Dissertations / Theses on the topic 'Emergency nursing Saudi Arabia'

Although the kingdom of Saudi Arabia has most recently drawn media and global attention for the escalation terrorism and Hajj incidents, very little attention is paid to the increasing frequency of natural disaster affecting the country. Unfortunately, despite the increase in the number of these natural disasters, the government remains slow to react. This project provides a comprehensive and conclusive discussion on the negative impacts of poor response to these calamities. While the government is concerned with climate change and its role in increasing the frequency of natural disasters, it is important to pay attention to other disasters including human-inclined dangers and technological risks. Each of these calamities has had an adverse effect on the lives of all the people living or visiting the kingdom. There has been a proposition for establishing a government agency in order to improve disaster response. It has further been noted that this agency could coordinate between different government departments to implement crisis and rapid management as well as disaster readiness training programs for each and every sector of the nation. The agency would also work to offer support in case of emergency. Though the success of a program cannot be founded on the use of systems engineering, the project recognizes its significance towards attaining success. In a nut- shell, the project compels the Saudi government to think widely so as to prepare for and respond to the occurrence of disasters.

The healthcare services in Saudi Arabia currently face many challenges, the most pressing being the shortage of local nurses. In common with many other countries in the Gulf region this has necessitated the hire of expatriate nurses and has led to health care provision in Saudi Arabia being highly multicultural in its composition. The ensuing cultural diversity of the health care professional population has resulted in there being a significant challenge regarding the lack of culturally competent nurses to meet the growing needs and expectations of health care provision in Saudi Arabia. In essence, there is a cultural mismatch between the nurses and those they care for that extends far beyond not sharing the same native language. Moreover, the staff group itself is culturally diverse and as well as not sharing the same mother tongue they do not share the same mores, values, religion and training. In turn, culturally competent and effective nursing leadership, the literature suggests, is sadly lacking and not addressing the deficit in culturally appropriate nursing care for the Saudi population. Moreover, this lack of culturally competent leadership will negatively impact not only on work performance and quality of nursing care delivered but also on the job satisfaction of this multicultural and diverse staff group. The overall aim of this thesis is to understand the relationship between nurse leadership and the cultural sensitivity of nursing care delivered in the hospital setting in Saudi Arabia. Furthermore, this study will attempt to identify the future training and development needs of nurse leaders in Saudi Arabia to enable a service to be delivered that can best address the needs of its people. This thesis is based on a qualitative study carried out from the perspective of nurse leaders working in the medical city in Riyadh, the capital of Saudi Arabia. The sample in the study consisted of 46 participant nurse leaders from different cultural backgrounds who work in the largest Medical City in Riyadh (King Saud Medical City). Data for this qualitative study were collected by semi-structured interviews and 6 focus groups and were analyzed thematically. The results indicated that culturally competent nurse leaders require a set of characteristics and personal qualities. Moreover, it is demonstrated that cultural factors are of critical importance; not only in influencing the quality of nursing care delivered, but also on the effectiveness of the leadership style of nurse leaders and how they learn and develop professionally. This research study suggests that there are three considerations which need to be taken into account for the development of nurse leaders in this context. First, gender is a key issue and its implications are important for the future of nursing in Saudi Arabia. Second, key characteristics and essential personal qualities are required for culturally competent nurse leaders. Third, exploration of what works and (what does not) for nurse leaders is required to overcome situations where there may be a risk of cultural conflict. There has been a lack of previous research and knowledge into nurse leadership development in Saudi Arabia and the significance of this study is that it provides new empirical evidence to address this deficit. This new evidence will inform the development of training programmes for nurse leaders in Saudi Arabia that stress the need for cultural awareness and competency. The provision of such training could have far reaching benefits not only for nurse leaders and the staff they manage, but also for the quality of nursing care delivered and how it is perceived by the recipients of that care. In turn, this could impact the recruitment and training of other health care professionals in Saudi Arabia and delivery of its health care policy in a wider context. Keywords: cultural competence, nursing leadership, Saudi Arabia, expatriate, multicultural, thematic analysis, qualitative method. Note: Throughout this thesis the full name of Saudi Arabia, and its shortened form SA, are used interchangeably.

Thesis (MCur)--Stellenbosch University, 2011.
ENGLISH ABSTRACT: The quality of care nurses provide to patients is done with the expectation that skills and knowledge of each registered nurse will result in quality patient care. Compliance statistics for quality indicators (level of service indicators) or (LSI’s) in the tertiary health care institution in Saudi Arabia varies, raising the following questions: “Do nurses understand the importance of quality indicators in clinical nursing and do they know how to use them to improve patient care?” No studies done on registered nurses’ knowledge and opinions of quality indicators could be found thus indicate the necessity of a research study to determinine the knowledge and opinions of registered nurses on quality indicators in clinical nursing in the tertiary healthcare system in Saudi Arabia. This is the focus of this research. The objectives of the study were: - To determine the current knowledge and opinions of the professional nurses regarding quality indicators in a tertiary hospital in Saudi Arabia - To identify the factors that influence identification of quality indicators in clinical nursing - To identify the need for a training program regarding nurse sensitive quality indicators Data was collected through a questionnaire handed to more than 200 nurses working in general wards and intensive care areas in a single Saudi Arabian hospital. Participants were selected through a randomised list. The registered nurses who have participated in the pilot study’s responses were excluded from the final data analysis. No patients were included or involved in the study. A descriptive design with a quantitative approach was applied to investigate the professional nurses’ knowledge and opinions on quality indicators (level of service indicators) or (LSI’s) in clinical nursing in Saudi Arabia. Research data suggests that the knowledge and opinions of registered nurses in the tertiary health care institution in Saudi Arabia are not supporting the expectations of quality assurance in clinical nursing. Registered nurses have strong opinions of quality indicators in clinical nursing but do not have the knowledge to support those opinions. Improving initial and recurring training on quality indicators provided to nursing staff with diverse backgrounds and high turnover was recommended as an essential component in using quality indicators to drive improvements in patient care.
AFRIKAANSE OPSOMMING: Die kwaliteit verpleegsorg wat verpleegkundiges op ‘n daaglikse basis aan kliente bied gaan gepaard met die verwagting dat hulle oor die kennis en bevoegtheid moet beskik om kwaliteit verpleegsorg aan te wend wat ‘n langdurige positiewe uitkoms met verwysing na pasientsorg kan bied. Die kwaliteits aanwyser statistieke in die tersiere gesondheidsorg sisteem verskil maandeliks en het die navorser geinspireer om ‘n studie te doen om te bepaal of geregistreerde verpleegkundiges verstaan wat die belangrikheid van kwaliteits aanwysers is en of hulle die kennis het oor die gebruik daarvan, in watter opsigte dit gebruik kan word en wat die voordele inhou wanneer kennis en applikasie daarvan vir kliniese verpleging toegepas word. Literatuur met betrekking tot vorige studies omtrent kennis en opinies van geregistreerde verpleegkundiges tot kwaliteits aanwysers in kliniese verpleeging kon nie deur die navorser gevind word wat gebruik kon word as agtergrond of ondersteuning tot die studie nie. Die fokus van die navorsings studie was om geregistreerde verpleegkundiges se kennis en opinies te bepaal met betrekking tot kwaliteits aanwysers in kliniese verpleging in die tersiere gesondheidsorg sisteem in Saudi Arabie. Die doelwitte van die studie was om: - Die huidige kennis en opinies van geregistreerde verpleegkundiges met betrekking tot kwaliteits aanwysers in die tersiere gesondheidsorg sisteem in Saudi Arabie te bepaal - Om faktore wat ‘n invloed op identifikasie van kwaliteits aanwysers het te identifiseer - Om die nodigheid van ‘n opleidings program met betrekking tot kwaliteits aanwysers te bepaal Die data van die studie was ingesamel deur middel van ‘n vraelys wat aan die geregistreerde verpleegkundiges meesal werksaam is in algemene sale of intensiewe sorgeenhede. Deelnemers was gekies deur middel van ‘n alternatiewe lys. Die deelnemers aan die loots studie was ge-ellimineer van die finale data analise. Geen pasiente was betrokke by die studie nie. ‘n Beskrywende ontwerp met ‘n kwantitatiewe benadering was toegepas om geregistreerde verpleegkundiges se kennis en opinies omtrent kwaliteits aanwysers in kliniese verpleging in die tersiere gesondheidsorg sisteem in Saudi Arabie te toets. Die navorsing het bewys dat die kennis en opinies van geregistreerde verpleegkundiges in die tersiere gesondheidsorg sisteem in Saudi Arabie nie op ‘n aanvaarbare standard kan geklassifiseer word nie asook nie die nodige kwaliteits versekering in kliniese verpleging ondersteun nie. Die studie bewys dat geregistreerde verpleegkundiges beskik oor genoegsame opinies omtrent kwaliteitaanwysers maar nie noodwendig oor die kennis om hulle opinies daaroor te ondersteun nie. Die studie is ook uitkoms gebaseerd omtrent die nodigheid van ‘n opleidings program met betrekking tot kwaliteits versekering in kliniese verpleegkunde te implimenteer, insluitend die vakgebied van kwaliteits aanwysers in kliniese verpleeging.

For the last three decades, the Gulf Cooperation Council (GCC) states, comprising Bahrain, Kuwait, Sultanate of Oman, Qatar, Saudi Arabia and the United Arab Emirates (UAE) have relied heavily on doctors, nurses and allied health professionals recruited from other countries. Globally, there is a persistent shortage of doctors and nurses and the GCC countries are no longer able to meet their human resource requirements through international recruitment. They have thus pursued policies that aim to increase the supply of qualified indigenous health-care professionals - indigenization. This study aims to understand and examine why and how an indigenization policy has been formulated and implemented in a purposively selected sample of three Gulf States. Saudi Arabia, Bahrain and Oman have many commonalities and the structures of their health-care services, labour force and indigenization policies confront similar broad issues and challenges. However, they were selected to represent different social, cultural and policy environments in the region and different levels of success in creating an indigenous nursing workforce. This study employs a qualitative research approach to generate an in-depth understanding of the factors that facilitate or inhibit the implementation of indigenization policies in nursing. This includes semi-structured interviews with 78 stakeholders comprising current and former policy-makers, human resource managers, religious leaders and nursing officials living and working in one of the three Gulf States. Document analysis provided the historical and technical background for understanding the mechanism of the indigenization policy process and practices. Findings reveal that cultural, economic and political issues play important roles, as do society's views on education, the role of women and the image of nursing. The recommendations to address these issues, particularly in respect of increasing women's participation in the workforce, may contribute to the development of nursing in the Gulf.

