Saudi Cultural Missions Theses & Dissertations
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Item Restricted The Views and Experiences of Registered Nurses in Delivering Trauma Care as a Result of the Conflict at the Saudi Southern Border(Queen’s University Belfast, 2024-01) Sadhaan, Abdullah Faisal; Brown, MichaelBackground: Registered Nurses (RNs) provide care and support for patients affected by major traumatic injuries and can be challenged in meeting their physical, cognitive and emotional demands. RNs in trauma care settings are often exposed to threats and fear that affect them personally and professionally. RNs may lack the proper support to meet their emotional needs because of caring for trauma patients. Therefore, it is necessary to gain an understanding of their views and experiences to improve the clinical and personal experiences of trauma RNs serving in the Intensive Care Units (ICU) and Emergency Departments (ED) located in hospitals in the conflict zones along the Saudi-Yemen border. Aim: To identify the views and experiences of RNs providing care for patients requiring trauma care at the Saudi southern border because of the conflict. Methodology: A qualitative method using Thematic analysis (TA) was adopted to gather insights from the respondents. The thematic analysis used a homogeneous purposeful sample from a population of RNs working in the ED and ICU. Semi-structured interviews with 12 RNs were used to collect data while the insights gathered were analysed using the thematic analysis method developed and supported by Braun and Clarke (2006). Findings: The qualitative study established varied views and experiences of the trauma care RNs provide while working in the ED and ICUs. The RNs offered timely trauma care for the injured patients in the conflict zone along Saudi-Yemen border. The findings showed the views and experiences encompassed trauma care provision, education and practice development of RNs, barriers, and solutions to the barriers to the provision of trauma care. The views and experiences of the RNs about trauma care in the ED implied the existence of different models of trauma care. Their role in providing trauma care and the challenges in the ED such as communication barriers, teams or lines of communication, patient advocacy and support, and practice development for the dedicated intensive care operations. The models of trauma care mentioned by the xii respondents were ATLS model of trauma care, Canadian triaging system, and the team- oriented system of delivering trauma care. On the other hand, ED RNs faced challenges of organisation and resourcefulness and inadequate use of international trauma protocol standards. Education and practice development needs of the ED RNs were integral to the experience of delivering quality trauma care. Additionally, the primary barriers included professional, environmental, and organisational obstacles. The RNs described solutions to the barriers such as infrastructural changes, proper education and development, holding debriefing sessions, and development of trauma care teams. The analysis gathered that the ICU RNs had diverse views and experiences on trauma care for the patients from the Saudi-Yemen border. The themes from the analysis included building confidence, gathering or sharing knowledge, and understanding of offering trauma care in the ICU. The themes further include nurse-patient ratio, communication, proper organisation, and resource provision to the trauma RNs. Other findings discovered that the organisation and resource encompassed concerns such as staff shortage, excessive workload, and language barriers. Conversely, the key facilitators of trauma care in the ICU included teams or lines of communication, practice development for the RNs, and support from the hospital management through the equipment, and materials. The major practice and development needs found from the respondents included continuous learning and ATLS-based guidelines. However, the key barriers to trauma care delivery in the ICU include insufficient specialist trauma centres, a high number of trauma patients, and security threats. The ICU RNs proposed solutions such as access to education and practice development, access to the organisational resources, evidence-decision- making, workforce management initiatives, family and patient involvement, protocol and policy development in the ICU. Discussion and Conclusion: The discussion of the key findings was anchored on moral injury theory. The theory denotes the disturbing social, professional, behavioural, and