Saudi Cultural Missions Theses & Dissertations
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Item Restricted Effectiveness of mindfulness-based stress reduction (MBSR) in reducing burnout among mental health nurses: A Rapid Review(University of Wollongong, 2024) Almuqayti, Rana; Lapkin, SamExecutive Summary Background: Burnout negatively affects nurses and patients, as well as work quality. Mindfulness-based stress reduction (MBSR) can reduce stress and burnout levels among healthcare professionals, but studies are limited concerning mental health nurses. Aim: To evaluate the effectiveness of MBSR in reducing burnout among mental health nurses. Methods: A comprehensive search was conducted using PubMed, PMC, and JBI. Methodological quality of included studies was assessed using AMSTAR. Main findings: Ten systematic reviews met the inclusion criteria. MBSR reduced stress and burnout levels and improved nurses’ wellbeing. Conclusion: High quality studies that focus on mental health nurses are needed to corroborate the evidence.27 0Item Restricted Mindfulness as a Culturally Sensitive Moderator Between Stress and Anxiety in Saudi Female International Students(University of Cincinnati, 2024) Aldosari, Hend Abdullah; Brubaker, MichaelInternational students studying in the U.S. are becoming increasingly more common as students take advantage of new and existing educational opportunities. One of the larger populations of international students in the U.S. are Saudi students. While students face a number of stressors and anxieties related to schooling, Saudi international students face additional stressors related to adapting and acclimating to the new cultural environment. This is especially exacerbated in Saudi women, as they face discrimination based on the way they dress and have additional burdens such as family and childcare. However, culturally sensitive counseling approaches which address this unique population have yet to be fully investigated or developed. Mindfulness is a technique which involves quieting one’s mind and body and reflecting on one’s situation and circumstances without self-judgment. This approach has been used extensively as a technique to reduce and moderate the relationship between stress and anxiety generally and has been found to be effective in international students as well. Furthermore, mindfulness intersects directly with the principles of Islam through its focus on self-reflection and calming one’s mind, making it a culturally sensitive approach for Muslim clients, such as Saudi women. However, the moderating effects of mindfulness on stress and anxiety in Saudi female international students has yet to be investigated. The goal of this dissertation is to review what is known on the effects of mindfulness on stress and anxiety in international students and to investigate the moderating effects of mindfulness on stress and anxiety in Saudi female students in the U.S.19 0Item Restricted Intensive Care Nurses' Experiences of Burnout During the COVID-19 Pandemic in Saudi Arabia: A Constructivist Grounded Theory Study(King's College London, 2024) Alzailai, Nawal; Xyrichis, Andreas; Barriball, LouiseBackground: Burnout amongst healthcare staff, particularly amongst intensive care unit (ICU) nurses, is a critical issue that intensified during the COVID-19 pandemic. Previous research, especially within the Saudi context, has identified significant levels of burnout in ICU nurses. However, a notable gap exists in the use of qualitative methodologies to deepen our understanding of ICU nurses’ burnout in the Saudi context. Moreover, comprehending the experiences of nurses who suffered from burnout during the pandemic, focusing on the factors that contributed to their stress, has been essential for identifying developmental needs and for shaping interventions aimed at mitigating burnout amongst nurses. Despite this, the existing literature lacks a reliable theory or model that adequately captures the phenomenon of burnout within highly demanding environments like ICUs, particularly under the unpredictable and greatly challenging circumstances of disasters. Aim: To construct a theory grounded in burnout experiences of ICU nurses in Saudi Arabia during the COVID-19 pandemic, intended to act as a foundation for future research that explores burnout in high-stress environments for nurses or other healthcare staff working in similar contexts. Methods: Building from one scoping review and one systematic review, a constructivist grounded theory design was employed for this study, as proposed by Charmaz (2014a). Conducted in four distinct adult ICU departments of a tertiary hospital in Saudi Arabia, the research involved 22 ICU nurses experienced in caring for COVID-19 patients and 10 decision-makers, recruited through initial purposive sampling and subsequent theoretical sampling until theoretical saturation was reached. Data were collected through semi-structured, in-depth interviews. Field notes and a reflexive methodological journal were maintained throughout the research process. Interviews were transcribed verbatim and translated into English where necessary. The analysis followed “Charmazian” principles, which include initial, focused and theoretical coding; constant comparison; theoretical sampling and sensitivity; memo writing; and diagramming. Ethical approval was secured from King’s College London and from the relevant Institutional Review Board in Saudi Arabia. Results: The theory generated by this investigation suggests burnout is a process, resulting from multiple interrelated factors within and beyond an individual’s working environment. This process occurs in three dynamic stages affected by the coping and supportive resources that the nurse has used/received. The core category that emerged, ‘we fought and now