Thesis (MCur (Nursing Science))--University of Stellenbosch, 2009.
ENGLISH ABSTRACT: Nursing documentation is the written evidence of nursing practice and reflects the accountability of nurses to patients. Accurate documentation is an important prerequisite for individual and safe nursing care. It is a severe threat for the individuality and safety of patient care if important aspects of nursing care remain undocumented. Nursing staff cannot rely on information that is not documented. Every patient is important and unique hence every patient’s care is individualised and different according to his/her needs. This is why important aspects of his/her care need to be documented. Ultimately, the documentation practices reflect the values of the nursing personnel (Isola, Muurinen and Voutilainen, 2004:79-80). The goal of this study was to investigate documentation of nursing care with reference to current practices and perceptions of nurses in a teaching hospital in Saudi Arabia Specific objectives of the study were:  to identify whether the hospital policies are being carried out  to identify whether the procedures regarding current documentation are being carried out and  to explore the perceptions of the nurses regarding the current documentation practices. Research Methodology For the purpose of this study, a non-experimental descriptive design with a quantitative approach was used. The study was carried out at King Faisal Specialist Hospital in Jeddah in Saudi Arabia. The total population of 90 registered nurses were used in this study. Questionnaires were distributed to the participants and they were answered with no identities written on the questionnaires. After the questionnaires were completed, it was posted in a box and was collected by the researcher. The questions are straightforward, easily understood, unambiguous, non-leading, objectively set and aimed at obtaining views, experiences and perceptions of documentation of nursing care. . Involvement of participants was voluntary and non-coercive. Data analysis were carried out with the support of a statistician, expressed in tables, frequencies and statistical associations were done between various variables based on a 95% confidence interval. The study revealed that:  Hospital policies are being carried out N=76 (95%)  Procedures pertaining to documentation of nursing care are being carried out N=67(83,7%).  Nurses N=45(56,3%) indicated that paper documentation included a lot of paperwork.  The Cerner (computer system) is regarded as the best system ever used for documentation of nursing care N=44(55%)  The Mycare system (medication ordering system) is regarded as the most reliable, user-friendly system and nurses are happy with it N=68(85%) Recommendations are:  Nurses still need to be taught about the hospital policies  Nurses should be taught the correct procedure on documenting the patient data  Nurse clinicians and managers should check the Cerner for compliance with regard to documentation of physical assessment when conducting audits  Use of paper for nursing documentation should be minimized by shifting some of the nursing documentation procedures from paperwork to electronic version  Continuous updating, in-service training and monitoring to keep nurses abreast with the dynamic nature of computer usage  Reviewing of the system, troubleshooting and suggestions from users need to be attended to on a continuous basis  It is recommended that a backup system (generator) is in place to ensure continuity of documentation.
AFRIKAANSE OPSOMMING: Die dokumentering van verpleegsorg is die skriftelike bewys van die verpleegpraktyk en weerspieël die toerekenbaarheid van verpleegsters teenoor pasiënte. Noukeurige dokumentering is ’n belangrike voorvereiste vir individuele en veilige verpleegsorg. Dit is ’n ernstige bedreiging vir die individualiteit en veiligheid van pasiënte-sorg, indien belangrike aspekte van verpleegsorg nie gedokumenteer word nie. ’n Mens kan nie inligting vertrou wat nie gedokumenteer is nie. Die versorging van elke pasiënt is belangrik en uniek. Dit is waarom belangrike aspekte aangaande haar/sy versorging gedokumenteer behoort te word. Uiteindelik weerspieël die dokumenteringspraktyke, die waardes van die verpleegpersoneel (Isola, Muurinen en Voutilainen, 2004: 79-80). Die doel van die studie was om dokumentasie van verpleegsorg met verwysing na huidige praktyke en persepsies van verpleegkundiges in ‘n opleidingshospitaal in Saudi Arabia te ondersopek. Spesifieke doelwitte was  om vas te stel of die hospitaal se beleidsrigtings toegepas word  om vas te stel of die prosedure t.o.v die huidige dokumentering uitgevoer is  en’n ondersoek na die persepsies van verpleegsters aangaande die huidige dokumenteringspraktyke Vir die doel van hierdie studie is ’n nie-eksperimentele beskrywingsontwerp met ’n kwantitatiewe benadering gevolg. Hierdie studie was in King Faisal Specialist Hospital in Jeddah, in Saudia Arabia gedoen. ’n Totale bevolking van 90 geregistreerde verpleegsters was betrokke. Vraelyste was versprei na die deelnemers en is naamloos beantwoord, sonder dat hulle identiteite op die vraelys aangebring is. Na voltooiing van die vraelyste, is dit in ’n houer geplaas en deur die navorser afgehaal. Die vrae is direk, eenvoudig, maklik verstaanbaar, ondubbelsinnig, nie-afleibaar, objektief opgestel en is daarop gemik om gesigspunte, ervaringe en persepsies oor dokumentering van verpleegsters te verkry. Betrokkenheid van deelnemers was vrywillig en nie afdwingbaar nie. Data is getabuleer en in histogramme en frekwensies voorgestel. Deur die Chi-square- toets te gebruik, is statisties betekenisvolle assosiasies tussen veranderlikes bepaal. Bevindinge sluit die volgende in:  Die hospitaalbeleid word toegepas N= 76(95%)  Prosedure t.o.v. dokumentering aangaande verpleegsorg word uitgedra N=67(83,7%)  Verpleegsters het aangedui dat dokumentering op papier, baie papierwerk behels N=45(56,3%)  Die Cerner (rekenaarstelsel) word beskou as die beste stelsel ooit in gebruik vir die dokumentering van verpleegsorg N==44(55%)  Die Mycare stelsel (medisyne bestellingstelsel) word beskou as betroubaar en gebruikersvriendelik, en een waarmee verpleegsters gelukkig is N=68(85%). Aanbevelings is gemaak, gebaseer op die volgende bevindinge:  Dit is steeds nodig dat verpleegsters die hospitaal se beleidsrigtinge geleer moet word  Verpleegsters moet die korrekte prosedure aangaande die dokumentering van die pasiënt se data geleer word  Verpleegklinici en bestuurders moet die Cerner nagaan ter voldoening van die dokumentering van fisiese waardebepalinge tydens ouditeringe  Die gebruik van papier vir verpleegdokumentering behoort afgeskaal te word deur van die praktyk van papierwerk na elektroniese dokumentering te skuif  Voortdurende bywerking van data, indiensopleiding en monitering van verpleegsters om hulle op die hoogte te hou van die dinamiese aard van rekenaargebruik  Hersiening van die stelsel, foutspeurdery en voorstelle van gebruikers moet op ’n voortdurende basis aandag geniet.

Objective: This study aims to examine the relationship between nurse managers' leadership style and nurses' organizational commitment in Saudi Arabia. Background: The contribution that nurses make to healthcare systems is fundamental to meeting the goals of the organization in providing safe and high quality health care services. Quality of care can thus be jeopardized by a shortage of nurses: a problem of increasing concern in Saudi Arabia. Design and methods: The study used a quantitative methodological approach: the Multifactor Leadership Questionnaire (1995) was used to measure nursing leadership styles, and the Organizational Commitment Questionnaire (Mowday et al., 1979) was used to assess organizational commitment. Data was collected in a one-stage cluster random sample of 219 nurses and nurse manager from two medical cities in Riyadh, Saudi Arabia. Results: Transformational and transactional leadership were the two most dominant leadership styles as perceived by nursing managers and their staff in the sample. Both nurse managers and staff nurses considered the transformational leadership style to be the most frequent followed by the transactional leadership style. However, differences between the perceptions of nurse managers and their staff as to their leadership style were apparent. Nurse managers' self-rating scores were higher than their nursing staff rating scores on all five transformational, and two transactional, leadership styles. Overall, the level of organizational commitment was higher in nurse managers than nursing staff. In both, nurse managers and nursing staff, there was a positive relationship between transformational and transactionalleadership styles and the commitment to stay. Transactional leadership displayed a strong positive relationship with organizational commitment. However, after controlling for the influence of manager/staff statues, nationality, and hospitals, transformational leadership styles was the strongest contributor to the organizational commitment. Perceptions of both, transformational and transactional leadership styles, increased with age for nurse managers and nursing staff; however, there was no concrete relationship between the length of experience and the perception of leadership style. Conclusion: Transformational leadership enhances organizational commitment, which can result in enhanced staff retention. If the nursing workforce is well managed and the retention of nurses is enhanced, better health outcomes for patients could be the result. An understanding of the relationship between leadership and organizational commitment, which is a predictor of nursing retention, is of paramount importance. Introducing the Full Range of Leadership model to the Saudi nursing system will help to prepare Saudi nurses for positions as nurse managers and leaders. This will not only develop and strengthen the health care system in Saudi Arabia but will also contribute to the "Saudization" programme.

Road traffic accidents are a prolonged and on-going problem of modern times. The objective of this study is to characterise the distribution of road traffic accidents with Riyadh City and provide recommendations and suggestions to improve the existing emergency medical services system. A pilot study was undertaken using two forms designed for collection of the data; one was for the Red Crescent Society (RCS) and one was for the police. The above mentioned forms were applied for a period of two weeks, one week in the wet season and the second in the dry season, plus many meetings and interviews with people with relevant responsibilities in the health field. A comprehensive review was undertaken of both the RCS and Public Safety documents. The findings suggest the need to construct safety programmes to modify the behaviour of the individual at risk, the vehicle and the environment. In addition the study provides an evaluation of the present emergency medical services system and the means to improve it. Thus the findings should be of value in determining the need to improve the system and to make more efficient and better emergency medical services available.

Thesis (MCurr)--Stellenbosch University, 2013.
ENGLISH ABSTRACT: Literature suggests that job satisfaction and retention of nurses can be improved by empowering nurses in decision making (Mark, Lindley & Jones, 2009:120; Mangold, Pearson, Schmitz, Scherb, Specht & Loes, 2006:266; Manojlovich, 2007; and Scherb, Specht, Loes & Reed, 2010:2). Positive work environments such as those found in Magnet® accredited hospitals and those where management models have flat hierarchical structures, support the decisional involvement of registered nurses. Decisional involvement is described as “the pattern of distribution of authority for decisions and activities that govern nursing practice policy and the practice environment” (Havens & Vasey, 2005:377). The purpose of this study was to explore the decisional involvement of registered nurses in a tertiary hospital in Saudi Arabia. It is hypothesized that an empowering shared governance structure will result in a high level of decisional involvement of registered nurses who provide direct patient care. A quantitative study with a descriptive exploratory design was chosen to answer the research objectives. Through simple random sampling, n=140 registered nurses who provide direct patient care (target population N=672) and through non-probability purposive sampling n=18 nurse managers (target population N=21), participated in the study. A self-administered questionnaire was designed which included a validated tool, namely the Decisional Involvement Scale (Havens & Vasey, 2003:333). A pilot study was completed to test the validity of the self-designed sections of the questionnaire. Numerical data was analysed using STATISTICA v. 11.5 while the open-ended questions were analysed and placed into themes. It was found that registered nurses who provide direct patient care have low levels of actual and preferred decisional involvement, implying that the authority for decisional involvement lies with managers. The hypothesis that empowering shared governance structures will result in a high level of decisional involvement is not supported. There was no statistical difference identified between bedside Registered Nurses (bedside RNs) and nurse managers in the overall perception of decisional involvement. Factors that were identified to impact on decisional involvement included educational level, experience, leadership styles, the work environment and a culture of shared decision making. It is recommended that the focus to improve the decisional involvement of registered nurses who provide direct patient care should be on addressing those activities where more decisional involvement is preferred, while concurrently addressing those factors that were identified which would impact on the decisional involvement of all registered nurses.
AFRIKAANSE OPSOMMING: Literatuurstudies dui aan dat bemagtiging van verpleegkundiges in die proses van besluitneming tot meer werksbevrediging en retensie sal lei. Positiewe werksomgewings soos die by Magnet geakkrediteerde hospitale en die met plat hiërargiese bestuursmodelle dra by tot betrokkenheid van geregistreerde verpleegkundiges in besluitneming. Betrokkenheid by besluitneming word beskryf as ‘die wyse waarop outoriteit versprei is sodat besluite en akwiteite wat verpleegpraktykbeleid en die praktykomgewing bepaal, uitgevoer kan word’ (Havens & Vasey, 2005:377). Die doel van die studie was om die betrokkenheid te bepaal van geregistreerde verpleegkundiges by besluitneming in ‘n tersiêre hospitaal in Saoedi-Arabië. Die hipotese is dat ‘n bemagtigende, gedeelde bestuurstruktuur sal lei tot ‘n hoë vlak van deelnemende besluitneming by geregistreerde verpleegkundiges verantwoordelik vir direkte verpleegsorg. Die navorsingsdoelwitte is beantwoord deur middel van ‘n kwantitatiewe studie met ‘n beskrywende, ondersoekende ontwerp. Geregistreerde verpleegkundiges (n=140) wat direkte verpleegsorg lewer (teikengroeppopulasie N=672) is gebruik as deelnemers in die studie. Verpleegdiensbestuurders (n=18) is ook gebruik as deelnemers en gekies deur nie-waarskynlike, doelbewuste steekproefneming (teikenpopulasie N=21). ’n Self-toegepasde vraelys is ontwerp, met insluiting van ‘n geldig verklaarde Besluitnemende Betrokkenheidskaal (Havens & Vasey, 2003:333). ‘n Loodsstudie om die geldigheid van die selfontwerpte deel te bepaal, is voltooi Numeriese data is ontleed deur middel van STATISTICA v. 11.5. Oop-einde vrae is ontleed en in kategorieë georganiseer. Daar is gevind dat geregistreerde verpleegkundiges wat direkte pasiëntsorg lewer, laer vlakke van werklike en verkose betrokkenheid het in besluitneming, wat aandui dat die outoriteit vir besluitnemende betrokkenheid by bestuurders lê. Die hipotese dat bemagtigende gedeelde bestuurstrukture tot ‘n hoë vlak van deelneming in besluitneming sal lei, word nie ondersteun nie. Daar was nie ‘n beduidende statistiese verskil tussen geregistreerde verpleegkundiges wat by die bed betrokke is en verpleegdiensbestuurders met algehele waarnemingsbetrokkenheid by besluitneming nie. Geïdentifiseerde faktore wat ‘n rol speel by betrokkenheid by besluitneming behels opvoedkundige vlak, ondervinding, leierskapstyle, die werkomgewing en ‘n kultuur van gedeelde besluitneming. Daar word aanbeveel dat aktiwiteite waarby geregistreerde verpleegkundiges wat direkte pasiëntsorg lewer, verkies om meer betrokke by te wees tydens besluitneming, aangespreek word. Terselfdertyd moet geïdentifiseerde faktore wat ‘n rol speel in die betrokkenheid van besluitneming van alle geregistreerde verpleegkundiges ook aangeroer word.

The study is undertaken for a more compressive understanding for organizational theory and its applicability to tendency towards improvisation during emergency times among individuals in Non Profit Organizations (NPOs) in Saudi Arabia. The analysis involved an examination of direct effect of learning on tendency towards improvisation and possible mediating effects between organizational learning and tendency towards improvisation among individuals in NPOs, while controlling for key demographic differences (e.g. individuals’ age, education level and years in service, number of full-time staff and volunteers). Self-administered questionnaires were distributed to full-time employees in 13 NPOs in three cities in the western area of Saudi Arabia, namely Jeddah, Makkah and Madinah (N= 304). The main statistical method employed to hypotheses examination was Structural Equation Modeling. The hypothesis examination resulted in three out of five hypnotized paths are to be significant. Two direct relations were interpreted as outcomes of organizational learning, with increases in the level of organizational learning is being positively related to individuals’ self –efficacy and agility. The third significant path interpreted as individuals’ agility is positively related to their tendency to improvise during emergency times, which indicates organizational learning has indirect effect on tendency towards improvisation. Finally, the applicability of organizational learning theory to the field of emergency management and suggestions for future research in light of the findings of this research are also discussed.