psychological exposures affecting the trauma RNs’ moral beliefs and individual values. The RNs providing trauma care to patients from the conflict zones faced challenges and experiences that deviated from their moral beliefs, particularly within the context of their xiii nursing practice. The suffering at the patient and professional level altered the nurses’ views, social acceptance, connectedness, belonging, trust, and ability to engage with the practice. The study concludes that RNs in the ED and ICUs need additional courses, resources, security, debriefing sessions, incentives to work in the conflict zones. Future studies should use longitudinal designs to identify the effectiveness of overtime pay and hardship allowances in reducing the turnover rates of RNs serving in conflict zones.38 0Item Restricted The Association Between Adverse Childhood Experiences and Chronic Pain in Children and Adolescents(William James College, 2024-06-23) Aljarboua, Abdulateef; Peterson, EmmaThere is increasing evidence to suggest that children who have experienced adverse childhood experiences (ACEs) are more prone to developing long-term pain issues compared to their peers who have not experienced ACEs. However, there is still a need for more research on the psychological and social risk factors that contribute to chronic pain conditions in children and adolescents. Unlike research on adults, the association between psychological and social risk factors and pain-related outcomes during childhood and adolescence is a relatively new area that has limited research. The current study assessed the association between parental report of lifetime chronic pain in children and adolescents and specific ACEs pertaining to interpersonal stress in families. The association was examined using archival data from the 2016 National Survey of Children’s Health (NSCH). A logistic regression was used to predict the outcome of the dependent variable (chronic pain) based on the probability of the independent variable (ACEs exposure). The results suggest that exposure to ACEs increases the odds of experiencing chronic pain by 1.5 times for children and adolescents. These findings indicate that addressing adverse childhood experiences (ACEs) could be an important approach to reducing chronic pain conditions. Additionally, regularly evaluating ACEs during childhood could offer valuable information about the psychological and social factors that contribute to this type of pain condition.36 0Item Restricted Altering the Morphological Properties of Nano-Scale Hydroxyapatite Via Sol-Gel Synthesis.(Saudi Digital Library, 2023-11-03) Alnasr Allah, Fahad; Miller, Cheryl; Harrison, Caroline; Joshi, ShivaniBackground: Bone defects and infections are significant clinical challenges facing maxillofacial and orthopaedic surgeons. These conditions can arise from trauma, cancer or infections, leading to bone tissue loss and structural changes requiring intervention and treatment. Traditional approaches to bone regeneration and infection management have limitations (e.g., immunological rejection by the host, transmission of diseases and costs); this highlights the need for innovative solutions to overcome the clinical obstacles associated with traditional treatment of bone defects. Nano-hydroxyapatite biomaterials have shown promising effects when used as bone graft substitutes because they promote bone tissue growth, making them candidates for addressing bone defects. Materials and Methods: Nano-scale hydroxyapatite was synthesised via the sol-gel method, three with different stirring speeds overnight and the fourth batch with 5 g of 3-Aminopropyltriethoxysilane (APTES) stirred at medium stir speed overnight. After that, the supernatant was poured off, and the nHA was washed until the conductivity was stable. The suspensions were dried to a powder (for characterisation) in the oven at 60°C overnight. The samples were characterised using x-ray diffraction (XRD) to identify the crystal phases, transmission electron microscopy (TEM) to image the particle shapes and zeta potential to analyse the surface charge. Results: All samples were successfully crystallised based on the XRD results. The main crystal phase of all the experimental samples was identified precisely and matched those specified in (pure hydroxyapatite, JCPDS card #09-0432), but the samples prepared had a lower degree of crystallinity than the ReproBone® novo. In addition, the stirring speed and/or the addition of APTES affected the size, morphology, particle aggregate and surface charge. Conclusion: Within the