographic data, fatigue using the Three-Dimensional Work Fatigue Inventory (3D-WFI), and burnout using the Copenhagen Burnout Inventory (CBI). Of the 188 targeted nurses working at King Khalid Hospital in Saudi Arabia who were sent invitation emails, 148 of them returned a fully completed survey questionnaire. The findings showed that night shifts are significantly associated with the highest levels of fatigue, while burnout was linked to the morning and rotating shifts. Fatigue and burnout, as found in this study, are distinct phenomena driven by different mechanisms. Fatigue appears to be a primarily physiological response to circadian disruption inherent in night work. In contrast, burnout is more likely a psychosocial response to the high-demand, high-pressure organisational environment of daytime and rotating shifts. Shift-specific interventions should be tailored to meet each shift's needs, such as mitigating physiological fatigue for night staff and a separate approach to address the organisational stressors that cause burnout among day and rotating shift nurses.20 0Item Restricted A Focused Ethnographic Study of Hospital Nurses’ Perceived Barriers to Healthcare Error Reporting in the United Kingdom(Saudi Digital Library, 2025) Almutairi, Amani; Lowrie, RichardPatient safety remains a critical concern in healthcare, as it is vulnerable to errors that may occur during the delivery of care. A recommended strategy for preventing these errors by key international organisations is the proper reporting of patient safety incidents. However, underreporting of errors persists, undermining progress toward safer clinical environments. Nurses, as the largest professional group within healthcare and central to patient care delivery, play a vital role in error reporting. However, evidence suggests that nurses often choose not to report incidents, indicating a disconnect between established reporting frameworks and clinical practice. Research to date has identified a complex interplay of personal, organisational, and socio- cultural factors contributing to this problem. However, much of the existing literature originates from Asian contexts, with limited exploration in the UK, where underreporting persists despite national guidelines and adverse event reporting systems. Furthermore, the predominance of quantitative methods has restricted a deeper understanding of nurses’ lived experiences, while also making it difficult to capture organisational and socio-cultural factors, which are often unique to each context. To address these gaps, this study proposes a qualitative, focused ethnographic approach to investigate perceived barriers to error reporting among hospital nurses in NHS Scotland. The Royal Infirmary of Edinburgh, a tertiary teaching hospital, will serve as the study site. Semi- structured interviews will be conducted following ethical approval and formal organisational access, with data analysed thematically. The anticipated findings will inform policy, practice, education, and future research. Additionally, by reducing preventable harm and enhancing reporting systems, this study has the potential to improve patient safety, optimise resource use, and deliver positive economic impact.8 0Item Restricted The Association of Patient Portal Engagement with Critical Diabetes Care Indicators and Healthcare Utilization Among Adults with Type 2 Diabetes(Saudi Digital Library, 2025) Altamimi, Mujahid M; Imes, Christopher CType 2 diabetes mellitus (T2DM) remains a significant health problem that is increasing in prevalence. Despite recent advances in drug development and well-publicized guidelines for glycemic, blood pressure (BP), and cholesterol management, achieving the major goals of T2DM remains suboptimal. Patient portals can facilitate disease self-management by allowing patients to access and interact with their health records and communicate with their health care providers. Patient portals provide patients with T2DM the information and tools needed to achieve goal hemoglobin A1c (HbA1c), low-density lipoprotein cholesterol (LDL-c), and BP measurements. Methods This project aimed to comprehensively evaluate the long-term effects of patient portal use on critical T2DM care indicators (HbA1c, LDL-c, and BP assessed using mean arterial pressure [MAP]) and healthcare utilization metrics over four years of follow-up. A retrospective observational cohort study of patients with T2DM treated at UPMC was conducted. Propensity score matching was used to create comparable high and low portal engagement groups. Linear mixed-effect modeling was used to examine the longitudinal association between portal engagement and critical T2DM care indicators. Further, a comprehensive portal feature analysis and its association with improved HbA1c over time were completed using linear mixed-effect modeling. Negative binomial regression modeling was employed to evaluate the association of patient portal use with the utilization of the healthcare system. Results The study included 96,391 patients and identified 10,573 (11%) high-engagement users. This group, compared to 21,146 matched low-engagement users, was predominantly female (53 vs 51%), White (90 vs 82%), and exhibited a more favorable socioeconomic profile. Engaged portal users presented with lower baseline HbA1c (7.4 vs 7.7%) and a greater number of prescriptions (27 vs 25). The longitudinal analysis revealed a modest yet statistically significant negative association between portal engagement and HbA1c affecting both the baseline and the rate of change over time (P<0.01). The analysis of LDL-c showed an association between higher portal engagement and improved LDL-c trajectories (P<0.01). No significant association was found between MAP and portal use. The portal features of clinical data review and patient-provider communication had the strongest associations with better glycemic control. Portal use was also associated with significantly higher outpatient encounters but lower emergency visits. Discussion Patient portal engagement can lead to modest but meaningful improvements in HbA1c and LDL-c for patients with T2DM. These improvements assist patients in meeting treatment goals and potentially reduce the risk of complications. The proactive care pattern among engaged users can lead to consistent management of T2DM, limit complications, and ultimately lead