Saudi Cultural Missions Theses & Dissertations
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Item Restricted Nurses’ Experiences of Breaking Bad News in Oncology Settings With Adolescents and Young People(Trinity College Dublin, 2024-08-22) Alyami, Malak; Murphy, MaryanneABSTRACT Background: Oncology nurses communicate with adolescents and young adults (AYAs) at the end of life to break bad news, communicate important information, or gain insight into the patient’s condition, anxiety, fear, or pain. However, oncology nurses face many barriers to communicating with AYAs to break bad news at the end of life, so identifying these barriers is an essential step in overcoming them. What barriers do oncology nurses face when communicating with AYAs to break bad news at the end of life? Aim: To conduct a systematic review examining barriers oncology nurses face when communicating with AYAs to break bad news at the end of life. Methods: A systematic review question was developed, a search strategy was defined, and inclusion and exclusion criteria were applied to the search results. Afterwards, a quality assessment of the included studies was conducted, and data extraction was conducted according to JBI standards and protocol. The meta-aggregative approach was applied, and the extracted data were grouped into prominent themes. Results: The search and selection strategy resulted in 2,080 studies to which the inclusion and exclusion criteria were applied. After filtering the studies, 20 remained. Four met the high-quality assessment criteria and were included in the thematic analysis and meta-aggregative process. The analysis and synthesis process resulted in the emergence of five main themes related to the barriers faced by oncology nurses in breaking bad news to AYAs at the end of life: 1) communication skills and experiences of oncology nurses, 2) individual barriers, 3) professional barriers, 4) institutional barriers, and 5) societal barriers to breaking bad news. Conclusions: Oncology nurses face many barriers related to their lack of competence and effective communication skills. These barriers may be professional or related to the lack of protocols for breaking bad news and communicating with AYA oncology patients. They may also be due to institutional barriers resulting from inadequate resources, time, and nurses. In addition, the relationships between nurses and multidisciplinary teams, the overlap of tasks, and the lack of clarity of roles in the process of breaking bad news constitute barriers to the success of the communication process, in addition to the linguistic and cultural diversity between nurses, patients, and their families, which constitute major challenges in the communication process.12 0Item 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 LIVED EXPERIENCES OF SAUDI NURSES WORKING WITH COVID-19 PATIENTS: A PHENOMENOLOGICAL INQUIRY(Barry University, 2024-05-08) Alharbi, Bandar; Colin, JessieBackground: Nurses in Saudi Arabia who have worked with COVID-19 patients practice under highly stressful conditions which threaten their health and ability to work. The negative impacts will continue to occur and may result in an unsafe working environment without an understanding of the lived experience of Saudi nurses working in a clinical setting. Purpose: The purpose of this study is to explore the lived experiences of Saudi nurses working with COVID-19 patients. Philosophical Underpinning: A transcendental phenomenological qualitative approach guided by an interpretivist paradigm was engaged to gain an understanding of the lived experiences of Saudi nurses working with COVID-19 patients. Methods: The target population for the study participants was Saudi nurses who work with COVID-19 patients in Al Madinah City, Saudi Arabia. Purposive and snowball sampling was used. Data analysis was guided by Moustakas’ 1994 model of transcendental phenomenology. Results: Four themes emerged from fifteen study participants: Fearing COVID-19, Lacking Resources, Supporting and Encouraging, and Being Socially isolated. Conclusions: This study revealed that Saudi nurses face many challenges while caring for COVID-19 patients. The findings of this study have the potential to assist healthcare institutions in understanding the challenges nurses face while providing care to infected patients. These will enable institutions to devise strategies that effectively tackle these challenges and enhance the overall quality of patient care.24 0Item Restricted The Impact of Relational Leadership Styles on the Burnout of Nurses: A Systematic Review(Saudi Digital Library, 2023) Alghathayan, Abdulrahman Khaled H; Charnock, DavidABSTRACT Background: Relational leadership styles are integral to the nurse management. Nurses are prone to burnout levels due to the work schedules, work environment, bullying incidences, and overall demanding nature of work. However, there is a lack of systematic reviews that synthesise the existing evidence. Although the majority of studies showed that relational leadership styles can reduce the risk of burnout, little is known about the potential mechanisms and pathways through which relational leadership styles reduce the risk of burnout. Aim: To determine the impact of relational leadership styles on the burnout of nurses Methodology: A systematic review approach was used. The approach was anchored in evidence-based practice. A search strategy was developed and implemented in four databases namely ScienceDirect, PubMed, CINAHL, and SCOPUS. A matrix was used to extract data from the included studies. The study used ROBINS-I and RoB 2 Tools to assess methodological quality of non-randomised and randomised studies, respectively. Thomas and Harden’s (2008) thematic synthesis were used for synthesising the findings from the eleven studies. Results: Search in ScienceDirect, PubMed, CINAHL, and SCOPUS generated 144, 42, 22, and 137 articles, respectively. Screening and inclusion process found 11 studies for the final qualitative synthesis. The synthesis of the outcomes of the 11 included studies revealed the different forms of relational leadership styles including transformational leadership style, resonant, emotionally intelligent, ethical, and authentic leadership styles. The findings revealed that emotionally intelligent leaders created a conducive environment and fostered their adaptation to the demanding clinical practice to curb burnout rates. This study found that transformational leadership style reduces burnout among nurses. This leadership style inspires, motivates, and empowers team members