Thesis (MCur)--Stellenbosch University, 2015.
ENGLISH ABSTRACT: Disruptive behaviour among health care providers in high stress areas such as the perioperative setting has been linked to negative patient safety. Conflicts of power, role and personality lead to communication failure, which are identified as the leading root cause of medication errors and wrong site surgery. The aim of the study was to explore and describe the factors underlying registered nurse (RN) interactions in a tertiary healthcare perioperative area. A non-experimental, descriptive, exploratory study with self-administered survey using a quantitative approach was used. The total population of N=52 participants working in the perioperative area of a Middle Eastern tertiary healthcare centre were invited to participate in the study and the response rate was n=44, 85%. A structured self-administered questionnaire was used to collect the data. Reliability and validity was assured by means of a pilot study and consultation with nursing experts and a statistician. The Health Research Ethics Committee of the University of Stellenbosch approved the study. Permission for the study to be done in the tertiary care centre was obtained from the Internal Ethical Review Board and the Nursing Executive. Informed written consent was obtained from the participants. Anonymity and confidentiality was respected. The data was analysed with the assistance of a statistician and presented in frequencies, tables and histograms. The responses were compared using Mann-Whitney U test, Kruskal- Wallis ANOVA and Spearman’s Rank correlation, on a 95% confidence level. Only one factor showed a significant result, following Spearman’s Rank correlation that an association exists between work experience and lateral violence (p≤0.045239). The open-ended questions were categorized into themes and respect and communication emerged as factors necessary in teamwork and task management The level of respect and open communication between RNs were seen as important factors for interacting with colleagues in the workplace and if poor, affects team work. An area of concern was the high number of neutral responses to the statements on morale and conflict. Underpinned by the literature and the outcomes of this study, it is recommended that strong leadership is required to implement regular team building activities. Furthermore, perioperative staff should be monitored for emotional fatigue which results from conflict situations in order to avert adverse patient care events.
AFRIKAANSE OPSOMMING: Steurende gedrag onder gesondheidsorgwerkers in hoë gespanne areas soos in die perioperatiewe omgewing, word gekoppel aan negatiewe pasiënt veiligheid. Konflikte van mag, rol en persoonlikheid lei tot mislukking van kommunikasie wat geïdentifiseer word as die hoofoorsaak van foute by die toediening van medikasie en verkeerde plek vir chirurgie. Die doel van die studie was om die faktore te ondersoek en te beskryf wat onderliggend is aan geregistreerde verpleeg (GV) interaksies in ’n tersiêre gesondheidsorg perioperatiewe area. ’n Nie-eksperimentele, beskrywende, ondersoekende studie met ’n self-administrerende opname deur ’n kwantitatiewe benadering, was gebruik. Die totale populasie van N=52 deelnemers wat in die perioperatiewe area van ’n Midde-Oosterse tersiêre gesondheidsorgsentrum werk, was uitgenooi om deel te neem aan hierdie studie en die responskoers was n=44, 85%. ’n Gestruktureerde self-administrerende vraelys was gebruik om die data te kollekteer. Betroubaarheid en geldigheid was verseker deur die gebruik van ’n loodsprojek en konsultasie met verpleegdeskundiges, asook ’n statistikus. Die Gesondheidsnavorsingsetiekkomitee aan die Universiteit van Stellenbosch het die studie goedgekeur. Toestemming vir die uitvoer van die studie by die tersiêre gesondheidssentrum was verkry van die Interne Etiese Oorsigraad en die Uitvoerende Verplegingsbestuur. Ingeligte geskrewe toestemming was verkry van die deelnemers. Anonimiteit en vertroulikheid was gerespekteer. Die data was geanaliseer met die hulp van ’n statistikus en aangebied in frekwensies, tafels en histogramme. Die response was vergelyk deur van Mann-Whitney U-toets, Kruskal-Wallis ANOVA of Spearman se Rangkorrelasie op ’n 95% vertroulikheidsvlak gebruik te maak. Slegs een faktor het ’n beduidende resultaat getoon, dat daar ’n assosiasie bestaan tussen werkservaring en laterale geweld (p≤0.045239), deur Spearman se Rangkorrelasie te volg. Die ope-vrae was gekategoriseer in temas. Respek en kommunikasie het as noodsaaklike faktore vir spanwerk en taakbestuur na vore gekom. Die vlak van respek en ope kommunikasie tussen geregistreerde verpleegsters was gesien as belangrike faktore vir interaksie met kollegas in die werkplek en indien dit swak is, affekteer dit spanwerk. ’n Area van besorgdheid was die hoë aantal neutrale response op die stellings oor moraal en konflik. Ondersteun deur die literatuur en die uitkomste van die studie, word dit aanbeveel dat sterk leierskap vereis word om gereelde spanbou aktiwiteite te implementeer. Verder behoort perioperatiewe personeel gemonitor te word vir emosionele moegheid wat spruit uit konfliksituasies, ten einde nadelige pasiëntsorg af te weer.

Thesis (MCurr)--Stellenbosch University, 2013.
ENGLISH ABSTRACT: Saudi Arabia has experienced a number of changes due to revolutionary new findings and technologies, discoveries and new research in the health care arena, which has proven and contradicted a new approach to health care delivery. Demands by patients who have become more educated, the emergence of new or modern disease profiles which demand a new way of approach and a quickening in the pace of change, hurled unfamiliar and often demanding and challenging conditions at management One such change, as addressed in this study, is the change from a paper-based patient record system to a computer based patient information system to which all healthcare professionals in the multidisciplinary team had access to. However, not all change is welcomed, accepted or viewed as necessary by those who have to carry out or use new technologies. Change is harsh, and part of the problem is identifying factors that influence change initiatives. This study addresses the perceptions of nursing personnel of the process of change from a paper-based to a computer based (Quadramed) patient record system. The study design used a quantitative and descriptive approach in which a structured, self-designed questionnaire was used to obtain data from 117 professional nurses at a selected healthcare facility in the Eastern province of the Kingdom of Saudi Arabia. The theoretical framework used for this study was the Model for Change Management as designed by the Prosci Institute for Research, also referred to as the ADKAR Model of Change Management (Awareness, Desire, Knowledge, Ability and Reinforcement). The major findings of this study revealed that 97.44% of the respondents were non-Saudi individuals, and were mainly from the Philippines (69.24%), with (95.65% being female with an average age of 37-42 years. Most (47%) were in possession of specialty qualifications in medical, surgical nursing and experience between 8-10 years, of which 2-3 years had been in Saudi Arabia. In regard to 61.3% of the respondents it was found that they had no prior knowledge of computerised patient records. The nurse managers played a vital role in providing the most information and support to adjust to the system. With reference to the aspect of patient safety, positive feedback about the QCPR was provided by the majority of respondents. Most of the respondents experienced change positively, and 70% indicated that being involved played a major role in their positive attitude. Recommendations include that reasons for change should be more clearly communicated, suggestions for change should be valued more by managers and rumours and uncertainties about change should be addressed as and when appropriate.
AFRIKAANSE OPSOMMING: Saoedi-Arabië het 'n aantal veranderinge ondervind as gevolg van revolusionêre nuwe bevindings en tegnologie, ontdekkings en nuwe navorsing in die gesondheidsorg arena, wat 'n nuwe benadering tot die lewering van gesondheidsorg bewys en weerspreek. Eise deur pasiënte wat meer geletterd is, en nuwe en moderne siekte profiele eis 'n nuwe benadering tot verandering. Die versnelling in die tempo van verandering is dikwels onbekend, veeleisend en uitdagende vir die bestuur van gesondheidsinstellings. Een so 'n verandering, soos dit in hierdie studie aangespreek word, is die verandering van 'n papier-gebaseerde na 'n rekenaar-gebaseerde pasiënt inligting stelsel wat aan alle lede van die multidissiplinêre gesondheidsorg span toegang verleen. Nogtans word nie alle verandering verwelkom, aanvaar of as nodig beskou deur diegene wat die dienste uitvoer of die nuwe tegnologie moet gebruik nie. Verandering is gekompliseerde proses, en deel van die probleem is die identifisering van faktore wat 'n invloed op die veranderings inisiatiewe het. Hierdie studie fokus op die persepsies van die verpleegpersoneel tydens die proses van verandering van 'n papier-gebaseerde tot 'n rekenaar gebaseerde (Quadramed) pasiënt rekord stelsel. Die studie-ontwerp gebruik 'n kwantitatiewe, beskrywende benadering wat 'n gestruktureerde, self-ontwerpte vraelys gebruik om data te verkry van 117 professionele verpleegsters by 'n geselekteerde gesondheidsorg fasiliteit in die Oostelike Provinsie van die Koninkryk van Saoedi-Arabië. Die teoretiese raamwerk wat gebruik word vir hierdie studie was die model vir veranderingsbestuur soos ontwerp deur die Prosci Instituut vir Navorsing, waarna ook verwys word as die “ADKAR Model of Change Management” (Awareness, Desire, Knowledge, Ability and Reinforcement). Die belangrikste bevindings van hierdie studie het aan die lig gebring dat 97,44% van die respondente was nie-Saoedi-individue nie, en was hoofsaaklik van die Filippyne (69,24%), met (95,65%) vroue met 'n gemiddelde ouderdom van 37-42 jaar. Die meeste (47%) was in besit van gespesialiseerde kwalifikasies in mediese, chirurgiese verpleeging. Die meeste van die respondente het tussen 8-10 jaar ervaring in verpleegkunde gehad, waarvan 2-3 jaar in Saoedi-Arabië was. Met betrekking tot 61,3% van die respondente dit is gevind dat hulle geen vorige kennis van die gerekenariseerde pasiënt rekords gehad het nie. Die saal bestuurder het 'n belangrike rol gespeel in die verskaffing van die meeste inligting en ondersteuning om aan te pas tot die nuwe stelsel. Met verwysing na die aspek van die veiligheid van pasiënte, is positiewe terugvoer oor die QCPR voorsien deur die meerderheid van die respondente. Die meeste van die respondente het ook die verandering positief ervaar, en 70% het aangedui dat hul betrokkenheid 'n belangrike rol gespeel het in hul positiewe gesindheid. Aanbevelings sluit in dat die redes vir verandering duidelik gekommunikeer behoort te word, voorstelle vir verandering moet erkenning kry deur bestuurders en gerugte en onsekerhede oor verandering moet aangespreek word soos en wanneer toepaslik.

Aim. This study aimed to explore factors influencing health practitioners’ work performance. This knowledge will facilitate development of appropriate support and education for health practitioners in delivering quality healthcare. Design and participants. A mixed method exploratory descriptive study using cross-sectional methodology was used to gather relevant data and obtain an overview from 60 health workers and 40 health managers in health facilities operated by the Ministry of Health (MOH) in Jazan region, Saudi Arabia. Survey questionnaire followed by selected unstructured interviews to gather data were used. Descriptive statistics, particularly the percentage and weighted mean (Wm) were used. Findings: Results showed that a typical health practitioner in Jazan, KSA has a mean age of 31.17 (health workers) and 28 (health managers). Majority are female (68.33% health workers; 85% health managers) and from other Asian countries. Most have Diploma in Nursing/Midwifery (46.67% health workers; 55% health managers) as educational qualification. Many of them are charge nurses (41.67%). The average number of years they have worked is 6.92 years for the health worker and 12.63 years for the health managers. The health workers showed agreement on the utilization of performance appraisal in their unit (Wm=3.66); however, they were uncertain on their appraisal regarding remuneration, benefits, and recognition (Wm=3.30) as well as uncertain on staffing and work schedules (Wm=3.01) and staff development (Wm=2.39). Factors affecting their work performance were generally intermediate in nature (Wm=2.39), but shortage of staff specifically was a major factor (Wm=3.27). They perceived the strategies to improve and maintain excellent performance as moderately needed (Wm=2.23). Health managers were often involved in management tasks (Wm=2.89) and they assessed their skills as “Good” (Wm=3.63). Conclusion. Many of the health practitioners in Jazan are predominantly younger, female expatriates. They encounter issues in their job and in management that may affect their work performance. Addressing these issues is necessary to assist their development and support work performance. The strategic plan developed from these results will support the education and training of these health practitioners and will be implemented and evaluated.

Background and Objectives: While trauma is currently the second leading cause of death in Saudi Arabia, little statistical information is available about injury rates and related patient outcomes. There is a need to understand trauma epidemiology to determine strategies that can be put in place to prevent and treat such trauma. We aimed to describe trauma rates, types of injuries, demographic distribution of injury and body regions affected by trauma in King Fahad Hospital in the city of Medina. Methods: The study was undertaken in King Fahad Hospital, the first multi-speciality reference hospital in the Medina region and the only trauma centre in the city. We collected retrospective data on all the trauma victims who visited the Emergency Department from 1st January to 31st December 2018. Simple descriptive statistics were calculated. Trauma mortality was compared with trauma scores with Receiver Operator Curves. Results: During the study period, 8793 patients were evaluated, 5846 (66.5%) males. The mean age was 27.5 years. 5608 (64%) were admitted in one of the in-hospital departments and rest were referred to OPD. Traffic-related injuries (4086; 46.5%) and falls (2993; 34%) were the most common causes of injury. Extremities injury (5929; 67.5%) was recorded as the most common body part. From the in-hospital patients, 5077 (90.5%) were discharged home and 167 (3%) died. Considering the mortality prediction accuracy of RTS and NTS. The RTS score of ≤9 had sensitivity and specificity of 90.2% and 90.4%, respectively, in predicting mortality in >5-year-old patients. NTS score of ≤13 had 90% sensitivity and 97.3% specificity in predicting mortality in the age group of 0-5 year-old. Conclusion: This descriptive study is a crucial step in addressing the burden of trauma in Saudi Arabia. Information related to the characteristics of injuries and relevant patient 2 outcomes may assist in further research into possible causal factors. It may contribute to the creation of new protocols in preventing and managing injuries more efficiently.