to potential cost savings for both patients and the healthcare system. Future research should explore the development and testing of new portal functionalities and include patients and nurses in the process of design and implementation of new portal features.24 0Item Restricted Shared decision-making during pregnancy and childbirth in Saudi Arabia: A mixed-methods study(Saudi Digital Library, 2025-07-13) Alruwaili, Tahani Ali; Fooladi, Ensieh; Crawford, KimberleyBackground Shared decision-making (SDM) is fundamental to quality pregnancy and childbirth, representing a collaborative approach between healthcare providers (HCPs) and women. In Saudi Arabia's obstetrician-led maternity care system, the implementation of SDM and the experiences of women and their husbands remain understudied, particularly in the context of unique cultural, religious, and healthcare factors. Aim To explore women’s and their husbands’ experiences of shared decision-making with healthcare providers during pregnancy and childbirth in Saudi Arabia. Methods The study employed a convergent parallel mixed-methods design guided by the Three-Talk Model for SDM, which conceptualises SDM as a process involving team talk, option talk, and decision talk. The quantitative strand involved a nationwide, online survey conducted between January and May 2023, targeting women aged 18 and above who were either pregnant or had experienced pregnancy/childbirth in the past 12 months. Low to very low SDM and respect were defined as scores of ≤24 on the Mothers’ Autonomy in Decision-Making (MADM) scale and ≤49 on the Mothers on Respect Index (MORi), respectively. Using the same inclusion criteria, the qualitative strand conducted semi-structured interviews with women and husbands, recruited through convenient sampling from two maternity hospitals and social media. Interview data were analysed thematically and mapped onto the Three-Talk Model for SDM. Data from both phases were integrated during the interpretation phase to provide comprehensive insights into SDM experiences. Results The survey of 505 women revealed that 34.1% (95% confidence interval [CI], 29.6–38.9) reported low to very low SDM. Statistical analysis identified significant factors associated with low SDM, including seeing different obstetricians of a different gender at each visit (adjusted odds ratio [AOR] 2.0, 95% CI, 1.0–3.9), not meeting the same obstetrician throughout the pregnancy (AOR 2.6, 95% CI, 1.2–5.6), and having an instrumental vaginal birth (AOR 6.67, 95% CI, 1.6–28.1). A strong positive association emerged between low to very low SDM and reporting of low to very low respect (χ2 = 83.8173, p < 0.001). The qualitative data from 19 women and 5 husbands identified the following three major themes aligned with the Three-Talk Model: (1) Team Talk; communication and relationship building were limited by discontinuity of care, time constraints, language barriers, emotional readiness, and gender preferences; (2) Option Talk; information exchange highlighted the importance of clarity, despite reported insufficient details and perceived HCP biases towards intervention; and (3) Decision Talk; autonomy and SDM revealed varying levels of autonomy influenced by hierarchical healthcare structures, religious beliefs, and family involvement. Many participants mistook signing consent forms for engaging in SDM, indicating a gap in understanding of SDM processes. Participants’ experiences centred primarily on interactions with obstetricians, with minimal midwifery involvement. Conclusion The findings reveal challenges in implementing SDM within Saudi maternity care, including discontinuity of care, language barriers from non-Arabic-speaking obstetricians, gender preferences, and rigid institutional hierarchies. These findings highlight the need for healthcare reforms, including professional interpretation services, improved continuity of care, and exploration of midwifery-led models. Future maternity care policies should consider the complex interplay of religious beliefs and family dynamics when developing strategies to improve SDM in Saudi pregnancy and childbirth.50 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.30 0Item Restricted The effectiveness of simulation-based learning in nursing education(University of Glasgow, 2024) Alharbi, Ali; Miller, WilliamBackground: Simulation-based learning (SBL) has emerged as a valuable pedagogical approach in nursing education, allowing students a safe and controlled environment to practice clinical skills with varying levels of fidelity. Furthermore, SBL has become an increasingly popular teaching strategy in nursing education; however, few studies have investigated the effectiveness of SBL in Saudi Arabia. Research shows that simulations can enhance student satisfaction and self-confidence. Moreover, evidence suggests that student satisfaction can contribute to building self-confidence, which may help students develop skills and knowledge. This thesis evaluates the impact of SBL on nursing students' knowledge and skill acquisition and retention. Further, assessed their perception of satisfaction and self-confidence following the simulation experience. Methods: This thesis consists of two studies. First, a systematic review was conducted from 2017 to 2023 to identify relevant studies. A total of 33 studies were evaluated using the Joanna Briggs critical appraisal tools. A narrative synthesis was used to extract and report data. Second, a quasi-experimental study employed a repetitive test design with 100 nursing students exposed to a simulation protocol during the internship year. Benner’s model and Kolb’s theory were the conceptual frameworks underpinning this work. Descriptive statistics, paired t-tests, and ANOVA were used to analyse the data. Results: The systematic review showed that most studies focused on the impact of SBL on life-saving skills like cardiopulmonary resuscitation (CPR) or other lifesupport skills, with the remaining studies examining critical care skills or clinical decision-making skills. Consistent and significant improvements in knowledge and skills were highlighted. The quasi-experimental study indicated that SBL significantly improved nursing student knowledge and skills, regardless of individual characteristics. Furthermore, the study found that students had a high level of satisfaction with the