study's limits, it was concluded that the difference in the stirring speeds and/or the addition of APTES affect intense crystallisation. In addition, that affects the size, morphology, aggregate of particles and the surface charge of the particles. Thus, knowing the causes and effects of these changes may contribute to the synthesis of HA with better biocompatible and mechanical properties.24 0Item Restricted Vulnerability in the Writings of Elizabeth Bowen(Saudi Digital Library, 2023-10-13) Alsubaie, Nuwayyir; Royle, NicholasThe word ‘vulnerable’ is etymologically derived from the Latin noun vulnus (‘wound’). Across four themed chapters, I argue that vulnerability is at the heart of Elizabeth Bowen’s work, focusing especially on seven of Bowen’s novels: The Hotel, The Heat of the Day, The Death of the Heart, The Last September, Eva Trout, The Little Girls, and A World of Love. Vulnerability, for Bowen, operates in three indissociably linked registers: the physical; the psychological and emotional; and the verbal. While many critics – such as Andrew Bennett, Nicholas Royle, Victoria Gildersleeve, and Neil Corcoran – have written about suffering and trauma in the writings of Bowen, there has not been a study that focuses specifically on the concept of vulnerability in her novels. Allan Hepburn, in his introduction to Listening In, states that Bowen is ‘Never unsympathetic towards those who suffered’ (16). This thesis extends Bowen criticism by offering the first study of her writings to be informed specifically by vulnerability, arguing that the writings of Bowen are acutely preoccupied with forms of vulnerability. Besides that, it argues that vulnerability in Bowen is not just a theoretical topic. Rather it is an indispensable element in the reading experience, as Bowen’s novels make us as readers feel vulnerable and even enable us to experience our own vulnerability in new ways. Moreover, looking at her novels from the perspective of vulnerability prompts us to reconsider what a novel is. The project’s scope covers the three interrelated aspects of vulnerability in Bowen’s writings: the physical, the psychological, and the linguistic. Through a close engagement with representations of vulnerability in Bowen’s novels, critical essays, autobiographical sketches, and letters, this thesis examines how her writings anticipate and enrich our understanding of current vulnerability theory. It builds upon the arguments of many prominent Bowen critics, including Andrew Bennett, Nicholas Royle, Maud Ellmann, Victoria Gildersleeve, Neil Corcoran, Allan Hepburn, and Victoria Coulson. Theorists and philosophers such as Sigmund Freud, Jacques Derrida, Hélène Cixous, Martin Heidegger, Judith Butler, and Jean-Michel Ganteau are also essential to my study.16 0Item Restricted Pre-hospital use of tranexamic acid: patient profiles and outcomes after major trauma(Saudi Digital Library, 2023-07-26) Almuwallad, Ateeq; Davenport, Ross; Brohi, KarimTrauma associated haemorrhage accounts for 40% of all injury related mortality. Patients with major bleeding die early, with almost three quarters of mortality among bleeding trauma patients occurring within the first six hours of injury either in the prehospital setting or upon arrival to hospital. Acute Traumatic Coagulopathy (ATC) occurs within minutes after injury, exacerbates bleeding and is associated with worse clinical outcomes including increased mortality after major trauma. Hyperfibrinolysis (HF) is a key component of ATC and can be effectively treated with pharmacological interventions such as the antifibrinolytic drug Tranexamic Acid (TXA). National Institute of Care Excellence (NICE) guidelines recommend TXA in patients who are bleeding, or at risk of bleeding and have Systolic Blood Pressure (SBP) less than 90 mmHg and/or Heart Rate (HR) greater than 110 beats per minute. The NHS currently endorses the use of TXA immediately following injury and has recently modified the Trauma Best Practice Tariff to incentivise TXA administration within one hour of injury, which is typically the responsibility of pre-hospital (PH) care crews. The overall objective of this thesis was to systematically examine the evidence for PH TXA use, evaluate the use of PH TXA in a national trauma system, and finally investigate the effect of TXA both functionally and through biomarker analysis of admission blood samples taken from trauma patients who did or did not receive the drug prior to arrival at hospital. The evidence for PH TXA administration and mortality reduction in trauma haemorrhage was assessed by conducting