The global increase in the number of mass gatherings and crowded events has brought with it new emergencies and unintended consequences for public administrators and first responders. Crowd managers attempt to overcome these challenges by enhancing operations, alleviating financial losses, keeping event organizers safe from liability and, most importantly, keeping the attendees safe. Effective communication among and between officials and guests has been identified as a key element in this process. However, there is a lack of risk communication studies, especially about heterogeneous crowds that congregate at religious events. With this gap in mind, this research aims to investigate the use of major communication channels available and/or preferred by Muslim pilgrims in Makkah, Saudi Arabia during Hajj to gauge their effectiveness in communicating risk information. This annual religious pilgrimage was chosen because it attracts over 2 million pilgrims from more than 140 countries, most of whom speak different languages and belong to different cultures but perform the same rituals at the same time. This dissertation seeks to answer three broad research questions: “what are the most popular communication channels used by pilgrims,” “what are the weaknesses of the current communication strategies,” and “what can be done to improve risk communication among pilgrims, and between pilgrims and authorities to enhance crowd control and crowd management strategies.” The protective action decision model (PADM) is used as the theoretical framework to understand the influence of six factors (environmental cues, social cues, information sources, channel access and preferences, warning messages, and receiver characteristics) on risk communication. In collaboration with the Transportation and Crowd Management Center of Research Excellence (TCMCORE) of Saudi Arabia, a convenience sampling strategy was employed to interview 348 pilgrims in the Prophet’s Mosque area, during the Hajj of 2013. The surveys were conducted in Arabic and English and included pilgrims from different backgrounds and countries. Data analysis included an evaluation of the correlation between the use of risk communication channels and receiver characteristics, message content, and information sources. Findings highlight low percentages in the overall use of communication channels. It also demonstrated an over-dependence on channels that foster the passive top-down communication strategy (such as TV stations, messages at mosques, billboard, text messages, and pamphlets), while marginalizing channels that foster the horizontal and bottom-up strategies (such as bilingual staff outreach and social media). The findings also show the differences in risk communication channels used by pilgrims from different socio-demographic groups. The study concludes that adopting bottom-up and horizontal strategies is key to effective risk communication. Additionally, crowd managers must recognize the importance of social media and use this medium more proactively. They can also work towards increasing the overall effectiveness of risk communication channels by addressing the impact of information sources, channel access, and receiver characteristics to better suit the needs of pilgrims. Finally, the study states the limitations and future research directions.

Thesis (MCurr)--Stellenbosch University, 2013.
ENGLISH ABSTRACT: Healthcare organizations have implemented numerous safety initiatives to address errors due to the impact on the patient, families, healthcare provider and the organization as highlighted in the Institute of Medicine report. However, error identification, reporting and management remain a challenge. Nurses have been identified as the healthcare provider with the greatest potential for errors. Supportive work environments are needed to provide optimal care to the nurse who makes an error; which may be minor to severe repercussions. The patient is identified as the first victim and the nurse who makes the error as the second victim. How nurse errors are reported, managed and disclosed is dependent on the response of leaders and peers which may be in a shame and blame or just culture approach. The aim of the study was to assess error management in nursing amongst registered nurses working in a tertiary hospital in Saudi Arabia. The objectives were to identify the occurrence of nursing related errors, determine the current process of reporting nursing errors, describe the management of nursing errors and explore the factors impacting on the management of nursing errors. The research methodology for this study was a descriptive, quantitative approach which is applicable when exploring the unknown. Ethical approval was obtained from the Ethics Board, University of Stellenbosch and the Institutional Review Board, King Faisal Specialist Hospital and Research Centre (General Organization) -Jeddah (KFSH&RC-J). The population was registered nurses working in KFSH&RC-J and assigned to the job descriptions of Staff Nurse 1&2, Clinical Nurse Coordinators and Assistant/Head nurses. Sample was selected using proportional allocation for nationality and simple random selection for nursing specialty; 215 RNs from these three groups. Data was collected using a questionnaire developed by the researcher and analysis completed using SPSS and regression analysis to identify factors which influences the reporting and management of errors. Data was presented in the form of frequency tables and graphs using the EXCEL program to analyze the data. The main findings of the study; there was significant difference in nurse leaders and professional nurses ability to identify nursing errors; questioning of the practice of peers, views of a non-punitive environment and the ability to differentiate between error and negligence. The nurse executive was positively associated with the average positive responses received. RNs of Middle Eastern nationality and the Adult nursing division were found to be slightly more negative in their perceptions about error reporting and management than other respondents. Improvements are needed in the processes of error reporting and management which include education; leadership development, underreporting of errors, feedback and communication, nurse manager support and disclosure of errors. Recommendations are the implementation of the Just Culture principles within the organization and leadership development to address error reporting and management. The need to develop a national database for error reporting in Saudi Arabia is recommended. Nursing errors occurred in one tertiary hospital in Saudi Arabia and an on-line system is available to report errors. However, nurses do not report errors as they fear being blamed and shamed. The process of error management within the organization has not been clearly defined.
AFRIKAANSE OPSOMMING: Gesondheidsorganisasies het talle veiligheids inisiatiewe geïmplementeer om foute aan te spreek weens die invloed wat dit het op die pasiënt, families, die gesondheidsverskaffer en die organisasie soos uitgelig in die Mediese Verslag van die Instituut. Nietemin, die identifisering van foute, verslaggewing en bestuur bly ’n uitdaging. Verpleegsters is geïdentifiseer as die gesondheidsverskaffers wat oor die grootste potensiaal beskik om foute te begaan. Ondersteunende werkomgewings word benodig om optimale sorg aan die verpleegster te verskaf wat ’n fout van ’n mindere aard tot die met ernstige gevolge begaan. Die pasiënt word geïdentifiseer as die eerste slagoffer en die verpleegster wat die fout begaan as die tweede slagoffer. Die manier hoedat verpleegfoute gerapporteer, bestuur en openbaar gemaak word, is afhanklik van die reaksies van leiers en portuurgroepe wat ’n skaamte- en blameerbenadering of “just culture”-benadering kan wees. Die doel van die studie was om die hantering van verpleegfoute tussen geregistreerde vepleegkundiges wat in n tersiêre hospital in Saudi werk te ondersoek. Die doelwitte is om die voorkoms van verpleegverwante foute te identifiseer, die huidige proses van verslaggewing van verpleegfoute te bepaal, die bestuur van verpleegfoute te beskryf en die faktore te ondersoek wat ’n impak het op die bestuur van verpleegfoute. Die navorsingsmetodologie vir hierdie studie is ’n beskrywende, kwantitatiewe benadering wat van toepassing is wanneer die onbekende ondersoek word. Etiese goedkeuring is verkry van die Etiese Raad aan die Universiteit Stellenbosch en die Institusionele Beoordelingsraad, King Faisal Specialist Hospitaal en Navorsingssentrum (Algemene Organisasie) – Jeddah (KFSH & RC-J). Die teikengroep is geregistreerde verpleegsters wat werk in KFSH & RC-J aan wie die posbeskrywing van stafverpleegster 1 & 2 toegeken is, Kliniese Verpleegkoördineerders en Assistent/Hoofverpleegsters. Die steekproef is geselekteer deur gebruik te maak van proporsionele toekenning vir nasionaliteit en ’n eenvoudige ewekansige steekproef vir verpleegspesialiteit; 215 geregistreerde verpleegsters van hierdie drie groepe. Data is gekollekteer deur gebruik te maak van ’n vraelys wat deur die navorser ontwikkel is en die analise is voltooi deur gebruik te maak van SPSS en regressie-analise om faktore te identifiseer wat verslaggewing en bestuur van foute beïnvloed. Data is aangebied in die vorm van frekwensie-tabelle en grafieke deur gebruik te maak van die EXCEL-program om die data te analiseer. Die vernaamste bevindinge van die studie is dat daar beduidende verskille tussen verpleegleiers en professionele verpleegsters se vermoë is om verpleegfoute te identifiseer; bevraagtekening van die praktyke van portuurgroepe; beskouinge van nie-strafgerigte omgewing en die vermoë om te onderskei tussen foute en nalatigheid. Die verpleegeksekuteur is positief geassosieer met die gemiddelde positiewe response wat ontvang is. Geregistreerde verpleegsters van Midde-Oostelike nasionaliteit en die Volwasse Verpleegafdeling is gevind om effens meer negatief te wees in hulle persepsies van fouteverslaggewing en bestuur, as ander respondente. Verbeterings is nodig in die prosesse van verslaggewing van foute en bestuur daarvan wat opvoeding daarvan insluit; leierskapontwikkeling, onderverslaggewing van foute, terugvoer en kommunikasie, ondersteuning van verpleegbestuur en bekendmaking van foute. Aanbevelings is die implementering van die “Just”-kultuur beginsels binne die organisasie en leierskap ontwikkeling om die verslag van foute en bestuur aan te spreek. Die behoefte om ’n nasionale databasis te ontwikkel vir die verslag van foute in Saoedi-Arabië word aanbeveel. Verpleegfoute het in een tersiêre hospitaal in Saoedi-Arabië plaasgevind en ’n aanlyn sisteem is beskikbaar gestel om foute te rapporteer. Nietemin, verpleegsters rapporteer nie foute nie, want hulle vrees om geblameer te word en beskaamd te staan. Hierdie proses van foutebestuur binne die organisasie is nog nie duidelik gedefinieer nie.

Background: Since the 1980s, Saudi Arabia’s socio economic transformation has led to vast social development. As a result there has been increased adoption of behaviours such as smoking and sedentary life styles, which pose a risk to health. It is anticipated that cancer incidence will double over the next two decades and it is thus vital that high quality of care is provided to meet the growing health care demands. Moreover, it is important that patients are satisfied with their care provision. This thesis begins with a narrative synthesis of the existing literature about patient satisfaction in the Saudi context and beyond. An evaluation of the key concepts for understanding patient satisfaction illuminated the lack of evidence about the assessment of patient satisfaction including specific key domains of the structure and process of care. This evaluation also indicated the need to further investigate the Saudi patient perspectives in oncology hospital setting. The aim of my study was to examine the extent to which clinical effectiveness impacts upon patient satisfaction in oncology ward settings in the Kingdom of Saudi Arabia (KSA). Methods: A sequential explanatory mixed methods design was employed. The Donabedian quality framework (1980) and Patient experience model (Reimann and Strech 2010) were used to assess patient satisfaction with quality of care provided. A quantitative phase was followed by a qualitative phase. In the first phase, the European Organisation for Research and Treatment of Cancer (EORTC) IN-PATSAT32 validated questionnaire was used to collect data from 100 adult oncology inpatients at a Cancer Centre in Riyadh. The second qualitative phase involved semi-structured telephone and face to face interviews with 22 adult oncology inpatients who previously answered the questionnaire. Synthesis occurred at the intersection of quantitative Phase 1 and qualitative Phase 2 data. The qualitative Phase 2 thus further explored the satisfaction scores of quantitative Phase1 to deepen the understanding of patient satisfaction in oncology ward settings in KSA. Findings: The main findings were that patient satisfaction levels are influenced by the clinical effectiveness of doctors and nurses, accessibility to health care and socio-demographic factors. Specifically, the interpersonal aspects of care were deemed core to patient experiences in oncology ward settings in KSA. It emerged that doctor-patient relationships, nurse shortages and language barriers are particular areas where changes could be made to improve care, thereby enhancing patient satisfaction. These findings contribute important new insights into the interpersonal aspects of care in the light of the underlying social and cultural contextual factors that influence patient satisfaction in the KSA. Conclusion: This study has provided new evidence supporting the need for stronger interpersonal relations and a more patient-centred approach in the oncology health system in KSA. In particular, the influential role of cultural issues in influencing patient satisfaction in oncology ward settings was apparent. Evidence provided by this research will make a substantial contribution to policy makers and hospital management teams in the KSA wanting to improve patient satisfaction in oncology wards and in other health care settings.