to succeed. The study found that resonant leadership reduced burnout of nurses by enhancing job satisfaction. The review found that nurses registered low burnout rates because ethical leaders motivated and increased their morale for work. The review found that authentic leadership created an effective and conductive work environment for the nurses and reduced their burnout rate. Conclusion and Recommendations: Nurse leaders should adopt relational leadership framework to curb burnout among nurses. Further studies should use either cross-sectional or longitudinal studies to explore the impact of nurse managers adoption of relational leadership on the personal and professional issues affecting job demands.12 0Item Restricted The Impact of Electronic Health Records on Nursing Burnout in a Hospital Setting in Saudi Arabia: Mixed-Methods Study(Saudi Digital Library, 2023-11-27) Alobayli, Fatimah Yahya; Holloway, Aisha; Cresswell, KathrinBackground: There is growing evidence suggesting that electronic health records (EHRs) can be associated with clinicians’ burnout, which may hamper the effective use of EHRs and introduce risks to patient safety and quality of care. Nursing research in this area is minimal in comparison with studies conducted on burnout among physicians. In addition, although the majority of research on the impact of EHR use on nursing burnout was conducted in Western contexts, this study fills the gap by exploring this prevalent issue within the context of Saudi Arabia. Aim: The research aim was to examine the association between nursing burnout and EHR use and to explore the contributing factors to nursing burnout related to EHR use in a hospital setting in Saudi Arabia. Methods: The study used a mixed-methods approach with an explanatory sequential design: a quantitative study followed by a qualitative study. The study was conducted in a hospital that was adopting an advanced EHR system, in Riyadh, Saudi Arabia. Using a purposive sampling method, registered nurses working in inpatient units using an EHR system on a daily basis were included in the study. Two validated instruments were used in the online survey, the Mini-Z and EHR perceptions, to examine the association between nursing burnout and EHR-related factors. Qualitative interviews, undertaken both online and in- person, were used to gain an in-depth understanding of factors associated with nursing burnout and hospital EHR use. Survey data were analysed using regression analysis. Thematic analysis was utilised for the interview data. The study was informed by a iii sociotechnical approach to understanding the relationship between the social system (nurses) and the technical system (EHR use) in a given context (a hospital in Saudi Arabia). Results: A total of 282 completed survey responses were included in the study, and a total of 21 nurses participated in the interviews. Participants were predominantly female and worked in acute and critical care units. Most survey respondents were from the Philippines (53%), Malaysia (21%), and Saudi Arabia (11.7%), with South African and European nurses accounting for about 5% each. Interviewees were primarily from the Philippines and Saudi Arabia (33% each), and 24% from Malaysia. The findings indicated that despite the overall acceptance of the EHR among the nurse participants being relatively high, negative perceptions of the EHR and stress related to EHR use were found. There was a slight inconsistency between the quantitative and qualitative results regarding the perceived burnout outcome. The survey statistics showed that the minority of nurses who reported negative perceptions about the EHR were likely to be burnt out while the interviews showed that all participants who reported stress related to the EHR did not think that EHR-related stress would lead to burnout. This inconsistency suggests there is a weak link between EHR use and burnout may exist, possibly indicating the mitigating role of resilience identified in the qualitative study. In this qualitative study, I identified specific perceived organisational stressors associated with EHR use, such as high EHR documentation workload creating a conflict between organisational requirements and direct patient care. Technological stressors were also identified, including usability issues causing disruption to nurses’ workflow, and concerns about data privacy through unauthorised access by healthcare workers at the hospital. Despite these stressors, resilience was demonstrated at both individual and organisational levels, which emerged as a protective factor from EHR-related burnout. Factors like computer literacy, perceived usefulness of the EHR, and nurses’ adaptability to iv change were key contributors to individual resilience that aided nurses in navigating EHR stressors and adjusting to the EHR system. At the organisational level, health information infrastructure facilitated smoother interaction with the EHR system, reducing potential stressors while supportive organisational culture fostered teamwork, work–life balance, continuous learning, and iterative improvement, thereby bolstering resilience among nurses. Conclusion: EHR did not significantly contribute to nursing burnout in a specific Saudi Arabian hospital context. The resilience mechanisms in place at both individual and organisational levels mitigated the potential impact of EHR-related stress on nurses’ burnout. The unique contribution of this research is the introduction of a novel conceptual model elucidating the impact of EHR on nursing burnout. This renewed perspective emphasises the role of resilience at both individual and organisational levels and their collective influence on mitigating EHR-related burnout among nurses. This model has the potential for further development and application both locally and globally. This study signals a need for healthcare organisations to foster resilience-building strategies in their EHR implementation processes and usability that should be tailored to the specific needs and circumstances of each organisation, to effectively manage EHR-related stress and prevent potential burnout. These include encouraging self-care practices among nurses, promoting work–life balance, fostering supportive workplace culture, improving health information infrastructure, providing training and continuous learning, and improving EHR usability through regular feedback sessions from EHR users. Additional research is needed to corroborate this finding with different types of clinicians in the same hospital, and in other hospital settings within Saudi Arabia.42 0