we need to be healed’, encapsulates the essence of the nurses’ experiences with perceived burnout and their vital need for recovery and support. This finding led to the development of the BuRN-ICU19 model, a comprehensive framework representing the ICU nurses’ experiences with burnout during the COVID-19 pandemic and informed by results from two fundamental reviews: a scoping review and a systematic review. Conclusion: This thesis offers novel insights into the experiences of burnout among ICU nurses in Saudi Arabia during a disaster situation. It highlights the critical need for targeted interventions and policy reforms to alleviate burnout in, improve the well-being of and effectively support ICU nurses in demanding situations. The BuRN-ICU19 model presents a valuable framework for future research and practical application in ICU nursing, with potential implications extending beyond the Saudi context.45 0Item Restricted Exploring the Impact of Animal Assisted Activities on overall Well-being, Stress, and Mindful Awareness(Saudi Digital Library, 2023-12-01) Alraddadi, Majed; Roberts, JudithHuman-animal interactions have emerged as a promising intervention for improving mental health. Although several studies examined the impact of human-dog interactions on mental health, limited studies examined the psychological outcomes of human-donkey interactions. Hence, this study aims to examine the impact of human-donkey interactions on stress, mental health, mindful awareness, and other potential psychological outcomes. A total of six participants were recruited to take part in the quantitative phase, while only two of them were involved in the qualitative phase. They participated in an intervention involving interactions with donkeys in Snowdonia. Perceived stress, mindful awareness, and mental wellbeing were measured using the Perceived Stress Scale (PSS), the Mindful Attention Awareness Scale (MAAS), and the Warwick-Edinburgh Mental Wellbeing Scales (WEMWBS). The paired sample t-test demonstrated insignificant differences in the MAAS and PSS scores pre- and post-intervention. However, there were significant differences in the scores of WEMWBS. The results show improvement in mental health following the intervention. Five themes emerged: connection, mental refreshment, mild anxiety at the beginning, improved wellbeing in general and satisfaction of social needs and connectedness. Therapists are recommended to incorporate human-donkey interactions into their clinical practice. Longitudinal studies are needed to examine psychological outcomes in the long term.33 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 0Item Restricted Occupational Stress and Burnout in Nurses Working Extended Shifts: A Systematic Review(Saudi Digital Library, 2023-11-09) Almajed, Hamedh; Kerr, ClaireBackground: Extended nursing work hours have become common internationally, due to inadequate staffing levels and increasing population demands. Extended work hours can have adverse effects on the psychological well-being of nurses, including the manifestation of occupational stress and burnout.Aim: This review aims to explore if and how nurses working extended duty hours experience occupational stress and/or burnout.Methodology: A systematic search was conducted on four electronic databases: CINAHL Plus, MEDLINE, PubMed, and PsycINFO. A methodical search strategy was developed in collaboration with an expert librarian. Medical subject headings, keywords, and synonyms were utilised. Reference lists of papers eligible for inclusion in the review were also hand searched. The quality of each study was evaluated using the Joanna Briggs Institute's quality appraisal tool for cross-sectional studies. Meta-analyses were not possible; thus, findings were synthesised narratively.Results: Five studies were included, all focusing on the impact of extended shifts. One study focused on the nurses’ experience of occupational stress mainly; one study focused on the nurses’ experience of burnout; and two studies focused on the contributing factors of stress and burnout. The methodological quality of these studies was deemed satisfactory. The prevalence of 12-hour shifts was high, and evident across various countries. Long working hours and other variables such as inadequate rests, break-times, and fatigue contributed to the nurses’ experience of occupational stress and burnout. Conclusions: Extended shifts in nursing are a widely observed practise internationally. This systematic review sheds light on the effects of extended shift patterns and the prevalence of occupational stress and burnout among nurses. A better understanding of these concepts may help in building organisational initiatives and strategies to support nurses who work long shifts.14 0Item Restricted Eating disorder psychopathology predicts heart-rate variability under social evaluative stress in female adolescents(Saudi Digital Library, 2023-08-24) Allehyany, Bshaier; Burmester, VictoriaThis study investigated whether eating disorder psychopathology predicts increased vulnerability to social evaluative stress in female adolescents (mean age = 14.64 years) and whether social anxiety disorder symptoms amplified this relationship. Twenty-two females answered eating disorder and social anxiety psychopathology questionnaires and underwent a modified sing-a-song test to provoke social evaluative stress, while their heart-rate variability was recorded. We extracted mean heart-rate variability intervals for the sing-a-song stress test, and evaluated whether eating disorder psychopathology predicts heart-rate variability using a linear regression model with moderation analysis. Results indicated that higher eating disorder psychopathology predicted lower heart-rate variability (β = -4.082; p =.003) and that only high symptoms of