Quality care in intensive care units is expected by patients and is mandatory for nurses and other health professionals to provide. In Saudi Arabia, the demand for intensive care units (ICUs) is growing rapidly, partly due to the high levels of road trauma and a population increase. In response to these issues, the government has increased the number of ICU beds in some public tertiary regional hospitals. A corresponding increase in patients and a shortage of specialized nurses has major implications for nurses’ ability to provide quality care. In the Western world there is comprehensive literature related to research and factors that influence nursing care. To date, however, no such study has been conducted in an ICU in Saudi Arabia. The purpose of this study was, therefore, to explore and describe factors that influence nursing care in a Saudi Arabian ICU. Additionally, since clinical governance has been described as a structured system for promoting quality care and health service planning, a further aim was to describe the findings within this framework.This study employed a single exploratory descriptive case study using a qualitative approach. Data were collected from various sources with thematic analysis being used to establish themes that emerged from the data. The proposition taken in this case study was that multiple factors influence the quality care registered nurses provide in an ICU setting. It was an assumption that these factors would be both internal and external to the ICU. Findings from this study concurred with this assumption uncovering multiple, complex and interrelated factors that influenced the quality of nursing care in the ICU. It also uncovered factors which were located in the conduit between the internal and external environment: namely intermediate factors. The environment was seen as: direct factors that immediately affected nurses and their ability to provide quality care; intermediate factors were those that encapsulated regular, but intermittent elements; and indirect factors related to elements external to the ICU. Within each of these categories themes and sub-themes emerged. Themes in the direct factors were Continuance: with sub themes of Shift work arrangement, Workload, Collegiality, and Unit management. Burden of responsibility: with sub themes of Educational preparation and Availability of Resources. Proximity: emerged as a theme which related to being close contact with patients.Themes in the intermediate factors were: Relationships with superiors, as well as Policies and protocols. Themes in the indirect factors were: Leadership and bureaucracy, Quality management, and Ongoing education. Together these factors had a profound influence on the quality of nursing care in the ICU. Some had distinctive characteristics whilst others overlapped and were interrelated clarifying and explaining aspects of the complex open system in which nursing care was provided. It is anticipated that these findings will not only have relevance to the ICU in the setting, but also to other hospitals in the Saudi Arabian health care system.

Most undergraduate nursing students receive limited formal education regarding paediatric palliative care. The study employed a sequential explanatory mixed methods design to generate knowledge about how to enhance nursing students' competence in caring for dying children in Saudi Arabia. The study provides evidence of the benefits of well-designed educational programs in enhancing the learning of palliative care and improving students' knowledge, attitudes, and perceived self-competence in this field. Programs which include a mix of both didactic and active learning approaches are recommended. The study also identified a range of sociocultural influences on what competence means in the context of paediatric palliative care in Saudi Arabia and the importance of considering these when designing educational interventions.

The kingdom of Saudi Arabia, like the rest of the world, has a growing older population with urgent health care needs. However little prior research has been undertaken on this topic. In the light of this, the aim of this study was to explore the attitudes, knowledge, willingness and intentions to work with older people among nursing students, and to consider the effects of clinical nursing practice on such factors in the first year and the final (pre-registration) year of training in three major university hospitals. The study was underpinned by the theory of planned behaviour (Fishbein and Ajzen, 1975) which was used as a conceptual framework to explore the relationships between attitudes, subjective norms, perceived behavioural control and behavioural intentions amongst 566 nursing students. The study used a mixed methods design comprising of surveys with the nursing students and 132 faculty members and three focus groups with faculty members to explore their feelings about gerontological education in-depth. The questionnaires contained a range of previously validated instruments including Kogan's Attitude Towards Older People scale, Palmore's Facts on Ageing Quiz, a measure of students' willingness to work with older people and a measure of their perceived intention to work with them. Openended questions were also included. Data were analysed using both multivariate statistics and content analysis. The results provided some interesting and important insights into the complex factors potentially shaping students intentions to work with older people. For example the 566 nursing students who participated in this study displayed a lack of basic knowledge of the physical and behavioural aspects of ageing but held largely positive attitudes towards older people. Despite such positive attitudes a majority of the participants indicated that they would prefer not to work with older people after graduation, although those students who indicated that they would prefer to work with them had the most positive attitudes and the strongest willingness and intent to take care of older people. The data also highlight the potential of clinical training experience with older adults to improve the previous variables (attitudes, willingness and intentions). The qualitative data from both students and teachers highlighted a range of complex factors that in part explained some of the quantitative findings. These related to the influence of subjective norms and perceived control. Therefore at a cultural level Saudi students are exposed to strong positive norms in relation to older people but on entering training may be exposed to negative professional norms as to the status and desirability of gerontological nursing as a career. This, together with students' limited perceived control due to inadequate preparation for practice offer potential explanations as to the disparity between attitudes and behavioural intentions. The qualitative data also highlight the need for greater attention to the preparation of nursing students, with the provision of integrated skills and knowledge on the care of older people. The study also provides a limited critique of the theory of planned behaviour, which whilst supported in part cannot account fully for the complex cultural and professional factors shaping students future career intentions. The thesis, the first of its kind undertaken in Saudi Arabia, concludes with some reflections and suggestions for further research and the actions needed if the preparation of students to work with older people is to improve in the future.

This thesis presents work conducted for a structured doctorate consisting of four main components. The first element is a case study investigating the current practice of mentorship in a clinical setting in Jeddah, Saudi Arabia. The qualitative case study was conducted in a government nursing college and its associated government hospital. Data were collected through individual interviews (2) with nursing coordinators; semi-structured focus groups (8) with mentees (n=3), mentors and clinical educators (n=3), lecturers (n=1) and head nurses (n=1); and finally, documentary analysis. The findings show that neither mentors nor mentees were happy with the current arrangements. Mentees believed that mentorship did not benefit them, and mentors seemed to resent the request to devote time to mentees. Both parties need to approach the other with more empathy, appreciating their difficulties and respecting their individual choices and wishes. Mentors also pointed to a lack of coordination between university and hospital, and both mentors and mentees felt that the mentorship process lacked clarity. Devising and putting into practice a new policy could lead to important positive changes in mentors’ and mentees’ experiences and relationships. The second element of the structured doctorate, undertaken after the case study, is the best evidence literature review. The aim of the review was to examine published studies on mentorship in nursing from the perspectives of both mentors and mentees in order to obtain a holistic view of mentorship experiences. A critical evaluation of these published studies is presented, reviewing the definitions of mentorship in the literature and highlighting the sparse literature on nursing mentorship in Saudi Arabia. Next is a critical overview of the nursing mentorship experiences in Islamic countries. Mentors’ and mentees’ views on mentorship are discussed. The final section summarizes the findings and attempts to use them to answer the literature review questions whilst highlighting the gaps in the literature. The third element is the main study, which emerged from the literature and builds on the case study. It aimed to investigate the factors contributing to positive mentorship experiences in nursing in Jeddah by exploring mentors’ and mentees’ positive experiences. The qualitative study was conducted from the theoretical perspective of appreciative inquiry (AI). Data were collected in semi-structured focus groups (total of six) with mentees (n=3) and mentors (n=3) at three settings. The key contributing factors to positive mentorship experiences and the main themes from data analysis are communication; involvement; encouragement; reciprocity; students’ sense of fear; mentors’ role, including its characteristics, preparation for it and feedback; and organisational-level processes and resources, such as time availability, workload, allocation and college-university collaboration. It is recommended that a consensus definition of mentorship be issued to avoid conflict in roles and expectations, that systems be developed to give mentors time to spend with mentees and that mentors attend a mentorship training programme to gain understanding of the process and be prepared for their role. The fourth element is the dissemination artefact and plan, which communicate the findings to develop education, policy, practice and research. A briefing for stakeholders contains an overview of the study and key findings. An outline of a mentorship training programme and a draft handbook for local use in Saudi Arabia are proposed. The dissemination plan explains how the researcher plans to disseminate the artefact.

Abstract Cancer is one of the main public health problems in the world. People diagnosed with cancer may become depressed and fearful of dying. This causes them to question treatments and sometimes avoid treatment altogether. Cancer may change the person's life and the lives of others around them. The current study focused on the psychosocial impact of impending death for cancer patients in Saudi Arabia. Currently, the relationship between the death anxiety and death depression in persons with cancer in Saudi Arabia is not yet clear. Added to that, little research has been conducted with Muslim cancer patients and their emotional needs. This study explored the relationship between death anxiety and death depression among cancer patients in Saudi Arabia. The study sample consisted of 100 Saudi cancer patients, 50 male and 50 female, ranging in age from 18 to 85 with a mean age of 45.5. All participants completed a survey questionnaire that included three parts: the first part contained a demographic data form; the second part consisted of 20 statements to measure death anxiety using the Arabic Death Anxiety Scale; the third part was a 21-item, questionnaire designed to measure depression about impending death using the Death Depression scale-Revised Arabic version. The results of this study revealed statistically significant correlation between death anxiety and death depression (r= .85, p In addition, in Saudi Arabia health care providers target cancer symptoms and barely address the psychosocial issues. This may be due to a lack of communication between patients and health care providers. On the other hand, providers lack the time to spend with patients and have to treat to great number of patients. Therefore, the results of this study suggest that the health care providers should spend some time with each patient discussing feelings with no boundaries, and try to understand the patients' feelings, and involve them in decision making Death depression and death anxiety are universal feelings and should not be neglected. Consequently, this research may expand the knowledge base about death anxiety and death depression in Saudi Arabia that might lead to intervention that would help to improve patients' quality of life.

Accreditation is recognized worldwide as a tool to improve health care quality. In developing countries, the interest in attaining international accreditation is growing despite the considerable resources the accreditation process consumes and the lack of information about its impact on quality of care. The purpose of this study was to assess the impact of Joint Commission International (JCI) accreditation on health care quality and to explore the contributing factors that affect quality of care as perceived by nurses. The theoretical foundation for this study was based on total quality management theory and Donabedian's model. The research questions for the study examined the impact of JCI accreditation on quality of care and the relationship between quality improvement activities and quality of care. A cross-sectional quantitative design was employed in which a self-administered questionnaire was used to collect data. Participants from one accredited and another nonaccredited hospital in a developing country in the Middle East formed the purposive nonprobability sample that included 353 nurses. The results of a Wilcoxon Rank Sum Test and a correlation analysis indicated that JCI accreditation has a significant impact on quality of care ratings by nurses. Also, multiple regression analysis showed that leadership commitment is the best predictor of quality of care as perceived by nurses. This study may foster social change by encouraging hospital administrators and policy makers, particularly in developing countries, to implement quality improvement programs that will eventually improve the health care system in their countries.

Health system reconfiguration in Saudi Arabia as a response to changing demographics and related health needs is an important and timely driver for the development of nurse education, specifically, the introduction of degree education as a basic requirement for nursing practice. The Saudi government is trying to meet international standards by implementing a change to nurse education by making it an all degree profession. However, as a result, there are many challenges that still need addressing. Utilising a qualitative case study approach, documentary analysis was undertaken and semi-structured interviews were conducted with twenty-five key stakeholders in order to critically assess the actual implications of a nursing degree as the baseline criteria for and to enter nursing practice. The formal and informal documentary analysis indicated that there was a clear lack of involvement from nurses in the consultation process prior to implementing the degree education policy. However, the interviews conducted with nursing staff (at a macro, meso and micro level) indicated general agreement that a Bachelor degree in nursing would further support the knowledge and communication requirements for improving the quality of nursing practice. Factors affecting degree attainment included a personal commitment/passion for self-improvement, private versus government institutions, the quality of programmes of education and financial issues. Data indicated the increased knowledge base gained through degree education, supported a growth in confidence, decreased absenteeism, enhanced nursing skills and responsibilities, and gave opportunity for advancement. More importantly, such benefits increased the quality of nursing practice and patient safety outcomes. Recommendations based on the findings of this study, highlight the importance of a process of consultation between governmental bodies and relevant nursing staff, who are affected by future policy changes. The need for a national curriculum, and a differentiation of nursing job descriptions, based on the education level attained, together with improved clinical supervision for nurses in practice.

A new realm of discourse research has started examining medical interactions in the crowded space – hospitals (Iedema, 2007). Beyond clinical settings and dyadic doctor-patient interactions, scholars have begun investigating doctors’ interactions in various hospital settings including Emergency Rooms and hospitals’ wards (e.g., Eggins & Slade, 2012; Slade & Eggins, 2016; Slade et al., 2015). Other investigations have expanded this scope of discourse research to include other health professionals, such as nurses (e.g., Staples, 2015). Drawing on discourse analytic approaches (Critical Discourse Analysis, Halliday’s Systemic Functional Grammar, and Interactional Sociolinguistics), this study examined nurse-to-nurse handoff interactions in two hospitals in Saudi Arabia. Nursing handoff – the transfer of patient information, professional responsibility, and accountability between departing and incoming nursing teams (Manser et al., 2010; Riesenberg et al., 2010; Slade & Eggins, 2016; Wood et al., 2014) – is a critical communicative practice which ensures the continuity and quality of care provided to hospitalized patients. The aim of this study was to provide detailed analyses of the language used in this type of nursing discourse and its impact on the quality of handoffs. The data included 80 nursing handoff interactions, which were observed and audio-recorded in 7 different wards at two sectors (National Guard Hospital and King Fahad General Hospital) in Saudi Arabia including: Intensive Care Units, General-Adult, General- Pediatric, Oncology-Pediatric, Oncology-Palliative, ENT, Urology and Surgical wards. The nurse participants come from various cultural backgrounds including Philippines, Indonesia, India, Malaysia, Morocco, South Africa, Egypt, Jordan, and Saudi Arabia. The analyses provided a detailed description of this type of nursing discourse including the discourse pragmatic features (i.e., linguistic, interactional, and interpersonal features) which nurses use while delivering and receiving patient information. In addition, the findings provide insights into the various discourse features that contributed either positively (e.g., using discourse markers, presenting complete thoughts, presenting sufficient detailed patient information) or negatively (e.g., producing questions instead of statements, shifting verb tenses, focusing on one patient issue as opposed to providing detailed patient information report) to the nursing handoff practices in this setting. The findings also point to the vital role that head nurses play in this nursing discourse and its impact on enhancing the quality of nursing handoffs. Additionally, a six-stage nursing handoff model was developed from the data, which could be used for nursing training in the National Guard Hospital and its branches in Saudi Arabia. Finally, the findings provide further support for Eggins and Slade’s (2012) claim that communicatively effective handovers are achieved interactionally and with the collaboration of both departing and incoming teams. Furthermore, the use of standardized protocols (like SBAR) alone proved to be insufficient in guaranteeing effective nursing handoff.