a systematic review and meta-analysis. Four studies were included in the review and meta-analysis which identified a survival benefit in patients who received PH TXA vs those who did not (No TXA) with a significant reduction in 24-hour mortality; Odds Ratio (OR) 0.60 (95% CI: 0.37 – 0.99; p=0.05). There was no statistical difference for 28 or 30 days mortality OR 0.69 (95% CI: 0.47-1.02; p=0.06), nor the incidence of VTE OR 1.49 (95% CI: 0.90 - 2.46; p=0.12). Real world use of PH TXA and compliance with treatment guidelines was investigated by analysis of data from the UK Trauma Audit & Research Network for patients eligible for TXA treatment, and who were admitted to a Major Trauma Centre in England and Wales. The data was divided into two cohorts: 2013-2015 (n=32,072) and 2017-2019 (n=14,974) to assess temporal changes following introduction of TXA to PH treatment guidelines after publication of the CRASH-2 trial in 2010. PH TXA use increased from eight percent to 27% over the study period (p<0.001). Only three percent of eligible patients who fell <2m received PH TXA vs. 63% in patients with penetrating injuries (p<0.001). Older patients were less likely to receive TXA than younger patients; 20 years old: OR 1.14 (0.84-1.6), 40 years old: OR 0.88 (0.66-1.29), 60 years old: OR 0.68 (0.43-1.08), 80 years old: OR 0.52 (0.30-0.90). There was significant interaction between age and sex with fewer older women receiving PH TXA. In shocked patients, older people eligible for TXA were less likely to be treated: ≥65 years: n=263 (34%) vs <65 years: n=1655 (60%) (p<0.001). The description of the admission functional coagulation and fibrinolytic biomarkers profiles in patients exposed to PH TXA compared to No PH TXA was investigated by a retrospective analysis of a perpetual observational cohort study at a single-major trauma centre. 450 patients were included into the study who were shocked and/or had received a blood transfusion. Patients were divided into three groups PH TXA: 184 patients, No PH TXA: 266 (ED TXA: 53 patients; and no TXA: 213 patients). There were no significant differences in injury variables, age or shock status between PH TXA and no PH TXA patients, other than GCS, PH TXA, GCS<8: 38% vs no PH TXA, GCS<8 (24%) (p<0.001) and marginally higher ISS in PH TXA patients: 30 (IQR: 22 – 43) vs no PH TXA patients 27 (IQR: 17-36) (p<0.001). There was significant difference in the incidence of ATC: PH TXA, INR>1.2: 38% vs no PH TXA, INR >1.2: 21% (p<0.001), and MHP activations: PH TXA, MHP: 82% vs no PH TXA, MHP 49% (p<0.001). 178 (97%) of PH TXA patients received RBC transfusion with a median of 12 units (IQR: 6 – 21), compared to 228 (86%) of no PH TXA patients who on average received RBC 8 units (IQR: 3 – 16) (p= 0.003). Over half of patients who received PH TXA presented with ML Low admission and only one percent of patients had ROTEM defined hyperfibrinolysis (ML>15%). Regardless of TXA treatment all fibrinolytic biomarkers were elevated significantly above normal values. There was no difference between TXA treatment groups for D Dimer, PAP, PAI-1 or Plasminogen. A2-AP level was lower on admission in PH TXA patients with a median of 69 IU/dL (IQR: 50 – 86) compared to No PH TXA with a median of 97 IU/dL (IQR: 80 – 117) (p<0.001). tPA level was higher in PH TXA patients with a median of 24 ng/ml (17 – 39); compared to No PH TXA with a median of 19 (11 – 29) (p= 0.002). Age (β: 0.302; p= 0.002), sex (male) (β: -0.244; p= 0.010), tPA (β: 0.299; p= 0.002), and PAI-1 (β: -0.191; p= 0.041) were independent variables that significantly were associated with admission PAP values. For admission D dimer values, only ISS (β: 0.150; p= 0.043) and AIS head ≥3 (β: -0.192; p= 0.015) were significant independent variables. Admission ML was independently associated with admission t-PA (β: 0.199; p= 0.008) with a strong trend for PH TXA (β: -1.128; p= 0.139) The thesis has shown that PH TXA significantly reduces 24-hour mortality. TXA is safe and does not increase VTE for survivors. On a national level, there is a clear implementation gap between evidence-based guidelines for PH TXA administration, and universal administration for all eligible bleeding patients. It is clear that some specific patient populations are far less likely to not receive this intervention i.e. low energy trauma and older patients than others. Finally, PH TXA alters functional and biomarker profiles of bleeding trauma patients demonstrating significant modulation of fibrinolysis soon after administration.11 0Item Restricted Confronting The Shadow Side to