social anxiety intensified this relationship (β =.2973, p =.0001). We demonstrate that subthreshold eating disorder psychopathology may explain increased reactivity to social evaluation in female adolescents, and that social anxiety symptoms may facilitate this relationship. Future work should account for subthreshold eating disorder symptoms when investigating the stress response in female adolescents. As well, possible mechanisms underlying the associations between subthreshold eating disorder symptoms and social stress need to be investigated, such as body image anxiety and fear of weight gain.20 0Item Restricted Burnout of Transformational Nurse Leaders(2023-08-05) Alenezi, Latifah; Gillespie, Gordon Lee; Smith, Carolyn; Davis, KermitBackground and Purpose Nurse leaders need to pay attention to their own wellbeing by understanding what leads to burnout. The aims of this dissertation are to: (a) review the evidence and determine how transformational leadership (TFL) characteristics are associated with burnout among nurse leaders; (b) identify the differences in burnout between male and female nurse leaders while considering work-life balance and COVID-19 impact; and (c) investigate the relationship between TFL and burnout by examining the mediating effect of stress, role overload, peer support, and work-life balance. Methods Using PRISMA guidelines, an integrative review and critique of 11 articles was conducted. Personal burnout, work-related burnout, client burnout, work-life balance, and COVID-19 impact were assessed through a gender lens in a sample of 210 nurse leaders using ANCOVA testing. The relationship between TFL and burnout was investigated while examining the mediating effect of stress, role overload, peer support, and work-life balance in a sample of 210 nurse leaders using multiple regression analysis. Results Findings from the integrative review aid in developing a better understanding of the general construct of TFL and burnout among nurse leaders; however, studies exhibited several limitations warranting further research in this area. Females had significantly higher personal burnout than males (Mean 56.2 vs. 49.3, F= 5.853, p = 0.019). Males had significantly higher client related burnout than females (Mean 45.3 vs. 34.8, F= 7.014, p = 0.008). Quantitative data derived from the multiple regression analysis revealed that among transformational nurse leaders, inspirational motivation skills (p <.000, 95% CI [6.8, 2.6]), work-life balance (p = 0.022, 95% CI [5.7, 0.4]), stress (p <.000, 95% CI [4.1, 11.0]), role overload (p <.000, 95% CI [2.2, 5.7]), and peer support (p = 0.001, 95% CI [4.6, 1.2]) were all retained as significant predictors of the burnout score. Conclusions Examining factors that might be linked to burnout is important to increase awareness of the prevalence and impact of burnout in nurse leaders. Future researchers need to engage in meaningful conversations on the role of gender among nurse leaders and investigate TFL skills and their relationships with burnout among nurse leaders.25 0Item Restricted Reusable electrochemical impedance spectroscopy biosensor for the detection of cortisol in sweat: Introducing novel techniques suitable for future affective wearable devices and emotional stress.(2023) Zamkah, Abdulaziz; Sherratt, Simon; Andrews, SimonSkin conductivity is used in emotion and stress-detecting systems based on physiology (sweat). However, these technologies do not detect sweat biomarkers or utilize sweat's biological information. Stress-induced volatile organic compounds (VOCs) cannot be detected using these methods. This study explores biomarkers of human emotional stress and identifies key indicators for wearable sensors in affective systems. Crime, health, the economy, and quality of life are all affected by emotional stress. Blood cortisol testing, electroencephalography, and physiological parameter techniques are the gold standards for stress measurement; nevertheless, they are expensive, inconvenient, and impractical for wearable real-time stress monitoring, such as a smartwatch, due to their single-use design. Instead, sweat cortisol was found as the critical stress biomarker for wearable affective system sensors in this study. Modern sensor research aims to create synthetic receptors with similar selectivity and sensitivity to natural antibody-antigen behaviour. This molecular recognition could lead to selective, sensitive sensors that can identify and monitor targets noninvasively when paired with modern methods for monitoring recognition element modifications. Molecularly imprinted polymers, MIPs, are synthetic antibody-antigen systems. They selectively bind their production molecule using a "lock and key" method. MIPs may offer biological receptor specificity and selectivity with environmental durability and low cost. The current study explores the feasibility of using MIPs technology to detect cortisol in sweat for real-time monitoring of emotional stress episodes. A conceptual approach is given to make MIPs sensors more usable for monitoring cortisol sweat in wearable devices. As seen in the reviewed literature, cortisol and MIPs are under-researched biomarkers and their biosensors from the reviewed literature. Experiments employing electrochemical impedance spectroscopy techniques on a capacitance MIP confirmed this theory. It successfully detects cortisol within the physiological range as the higher response is recorded for a greater concentration. The literature also shows that no MIP biosensor is reusable in portable electronics. This work used a function generator simulation to evaluate the hypothesis that the target extraction technique employed Abstract Abdulaziz Zamkah 2023 Page iii during the MIPS fabrication step is repeatable and suitable for employment in wearables.18 0