This study addressed three research objectives related to non-Muslim nurses’ experiences providing health care to Muslim patients in Saudi Arabian hospitals. These objectives included: first, understanding what it is like to care for Muslim patients considering both religion and culture; secondly, exploring what it is like being cared for by non-Muslim nurses. In order to address these objectives, the study has employed a qualitative approach, represented in hermeneutic phenomenology. The target groups in this study were Muslim patients and non-Muslim nurses who were interviewed using interviews and focus group discussions. The study found that religious, cultural and linguistic factors have a negative effect on non-Muslim nurses’ experience of care in Saudi Arabia, which included a personal impact, and a practical impact resulting from working practices. However, the results indicated that nurses had some problems with family members who interfered in decisions related to patients, and that they also encountered disrespect from patients’ relatives and friends. The study results indicated that non-Muslim nurses, to some extent, have an understanding of the different aspects and practices of Islam, such as praying, fasting and spirituality. The study results also revealed a significant relationship between spirituality (Islamic faith) and the provision of health care. Nurses believe that religious and spiritual practices have an effect on care. However, they failed to understand the importance of religion and spirituality to Muslims in general and patients in particular. The lack of training and orientation concerning specific issues of religion and culture negatively affected not only the communication between nurses and patients, but also the provision of health care. It was envisaged that this study would have a positive impact on the delivery of nursing training and education, because it highlights the need to tailor this to specific contexts. The study distinguishes itself from other studies conducted in the same field by investigating non-Muslim nurses’ and Muslim patients’ confusion between religion and culture. The study stressed an overlap between religion and culture in Saudi society, which consequently affected nurses’ provision of health care. It was essential in this study to investigate the differences between religion and culture, to see of non-Muslim nurses would understand religion and culture are not the same; while in some cases they complement one another, in other cases they contradict. Furthermore, the study addressed the issue of professionalism when caring for Muslim patients’ and non-Muslim nurses’ point of view. Although nurses claimed to provide healthcare in professional way, they were not fully aware of Saudi local culture or the impact of religion on patient’s daily life It can be concluded, in general, that non-Muslim nurses are facing challenges to providing healthcare to Saudi Muslim patients, due to a lack of understanding of the importance of cultural values and religious practices, and the lack of training and alignment on such issues.

The current study projects the third-person perception phenomenon into the area of emergency management, specifically regarding risk communication in the context of religious gatherings. This study utilized the Umrah religious gathering in Makkah, Saudi Arabia, during summer 2019 as a case study (N = 257). This study aimed to investigate whether pilgrims perceive there was a greater effect of health information on others than on themselves. Survey results were translated and then coded and analyzed statistically using SPSS software. The findings indicated that third-person perception existed among pilgrims. Specifically, the perception of pilgrims that the influence of news about MERS-CoV, believed to be undesirable in its effect on themselves, was greater on others than on themselves was found statistically significant. Further, the findings indicated that the more pilgrims watched, listened to, or read news about MERS-CoV, the larger the effect of the news they perceived on themselves and others was. Thus, exposure to MERS-CoV news did not increase, but rather decreased the perception of difference between self and others. Also, the empirical findings indicated that pilgrims who were knowledgeable about MERS-CoV could relate to the coverage. Moreover, if pilgrims believed they were affected by MERS-CoV news, they believed that the MERS-CoV news had a similar or greater effect on other pilgrims. The findings indicated socio-demographics had a partial effect on third-person perception, Finally, the stronger the perceived effect of MERS-CoV news on oneself, the more likely these pilgrims were to take protective actions against the MERS-CoV epidemic. However, the third-person perception anticipated in the use of impersonal communication (pamphlets, television, radio, newspapers, Internet, social media, text message, health clinics, mosques messages, public events, and billboards) and of interpersonal communication (friends, family member, or others you know) was not found significant. Moreover, the perceived effects of MERS-CoV news on others did not show third-person perception regarding behavior intention or consequences. These findings have implications for risk communication and its governance during religious gatherings as well as for the prepared individuals to promote preparation for risk and actions toward risk mitigation.

Muslim majority societies' religious perspective towards nursing as a predominantly female profession has been suggested as one possible reason behind the nursing shortage and problems of retention. A literature review indicated that no research has been directed toward student nurses' pre-registration experiences in the Kingdom of Saudi Arabia. Therefore this study looked at the experiences of Saudi student nurses to explore the extent to which student nurses' experiences during pre-registration education impacted on their decision to choose nursing as a future career following exposure in the clinical environment. An ethnographic and interpretive phenomenological approach was adopted. Purposeful sampling was used to include Saudi and non-Saudi, 32 female and four male participants. Multi-method approach was adopted to collect data over a 12 month period which included face-to-face semi-structured interviews, participant observation, structured telephone interview and documentary analysis. Thematic analysis based on Van Manen's (1997) six research activities was used to analyse data. NVivo (2.0) computer software was utilized to organize, reduce, and inter-relate different data sets to synthesize into a picture of student nurses' experiences. Data and methods triangulation were used to ensure the trustworthiness of the findings. Analysis identified student nurses' feelings over three timeframes: feelings or perceptions during pre- clinical, clinical and post-clinical exposure. The study contributes to the body of knowledge about student nurses' experiences in Saudi Arabia and contributes towards an understanding of how social-cultural aspects and the role of gender impact on student nurses' feelings of nursing as a future career. Findings centre on the nursing stereotypes which remain dominant in Saudi society and socialization within the healthcare environment. These stereotypes and socialization processes allow Saudi society to view nurses from the perspective of their gendered roles which are grounded in the traditional culture of the Islamic world which influence student nurses' socialization in clinical nursing; These factors cause a high level of anxiety that affect student nurses' perceptions of nursing as a future career. The study raises questions about the role of nurse education in resolving student nurses' difficulties in the clinical setting in relation to the nurse's role and its approach to Saudi society as a means to change the public view of Saudi nursing.

Background: While there is much research on work-related stress among nurses in the literature, little attention has been focused on the effect of work-related stress and burnout on nursing performance and job satisfaction in hospitals within Saudi Arabia. In particular, studies from the western region of Saudi Arabia are lacking. Therefore, this study focuses on nurses in Jeddah, the country’s entry port and a city that regularly hosts pilgrims. Jeddah is highly multicultural, and the second largest city in Saudi Arabia with nearly 4 million people including travellers; it has the largest foreigner to citizen population ratio in Saudi Arabia, and a particularly high proportion of hospital nurses non-native to Saudi Arabia. Aim: The aim of this thesis was to identify research gaps and to contribute to existing knowledge by developing hypotheses pertaining to the level of work-related stress and burnout among hospital nurses in different hospital types in Jeddah. The study further evaluated the relationship between work-related stress and burnout, and how this related to nursing performance and job satisfaction. The analysis also examined the relationships between these variables among hospital nurses, and whether relationships are different for different hospital types. Methods: A systematic review of existing research into nursing stress in Saudi Arabia between 2003 and 2014 was carried out. From the 81 articles identified from the database search, 8 met the inclusion criteria. At the onset a pilot study was conducted was done among hospital nurses in King Abdulaziz University. Thereafter, a quantitative survey of 567 nurses derived from three large hospitals representing each sector (private, public and other governmental agency sector hospitals) was conducted. Bilingual questionnaires were used to collect quantifiable, reliable, and valid data in order to test the hypothesis derived from the pilot study. The data was analysed by quantitative research method of cross-sectional analysis and correlational study. Findings: Results showed levels of work-related stress varied among nurses depending on the type of hospital where the nurses were employed. Furthermore, there was a positive relationship between levels of work-related stress and burnout among hospital nurses working in all three types of hospitals in Saudi Arabia. However, there was a very weak relationship between work-related stress and job performance among private hospital (International Medical Center) nurses compared to the strength of this relationship observed in public hospitals. Stress was a significant predictor of burnout among nurses while burnout was the strongest descriptor of the relationship between work-related stress and job satisfaction among nurses. The analysis outcome revealed that work-related stress had the highest impact on job satisfaction, which was facilitated by burnout. Nurses working in the public (King Fahad Hospital) and university (King Abdulaziz University Hospital) hospitals reported high levels of stress and burnout, and also conveyed low levels of job performance and high levels of dissatisfaction compared with nurses working in the International Medical Center (IMC). The type of hospital moderated the effect between burnout and job satisfaction in both King Fahad Hospital (KFH) and King Abdulaziz University Hospital (KAUH) but did not affect the International Medical Center (IMC). The relationship between stress and burnout was significantly stronger in nurses working in the IMC compared with the KFH and KAUH hospitals. However, burnout was not important in the relationship between stress and satisfaction for those who worked in IMC. Therefore, hospital type did appear to moderate the mediation effect between burnout and job satisfaction, even though, the mediation effect occurred only in KFH and KAUH hospitals but not in IMC. Conclusion: The study demonstrated that there is evidence of work-related stress among nurses in Jeddah, Saudi Arabia. Its prevalence depended on the age,experience,nationality and the employment status of the nurses. Work-related stress and burnout impacted negatively on job performance and job satisfaction in nurses in public (KFH) and university (KAUH) hospitals but not in private (IMC) hospitals. Notably, there is a mediated relationship between work-related stress and burnout and a moderated mediation difference between the type of hospitals. Both work-related stress and burnout have shown an effect on the level of job satisfaction of nurses and their job performance. In essence, measures should be taken to help alleviate work-related stress and burnout levels of nurses working in non-privately funded hospitals Saudi Arabia. This study recommends an increase hiring Saudi Arabian nurses, a review of task allocation policies for nurses, provision of targeted training for nurses, increased focused government funds allocation to healthcare, an adoption of an integrated stress prevention intervention and management program throughout the healthcare system of Saudi Arabia.

Purpose: The purpose of this study was to improve the retention of primary healthcare (PHC) nurses through exploring and assessing their quality of work life (QWL) and turnover intention. Design and methods: A cross-sectional survey design was used in this study. Data were collected using a questionnaire comprising four sections (Brooks’ survey of Quality of Nursing Work Life [QNWL], Anticipated Turnover Intention, open-ended questions and demographic characteristics). A convenience sample was recruited from 143 PHC centres in Jazan, Saudi Arabia. A response rate of 87% (n = 508/585) was achieved. The SPSS v17 for Windows and NVivo 8 were used for analysis purposes. Procedures and tests used in this study to analyse the quantitative data were descriptive statistics, t-test, ANOVA, General Linear Model (GLM) univariate analysis, standard multiple regression, and hierarchical multiple regression. Qualitative data obtained from responses to the open-ended questions were analysed using the NVivo 8. Findings: Quantitative findings suggested that PHC nurses were dissatisfied with their work life. Respondents’ scores ranged between 45 and 218 (mean = 139.45), which is lower than the average total score on Brooks’ Survey (147). Major influencing factors were classified under four dimensions. First, work life/home life factors: unsuitable working hours, lack of facilities for nurses, inability to balance work with family needs and inadequacy of vacations’ policy. Second, work design factors: high workload, insufficient workforce numbers, lack of autonomy and undertaking many non-nursing tasks. Third, work context factors: management practices, lack of development opportunities, and inappropriate working environment in terms of the level of security, patient care supplies and unavailability of recreation room. Finally, work world factors: negative public image of nursing, and inadequate payment. More positively, nurses were notably satisfied with their co-workers. Conversely, 40.4% (n = 205) of the respondents indicated that they intended to leave their current employment. The relationships between QWL and demographic variables of gender, age, marital status, dependent children, dependent adults, nationality, ethnicity, nursing tenure, organisational tenure, positional tenure, and payment per month were significant (p < .05). The eta squared test for these demographics indicates a small to medium effect size of the variation in QWL scores. Using the GLM univariate analysis, education level was also significantly related to the QWL (p < .05). The relationships between turnover intention and demographic variables including gender, age, marital status, dependent children, education level, nursing tenure, organisational tenure, positional tenure, and payment per month were significant (p < .05). The eta squared test for these demographics indicates a small to moderate effect size of the variation in the turnover intention scores. Using the GLM univariate analysis, the dependent adults’ variable was also significantly related to turnover intention (p < .05). Turnover intention was significantly related to QWL. Using standard multiple regression, 26% of the variance in turnover intention was explained by the QWL F (4,491), 43.71, p < .001, with R² = .263. Further analysis using hierarchical multiple regression found that the total variance explained by the model as a whole (demographics and QWL) was 32.1%, F (17.433) = 12.04, p < .001. QWL explained an additional 19% of the variance in turnover intention, after controlling for demographic variables, R squared change =.19, F change (4, 433) = 30.190, p < .001. The work context variable makes the strongest unique contribution (-.387) to explain the turnover intention, followed by the work design dimension (-.112). The qualitative findings reaffirmed the quantitative findings in terms of QWL and turnover intention. However, the home life/work life and work world dimensions were of great important to both QWL and turnover intention. The qualitative findings revealed a number of new factors that were not included in the survey questionnaire. These included being away from family, lack of family support, social and cultural aspects, accommodation facilities, transportation, building and infrastructure of PHC, nature of work, job instability, privacy at work, patients and community, and distance between home and workplace. Conclusion: Creating and maintaining a healthy work life for PHC nurses is very important to improve their work satisfaction, reduce turnover, enhance productivity and improve nursing care outcomes. Improving these factors could lead to a higher QWL and increase retention rates and therefore reinforcing the stabilisation of the nursing workforce. Significance of the research: Many countries are examining strategies to attract and retain the health care workforce, particularly nurses. This study identified factors that influence the QWL of PHC nurses as well as their turnover intention. It also determined the significant relationship between QWL and turnover intention. In addition, the present study tested Brooks’ survey of QNWL on PHC nurses for the first time. The qualitative findings of this study revealed a number of new variables regarding QWL and turnover intention of PHC nurses. These variables could be used to improve current survey instruments or to develop new research surveys. The study findings could be also used to develop and appropriately implement plans to improve QWL. This may help to enhance the home and work environments of PHC nurses, improve individual and organisational performance, and increase nurses’ commitment. This study contributes to the existing body of research knowledge by presenting new data and findings from a different country and healthcare system. It is the first of its kind in Saudi Arabia, especially in the field of PHC. It has examined the relationship between QWL and turnover intention of PHC nurses for the first time using nursing instruments. The study also offers a fresh explanation (new framework) of the relationship between QWL and turnover intention among PHC nurses, which could be used or tested by researchers in other settings. Implications for further research: Review of the extant literature reveals little in-depth research on the PHC workforce, especially in terms of QWL and organisational turnover in developing countries. Further research is required to develop a QWL tool for PHC nurses, taking into consideration the findings of the current study along with the local culture. Moreover, the revised theoretical framework of the current study could be tested in further research in other regions, countries or healthcare systems in order to identify its ability to predict the level of PHC nurses’ QWL and their intention to leave. There is a need to conduct longitudinal research on PHC organisations to gain an in-depth understanding of the determents of and changes in QWL and turnover intention of PHC nurses at various points of time. An intervention study is required to improve QWL and retention among PHC nurses using the findings of the current study. This would help to assess the impact of such strategies on reducing turnover of PHC nurses. Focusing on the location of the current study, it would be valuable to conduct another study in five years’ time to examine the percentage of actual turnover among PHC nurses compared with the reported turnover intention in the current study. Further in-depth research would also be useful to assess the impact of the local culture on the perception of expatriate nurses towards their QWL and their turnover intention. A comparative study is required between PHC centres and hospitals as well as the public and private health sector agencies in terms of QWL and turnover intention of nursing personnel. Findings may differ from sector to sector according to variations in health systems, working environments and the case mix of patients.