Heal The Black Self: Southern Black Female Writers Theorize Blackness, Love, Beauty, and Spirit(2030) Alameroo, Asma; Watson, Veronica“Are you sure, sweetheart, that you want to be well?” This question is posed by Minnie Ransom, an old, fabled Southern healer in Toni Cade Bambara’s The Salt Eaters, to Velma Henry, a Southern Black woman in her forties, after Velma’s fight against the oppression of society in 1970s Georgia has led to her depression (Bambara 1). This question that Bambara, a Southern writer, asks in the 1980s, has also been asked by other Southern black women writers as they sought to envision a healthy black self that could build stronger families and communities and fight for change in the larger society. What these writers recognized was that the legacies of slavery and segregation, and the continuing realities of discrimination and disregard for black life and vitality, have left black Americans with an unrecognized, unresolved shadow that disrupts their connections to self and others in their families and communities. The novels of Toni Morrison, Zora Hurston, Toni Bambara, and Alice Walker, as well as scholars like bell hooks, Sally McMillen and Danielle McGuire, lay bare the trauma of American racism and sexism on black women in the U.S., and begin to imagine a path of healing and restoration that will revitalize individuals, families, and communities, allowing them to obtain their wholeness and to continue to develop and build a future for their progeny. Because wisdom is taken from the womb of suffering, I will critically examine five literary texts using the approaches and methodologies of trauma theory, critical race theory, and black feminism to consider how Southern Black female writers confront shadows to construct the road of self-love, understanding genuine beauty, and appreciating their spirits. Members of the Southern Black communities of the mid-twentieth century represented in the texts in my study needed to confront the shadows of violence toward black Americans and the continuing deprivation and discrimination they were forced to confront just to survive in order to achieve personal awakening, creativity, and energy that would benefit the individual and her/his family and community. Southern black women writers theorize that the progress of Black families and communities is tied to restorative investments in Black love, beauty, and spirit, that “a change in society is directly linked to a change in the individual” (University of California Television). As author and theorist Alice Walker says, “[Black individuals] need to look back to see how [they] managed [yesterday] and to learn the lessons that were left there” (Walker, “Alice Walker on the ‘Rosie’ Show”). Ultimately, this project aims to analyze what the southern black female writers have done through their literature, which is to give their readers creative ways to deal with their shadows and reach the best possible level of personal agency and definition of self-love within their families and communities. Chapter 1 will start with the eyewitness account of Miss Ozy, an eyewitness of South Carolina in the 1960s. I will then trace the history of Southern Black women as individuals in families and communities through Sally G. McMillen’s Southern Women: Black and White in the Old South, Danielle L. McGuire’s At the Dark End of the Street, and S. N. M. Jones’s Black Women Need Love Too. Through these books, I will describe how invisible problems move from one generation to the next and eventually reach the mid-20th century to form the “shadow side.” Using Jung’s concept of the shadow side of the self as a problematic and unconscious aspect of personality, and trauma theorists to examine how personality can be warped by sustained, multivariate violence and assault, I will posit the obstacles that stand in opposition to personal wholeness and wellness of Black Americans. This chapter will conclude with why the southern black female writers confront shadow in their writings to theorize Black concepts of love, beauty, and spirit. Chapter 2 explores how they use the discovery of the shadow to “open the first door to the Self” because we house “the discarded aspects of our personality” there; we have to rediscover these elements to begin the journey toward individuation (Park 191–192). We cannot change the past, but we can learn from history to improve the present for ourselves. With this understanding, I will examine and analyze Morrison’s masterwork Beloved, focusing on Sethe, the former Southern slave. I will argue that Beloved, as a