simulation experience. Most students also reported increased self-confidence in their skills. Conclusion: This thesis provides evidence supporting SBL as an effective teaching strategy within nursing education in enhancing knowledge and skill acquisition and retention, as well as student satisfaction and confidence. These findings have important implications for nursing education, particularly in Saudi Arabia, and provide valuable insights for nursing educators and policymakers on the benefits of SBL for enhancing student learning outcomes.82 0Item Restricted i Exploring Preparedness and Adaptive Capacity for Disaster Management during Hajj in Makkah City, Saudi Arabia(University of Tasmania, 2025) Althagafi, Ibrahim; Lindsay Smith, Dale Edward , Pieter Van DamAlthough the number of deaths from natural disasters has decreased over the years due to factors such as early warning systems and risk reduction, the losses from such disasters have not reduced and are still unequal across different regions. Kingdom of Saudi Arabia (KSA) is particularly vulnerable to natural and human made disasters, and faces additional risks related to the Hajj, one of the largest religious events in the world. This event is very important in the Islamic faith and millions of people attend it every year, increasing the chances of crowd-related disasters, health complications, and the pressure on the health care systems. Hajj as a mass gathering event with participants from different parts of the world presents numerous public health issues such as infectious diseases transmission and care of the chronically ill in the context of physical and environmental stressors of the pilgrimage. These dynamics call for proper disaster management measures that are suitable for religious mass gatherings given that such events are frequent in Saudi Arabia. The purpose of this study is to examine disaster preparedness and adaptive capacity during Hajj in Makkah City, Saudi Arabia, and to assess the strategies and the knowledge, skills, and preparedness of the healthcare providers for disaster management. It outlines the organisational and contextual factors that determine preparedness and looks at how the sociodemographic factors influence the preparedness of the healthcare providers, administrators and the pilgrims. The bioecological theory of human development underpins the study, integrating the Process-Person-Context-Time (PPCT) model's dimensions of individual characteristics (person), dynamic strategies (process), sociocultural and organisational environments (context), and time factors (time). It will explore the roles and interactions of these elements that help formulate a disaster resilience framework addressing the specific needs of similar large-scale religious gatherings. Employing a mixed-methods case study approach design this study integrates quantitative data from a survey of 161 healthcare providers with qualitative insights from semi-structured interviews of six healthcare providers, five health administrators, and five pilgrims/community members. This data is analysed using SPSS and NVivo software. The results reveal varying knowledge, skills, confidence, and implementation strategies. In terms of knowledge, which included understanding disaster, familiarity with disaster preparedness procedures, and management, 45.3% of participants demonstrated a high level of understanding. Skills, assessed through technical skills, soft skills, and experience in mass gatherings, revealed that 44.1% of healthcare providers possessed high disaster management skills. Confidence in disaster preparedness was notably high, with 54.4% of providers expressing strong confidence in managing disasters during Hajj. Implementation, which encompassed viii viii infrastructure readiness, healthcare facilities and resources, emergency response and coordination, risk assessment and mitigation, and monitoring and evaluation, saw 55% of providers displaying a high level of knowledge in implementing disaster preparedness measures. Challenges identified included language barriers, conflicting stakeholder roles, logistical issues, staff shortages, and extreme heat. However, opportunities for gaining disaster management skills, leadership experience, practical training application, and improved team collaboration enhanced overall preparedness and resilience. The religious aspect of Hajj preparation significantly motivated healthcare providers, many of whom view their work as a form of worship and charity, seeking spiritual rewards through their service. Applying the PPCT model to Hajj disaster preparedness highlighted the roles of individual characteristics, continuous learning, unique ecological challenges, and historical factors, underscoring a comprehensive approach to disaster preparedness. Additionally, insights from the Asia-Pacific Ministerial Conference on Disaster Risk Reduction (APMCDRR) 2022 conference resonated with the study's findings, emphasising the need for a holistic approach to building resilience. This connection emphasizes the need to integrate the global approaches and best practices in disaster risk reduction into the Hajj context. However, there are some areas of knowledge and skills that needed further development; suggesting the need for enhanced training, better coordination between agencies, and a more holistic approach to disaster management in terms of individual and organizational resilience. The study recommends that there should be better training in crowd control, disaster management and cultural sensitivity for the healthcare workers. It underlines the importance of improving the healthcare system in Makkah City and cooperation between different agencies; including the command center and integrated health strategies. Measures that include awareness campaigns for pilgrims, disaster preparedness through early warning systems, emergency plans and drills are also emphasized. Additionally, the study recommends the use of technology in the delivery of healthcare services such as electronic health records and telemedicine; and the alignment of strategies with the PPCT model which includes person-centered training, process improvement, contextualization, and time-sensitive planning and evaluation.46 0Item 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.32 0
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