Disasters are always local in their impact, and therefore approaches towards their alleviation need to be designed and implemented based on this certainty. Since the 1960s there has been a constant evolution in the common understanding of international disaster management. Various measures and structures were created to plan for emergency relief and the management of a disastrous event. Despite international efforts which aimed to reduce the impact of natural and anthropogenic hazards on humankind, very little progress was made. Loss of life, property, infrastructure and economic livelihoods are on the increase without any indication of improvement. Developmental activities can in most instances be blamed for the high level of disaster risk present in communities. On the other hand, very little has been done in the international arena (through a multi-disciplinary approach) to ensure a developmental focus on disaster risk. This study investigates the current state of disaster management practices in the Kingdom of Saudi Arabia (KSA) by benchmarking its activities against established frameworks applied in the developed world for disaster management. The aim of this thesis was primarily to provide a comprehensive framework for disaster risk management in KSA. Such a framework will serve as a guideline for all spheres of government on a strategic level in order to implement disaster risk management. Conclusions to the research demonstrate the importance of linking government policy and practice on disaster risk management across different stakeholders involved in managing disaster risk. This study proposed an integrated model for disaster management by introducing the dual paradigm of disaster management (proactive mindset and reactive mindset). In a nutshell, this thesis aimed to develop a comprehensive multi-disciplinary disaster risk management framework that would be tailor-made for the strategic management arena in Saudi Arabia¿s Ministry of Interior (Directorate of Civil Defence). The research provides the reader with a background study on the international development of the concept of disaster risk management and its components. It focuses on disaster risk management within the Saudi Arabian context. Four international disaster risk management frameworks are analytically compared and aligned with international best practices. Subsequently, the proposed Framework for Disaster in Saudi Arabia is analysed.

Disasters are always local in their impact, and therefore approaches towards their alleviation need to be designed and implemented based on this certainty. Since the 1960s there has been a constant evolution in the common understanding of international disaster management. Various measures and structures were created to plan for emergency relief and the management of a disastrous event. Despite international efforts which aimed to reduce the impact of natural and anthropogenic hazards on humankind, very little progress was made. Loss of life, property, infrastructure and economic livelihoods are on the increase without any indication of improvement. Developmental activities can in most instances be blamed for the high level of disaster risk present in communities. On the other hand, very little has been done in the international arena (through a multi-disciplinary approach) to ensure a developmental focus on disaster risk. This study investigates the current state of disaster management practices in the Kingdom of Saudi Arabia (KSA) by benchmarking its activities against established frameworks applied in the developed world for disaster management. The aim of this thesis was primarily to provide a comprehensive framework for disaster risk management in KSA. Such a framework will serve as a guideline for all spheres of government on a strategic level in order to implement disaster risk management. Conclusions to the research demonstrate the importance of linking government policy and practice on disaster risk management across different stakeholders involved in managing disaster risk. This study proposed an integrated model for disaster management by introducing the dual paradigm of disaster management (proactive mindset and reactive mindset). In a nutshell, this thesis aimed to develop a comprehensive multi-disciplinary disaster risk management framework that would be tailor-made for the strategic management arena in Saudi Arabia's Ministry of Interior (Directorate of Civil Defence). The research provides the reader with a background study on the international development of the concept of disaster risk management and its components. It focuses on disaster risk management within the Saudi Arabian context. Four international disaster risk management frameworks are analytically compared and aligned with international best practices. Subsequently, the proposed Framework for Disaster in Saudi Arabia is analysed.

Cancer is an illness that knows no international boundaries. There are more than eight million global cancer deaths each year. A life-threatening diagnosis generates significant emotional problems for many patients across cultures. Death distress—consisting of death depression, death anxiety and death obsession—often results in poorer treatment adherence and lower overall health and quality of life. The purpose of this study was to determine whether religiosity has a moderating effect on the relationship between death distress and quality of life among patients facing a life-threatening cancer diagnosis. The study sample consisted of 118 cancer patients: 82 cancer patients from a National Guard hospital in Saudi Arabia and 36 cancer patients from H. Lee Moffitt Cancer Center, Tampa, Florida. Three validated scales were used to obtain data from study participants: the Death Distress Scale, the Belief into Action Scale; and the Functional Assessment of Cancer Therapy Scale. After a Pearson correlation were conducted and results indicated a moderately strong inverse relationship between death distress and quality of life among both the Christian (r=-.45, p <.001) and Muslim (r=-.39, p <.001) patient samples. The degree of religiosity among study participants did not alter the effect of death distress on quality of life. Results reveal that the interaction term was not statistically significant (b=.005, p=.32). However, quality of life correlated with degree of religiosity in both the Christian(r=.39, p=.018) and Muslim patient groups ( r=.24, p=0.034)). This finding reinforces the importance of religious involvement among cancer patients found in earlier research. The current study highlights the importance of a holistic treatment approach that includes a spiritual component for these vulnerable individuals and their loved ones. This holistic emphasis is particularly important for nurses, who often spend more time with cancer patients than other health care professionals. By proactively discussing common issues surrounding death distress with patients and families, nurses can provide much needed education and emotional support and make appropriate referral. Given that death distress appears to be a nearly universal experience among cancer patients regardless of religious affiliation, future research should develop evidence-based nursing protocols to address this vital topic.

Dissertation (PhD)--University of Stellenbosch, 2005.
ENGLISH ABSTRACT: The Saudi Arabian Government has implemented a nation-wide policy to prepare its people for the workforce and has directed that the Saudi Council for Health Specialties (SCHS) be established. Under the SCHS umbrella the Saudi Nursing Board (SNB) has been formed for the purpose of regulating the nursing profession. While Saudi Arabia has for many years been dependent on the international community for nurses, it is now establishing its own nursing workforce. One challenge for the SCHS and the SNB is to ensure that practice standards are developed, since ultimately nursing practice affects the quality of the patient services and patient health outcomes. The Saudi nursing profession has a responsibility to develop its social mandate and provide a full range of services to the Saudi public. Systems and education programmes are required for all aspects of the regulatory process, including continuing professional development. Effective regulation systems are not based on a “one size fits all” approach. Furthermore, nurses need to insist on high quality education to develop both basic and ongoing competence and should be able to depend on the profession for social status and credibility. The purpose of this research was to develop, implement, validate and evaluate a continuing professional development learning programme for nurses working in Saudi Arabia. The learning programme was built from a vision of nurses (regardless of country) engaging in lifelong learning for the purpose of ensuring quality patient care and population health. The development of a continuing professional development learning programme is an initial step in fulfilling the need for educational structures to support standards of practice. The overall outcome of the research was functional by nature in that the knowledge of continuing professional development in nursing was generated and applied to nursing practice in Saudi Arabia. In view of the nature of the question, a mixed methodology was selected. Although the qualitative aspect was dominant, both the qualitative and quantitative aspects were used simultaneously. The design included exploratory and descriptive aspects. Furthermore, the researcher employed qualitative methods to develop, implement and evaluate the provisional learning programme and quantitative methods to validate the provisional programme, resulting in a partial explanation of the research phenomenon. The primary theoretical drive was inductive, as the purpose was to discover rather than to test the learning programme contents. Botes’ Research Model and King’s Theory of Goal Attainment were utilised. They complemented each other, as they both support a comprehensive, dynamic scientific approach to learning (health) outcomes influenced by the quality of nursing practice and practice environment. The research, which was outcomes–based, was carried out in the context of quality patient care (population health) and nursing practice situated within the Saudi Arabian setting, where the nursing regulatory system is emerging. As the questionnaire mean ( X ) results revealed scores of 3.0 to 3.9, data saturation was achieved during the first round of the Delphi technique. Fourteen experts from six different countries were asked to validate the provisional learning programme, which was duly done. The programme was implemented in a tertiary research hospital in Saudi Arabia. Formative and summative evaluations were also conducted. The results of the implementation and evaluation affirmed the effectiveness of the learning programme. Boyer’s Model for Scholarship was used to triangulate the research findings. These results formed the basis for the recommendations and final summary. The five broad recommendations that emerged from the research were that nurses should take on self-regulatory and leadership responsibilities; that they should engage in continuing professional development collaboration; that the nursing profession’s self-regulation responsibilities be acknowledged; that a healthy (quality) workplace environment be ensured; and that further research be done in this field.
AFRIKAANSE OPSOMMING: Die regering van Saoedi-Arabië het ʼn landwye beleid geïmplementeer om die mense van die land vir die arbeidsmag voor te berei en het opdrag gegee vir die stigting van die Saudi Council for Health Specialties (SCHS,) ʼn raad wat spesifiek met gesondheidsdienste gemoeid is. Die Saoedi Raad vir Verpleging (Saudi Nursing Board oftewel SNB) is tot stand gebring met die doel om die verpleegdiens in die land te reguleer. Nadat Saoedi-Arabië vir baie jare van die internasionale gemeenskap vir verpleegkundiges afhanklik was, word ʼn eie verpleegkorps nou in die land gevestig. Een van die uitdagings waarmee die SCHS en die SNB te kampe het, is die noodsaaklikheid om te verseker dat standaarde vir die praktyk ontwikkel word, aangesien die verpleegpraktyk inderdaad die gehalte van pasiënte-diens en gesondheidsuitkomste beïnvloed. Die verpleegberoep in Saoedi-Arabië is daarvoor verantwoordelik om sy maatskaplike mandaat te ontwikkel en ʼn volledige reeks dienste aan die mense van die land beskikbaar te stel. Stelsels en opvoedkundige programme is nodig vir alle aspekte van die reguleringsproses. Dit sluit voortgesette professionele ontwikkeling in. Vir ʼn reguleringstelsel om werklik doeltreffend te wees moet dit op spesifieke behoeftes gerig wees en kan een stelsel nie aan al die vereistes van diverse instellings voldoen nie. Dit is noodsaaklik dat verpleegkundiges op onderrig van ʼn hoë gehalte aandring ten einde basiese en voortgaande bevoegdheid te ontwikkel. Daarbenewens behoort hulle op die beroep te kan steun vir sosiale status en geloofwaardigheid. Die doel van hierdie navorsing was om ʼn voortgesette leerprogram vir die professionele ontwikkeling van verpleegkundiges wat in Saoedi-Arabië werk, te ontwikkel, te implementeer, te valideer en te evalueer. Die leerprogram het onstaan uit ʼn visie van verpleegsters (ongeag hulle land van oorsprong) wat hulle met lewenslange leer besig hou met die doel om diens van ʼn hoë gehalte aan pasiënte asook bevolkingsgesondheid te verseker. Met die ontwikkeling van ʼn leerprogram vir voortgesette professionele ontwikkeling is die eerste stap gedoen om in die behoefte aan opvoedkundige strukture ter ondersteuning van praktykstandaarde te voorsien. Die algehele uitkoms van die navorsing was funksioneel van aard deurdat die kennis van voortgesette professionele ontwikkeling in verpleging deur die verpleegpraktyk in Saoedi-Arabië gegenereer en ook daarop toegepas is. Vanweë die aard van die navorsingsvraag is besluit om ʼn gemengde metodologie, dit is kwalitatiewe en kwantitatiewe aspekte gelyktydig te gebruik, met die kwalitatiewe aspek as die dominante metode. Sowel verkennende as beskrywende aspekte is in die ontwerp ingesluit. Daarbenewens het die navorser kwalitatiewe metodes gebruik om die voorlopige leerprogram te ontwikkel, te implementeer en te evalueer, en kwantitatiewe metodes om die voorlopige program te valideer. Die navorsingsverskynsel is deur middel van ʼn gedeeltelike verklarende metode ontleed. Die primêre teoretiese dryfkrag was induktief, aangesien dit die doel van die navorsing was om die leerprogram se inhoud te ontdek eerder as om dit te toets. Daar is van Botes se Navorsingsmodel en King se Teorie van Doelbereiking (Theory of Goal Attainment) gebruik gemaak. Hulle het mekaar aangevul aangesien albei ʼn omvangryke, dinamiese wetenskaplike benadering tot leer- (gesondheid-) uitkomste, wat deur die gehalte van verpleegpraktyk en die praktykomgewing beïnvloed word, ondersteun. Die navorsing, wat uitkomsgebaseerd was, is uitgevoer binne die konteks van pasiëntediens van gehalte (bevolkingsgesondheid) en verpleegpraktyk, gesetel in die Saoedi-Arabiese milieu, waar die reguleringstelsel vir verpleegkunde aan die ontwikkel is. Data saturasie is reeds bevestig tydens die eerste rondte van die Delphi tegniek met gemiddelde tellings van ( X ) 3,0 en 3,9. Die navorsingsontwerp is daardeur verder versterk. Veertien deskundiges van ses verskillende lande is gevra om die voorlopige leerprogram te valideer, wat hulle ook gedoen het. Die program is in ʼn tersiêre navorsingshospitaal in Saoedi-Arabië geïmplementeer. Formatiewe en summatiewe evaluering is gedoen en die resultate van die implementering en evaluering het die doeltreffendheid van die leerprogram bevestig. Boyer se Wetenskaplikheidsmodel (Model for Scholarship) is gebruik om die navorsingsbevindinge te staaf. Hierdie resultate het die grondslag gelê vir die aanbevelings en die finale opsomming. Die vyf breë aanbevelings wat uit die navorsing voortgekom het was dat verpleegkundiges selfregulerende en leierskapverantwoordelikhede aanvaar; dat hulle aan samewerkingsaksies ten opsigte van voortgesette professionele ontwikkeling deelneem; dat die verpleegberoep se verantwoordelikhede ten opsigte van selfregulering erken word; dat ʼn gesonde (gehalte-) werkomgewing verseker word; en dat verdere navorsing op hierdie gebied gedoen word.