ghost, is Sethe’s shadow, which exists and lives in her unconscious as vital material that destroys her psyche and causes a disaster that crushes the rest of her family. I will next show how Sethe confronts her shadow to achieve self-love by passing through three phases of confrontation: encounter, manifestation, and assimilation. I will conclude by discussing the positive and negative impacts of confronting (or not confronting) the shadow side of the self. Chapter 3 will continue to trace the effect of the shadow side of the self by examining Pauline and Cholly Breedlove, the Southern couple in The Bluest Eye. I will argue that the failure of the individual to confront his/her own shadow creates a shadow in a spousal relationship that impacts the family and vice versa. I will show how the Breedloves fail to confront the shadow of self-loathing that damages them as a couple and moves to the rest of the family, particularly their daughter Pecola. In stark contrast, Tea Cake and Janie Crawford in Their Eyes Were Watching God provide a good example of Southern Black couples in the 1940s who confront their shadows and create genuine marital relationships. I will also compare the Southern Pecola to the Northern Claudia MacTeer to show two main ideas: the significance of planting healthy Black concepts into the souls of Black children and the responsibility of the family to plant these concepts in children. If the family fails to confront their shadow, they will produce individuals who just spread hatred to the Black community and derail the advancement of their society. Chapter 4 will explore the shadow side of the self on Southern Black communities in the 1980s through The Salt Eaters (1980) and The Color Purple (1982). Each discusses the issues of Georgia communities in a particular era, and my focus in each examination will be to understand how community change and health is set in motion or accomplished. I will show this by comparing the life experiences of Celie Alphonso and Velma Henry. These novels suggest that trauma negatively impacts individuals, leading to isolation and distance in the community. It is only when the community pulls together to embrace deeply traumatized members that healing can begin. The interconnectedness of the individual and her/his community is a source of strength and hope that can counteract generations of pain, but it is only possible when individuals and families have confronted their own traumas and are able to reach out to others. I will conclude with a discussion of how these novels aim to provide Blacks and other readers with the unique self-awareness that makes us admit the existence of the shadow and challenge our concerns in a more conscious and creative way—a spiritual awakening experience. Moreover, I will show how and why the southern black female writers propose constructing the wholeness of Black individuals to help them integrate Black souls that are far away from the shadow of slavery and how to practice Black spirituality daily by perceiving life as a struggle to grow.25 0Item Restricted The Relationship Between Childhood Trauma and Adult Aggressive Behaviour(2022) Alomayrini, Hamad; Yaneva, Mira; Dymond, HarrietRelationships connecting different kinds of childhood trauma with the aggressive behaviour in adulthood have been previously investigated. The majority of the studies have shown that childhood trauma could potentially lead to an adult aggressive behaviour in adulthood. This current study aims to investigate this hypothesis as well as to determine the potential factors in childhood trauma that could increase the adult aggressive behaviour. In that intention, an online survey was prepared using the "Adverse Childhood Experiences (ACEs) Questionnaire" and "Buss Perry Aggression Questionnaire (BPAQ)" to assess the childhood trauma experiences and the aggressive behaviour aspects of 100 participants. In the data analysis, the ACEs and BPAQ scores were calculated for each individual, and then a statistical analysis was performed. The results have shown that the childhood trauma exposure was directly linked to an adult aggressive behaviour. In addition, the regression models showed significant positive correlations between the childhood trauma and all the types of the aggressive behaviour. In conclusion, and in view of the obtained results, in addition to previous literature, it is extremely important to increase awareness about this subject for all parents, guardians and caregivers, in order to prevent childhood trauma in the first place and therefore adult aggression.36 0