Background: Mental disorder-related stigma, usually experienced through prejudice or discrimination, can gravely impact an individuals’ quality of life. Nurses play an important role in the advocacy and treatment of people with mental disorders. It is therefore important that their attitudes, behaviour and knowledge regarding people with mental disorders are understood within their cultural context and that they are educated appropriately during their early student years. Aim: To develop and evaluate the usability, feasibility and effectiveness of a media-based educational intervention (film) against education as usual practice (lecture), in reducing mental disorder-related stigma in terms of attitudes, knowledge and intended behaviour amongst Saudi nursing students. Methods: The research study draws upon the first two phases (development and feasibility/piloting) of the Medical Research Council’s framework for the development and evaluation of complex interventions. A mixed-methods research design was used, entailing: theoretical and systematic reviews of evidence-based literature; modelling, developing and refining of the intervention-prototype and outcome measures; usability testing with stakeholders; feasibility testing of the refined intervention through an exploratory randomised controlled trial and a qualitative evaluation study to assess the preliminary effectiveness of the intervention. Outcomes were measured at three time points: baseline, immediately post-intervention and at three months follow-up. Results: Outcome measures improved significantly for both intervention conditions in comparison to the control group; however, there was no significant difference in effectiveness between the intervention conditions. The film intervention was more effective in the 3rd-year and the lecture in the 4th-year nursing students. The findings of the qualitative evaluation study showed that student nurses expressed a preference for the inclusion of service users’ personal testimonies in the educational intervention. They were also more likely to remember this component of the intervention than other aspects when in clinical practice. Conclusion: This study contributes to a growing literature supporting the use of filmed social contact interventions containing personal testimonies as an effective educational option to reduce mental disorder-related stigma amongst healthcare students.

This thesis explored the dimensions of decision-making of nurses managing continuous renal replacement therapy in the intensive care unit. Variations in the levels of decision-making were largely the result of contextual factors including workforce characteristics, management practices, socialisation and organisational constraints. The concepts also constitute an explanation of the ways in which the interplay of social, organisational and technological boundaries constructed the process of nursing clinical decision-making and performance with advanced technology. These finding suggest that there is an urgent need for organisational and social change in the nursing profession in Saudi Arabia.

Introduction Saudi Arabia is the largest country in the Middle East occupying the majority of the Arabia Peninsula. In 1934 the exploration of oil propelled this country from one of the poorest to one of the highest in per capita income. Islamic law forms the basis of Saudi Arabia's constitution, its civil and penal codes and guides the Saudis in their daily and family lifestyles, governing morals, dress, eating habits and business dealings. Between 1970 and 1980, there was a sharp increase in the rate of population. Currently the population is estimated at 20.8 million with a projected increase to 44.8 million by the year 2025, with approximately 49% under the age of 20. This rise in population has implications for the health care industry, of which expatriates make up more that 85% of the country's health care system. Purpose The purpose of the study was to examine the social and cultural experiences associated with living and working as a registered nurse in a major teaching hospital in Saudi Arabia and to identify and understand how to develop critical thinking skills in Saudi nurses during a nursing education/intervention program in Saudi Arabia. Methodology The researcher reviewed the literature on critical thinking, which allowed the construction of a conceptual model (Appendix 1) to guide teaching and evaluation of critical thinking skills and maintained the focus on dialogue to stimulate interaction and participation in order to promote critical thinking abilities in Saudi nurses. This study adopted ethnography as a methodology and utilised Spradley's (1979)ethnographic research cyclical tasks for data collection and analysis, which are explained in the exploratory, descriptive and explanatory phases of the research. The researcher was a participant observer and collected ethnographic data in the social situation. A variety of data collection methods were employed, which included observation of students and clinical instructors, evaluation of clinical instructors teaching techniques in utilising critical thinking strategies, evaluation of students' responses in the use of critical thinking strategies, focus group interviews of students and clinical instructors and informal interviews conducted within the hospital setting with relevant informants. The use of multi-methods provided the opportunity to examine more fully the richness and complexities of the culture, by gathering data from various sources to validate the consistency of information to reflect the multiple realities of this cultural group. Cultural domains were identified after examining field notes and interviews for terms and clues repeatedly verbalised by informants, in particular students. The researcher organised the domains to formulate taxonomies, leading to cultural themes, which are answered within the research questions in Chapter 8. The research questions for this study are as follows: Research questions 1. What are the issues related to the implementation of critical thinking in a Professional Development Program to improve critical thinking in Saudi nurses? 2. What major elements are involved in creating and sustaining the Saudi Arabian nursing profession? 3. How might Saudi culture be used to support the development of professional nursing identity? Implications for the study This study has the potential to make a significant contribution to nursing education in Saudi Arabia in promoting critical thinking in nurses and in curriculum development for the following reasons. First, didactic instruction was replaced with an interactive approach by utilising critical thinking strategies and devices to facilitate the development of critical thinking abilities. Second, working with a conceptual framework or model made it easier to manage complex multifaceted concepts, such as critical thinking. The model maintained the focus on dialogue and experiential learning thereby assisting students and staff to integrate theory and practice. This model was effective for the program and if duplicated by other programs, could create a learning environment that would allow the effective development and evaluation of critical thinking. The model is reflected in Appendix 1. Recommendations for the nursing profession in Saudi Arabia * To establish the Nursing Practice Act which subsequently leads to the formation of a National Nursing Registration Board. * To transfer nursing into the higher education sectors, to be on par with their Western counterparts. To foster career incentives for men to meet the cultural needs of the people, increase Saudi nurses in the workforce and to raise the image of nursing. * To enact Saudiisation policy. * To incorporate Islamic nursing history into diploma nursing and other nursing educational programs and implemented into the workplace, government policy and the media. * To construct separate male and female hospitals to solve the gender issues. * To systematically collect, collate and analyse nursing data. * To develop continuing education programs to meet educational needs of nurses.

Introduction Saudi Arabia is the largest country in the Middle East occupying the majority of the Arabia Peninsula. In 1934 the exploration of oil propelled this country from one of the poorest to one of the highest in per capita income. Islamic law forms the basis of Saudi Arabia's constitution, its civil and penal codes and guides the Saudis in their daily and family lifestyles, governing morals, dress, eating habits and business dealings. Between 1970 and 1980, there was a sharp increase in the rate of population. Currently the population is estimated at 20.8 million with a projected increase to 44.8 million by the year 2025, with approximately 49% under the age of 20. This rise in population has implications for the health care industry, of which expatriates make up more that 85% of the country's health care system. Purpose The purpose of the study was to examine the social and cultural experiences associated with living and working as a registered nurse in a major teaching hospital in Saudi Arabia and to identify and understand how to develop critical thinking skills in Saudi nurses during a nursing education/intervention program in Saudi Arabia. Methodology The researcher reviewed the literature on critical thinking, which allowed the construction of a conceptual model (Appendix 1) to guide teaching and evaluation of critical thinking skills and maintained the focus on dialogue to stimulate interaction and participation in order to promote critical thinking abilities in Saudi nurses. This study adopted ethnography as a methodology and utilised Spradley's (1979)ethnographic research cyclical tasks for data collection and analysis, which are explained in the exploratory, descriptive and explanatory phases of the research. The researcher was a participant observer and collected ethnographic data in the social situation. A variety of data collection methods were employed, which included observation of students and clinical instructors, evaluation of clinical instructors teaching techniques in utilising critical thinking strategies, evaluation of students' responses in the use of critical thinking strategies, focus group interviews of students and clinical instructors and informal interviews conducted within the hospital setting with relevant informants. The use of multi-methods provided the opportunity to examine more fully the richness and complexities of the culture, by gathering data from various sources to validate the consistency of information to reflect the multiple realities of this cultural group. Cultural domains were identified after examining field notes and interviews for terms and clues repeatedly verbalised by informants, in particular students. The researcher organised the domains to formulate taxonomies, leading to cultural themes, which are answered within the research questions in Chapter 8. The research questions for this study are as follows: Research questions 1. What are the issues related to the implementation of critical thinking in a Professional Development Program to improve critical thinking in Saudi nurses? 2. What major elements are involved in creating and sustaining the Saudi Arabian nursing profession? 3. How might Saudi culture be used to support the development of professional nursing identity? Implications for the study This study has the potential to make a significant contribution to nursing education in Saudi Arabia in promoting critical thinking in nurses and in curriculum development for the following reasons. First, didactic instruction was replaced with an interactive approach by utilising critical thinking strategies and devices to facilitate the development of critical thinking abilities. Second, working with a conceptual framework or model made it easier to manage complex multifaceted concepts, such as critical thinking. The model maintained the focus on dialogue and experiential learning thereby assisting students and staff to integrate theory and practice. This model was effective for the program and if duplicated by other programs, could create a learning environment that would allow the effective development and evaluation of critical thinking. The model is reflected in Appendix 1. Recommendations for the nursing profession in Saudi Arabia * To establish the Nursing Practice Act which subsequently leads to the formation of a National Nursing Registration Board. * To transfer nursing into the higher education sectors, to be on par with their Western counterparts. To foster career incentives for men to meet the cultural needs of the people, increase Saudi nurses in the workforce and to raise the image of nursing. * To enact Saudiisation policy. * To incorporate Islamic nursing history into diploma nursing and other nursing educational programs and implemented into the workplace, government policy and the media. * To construct separate male and female hospitals to solve the gender issues. * To systematically collect, collate and analyse nursing data. * To develop continuing education programs to meet educational needs of nurses.

ANTECEDENTES: Después del hogar, la escuela representa el segundo entorno en el que se desatrrolla la vida de los niños. Su capacidad de aprendizaje está estrechamente relacionada con su bienestar y salud. Los estudiantes saludables asisten a clase con mayor asiduidad y son capaces de concentrarse mejor en las tareas escolares (Murray, 2007). Los enfermeros escolares desempeñan múltiples funciones en la protección y la promoción de la salud de los estudiantes. OBJETIVOS: A) General: ldentificar los factores que dificultan la implantación de la figura de la enfermera escolar en Jeddah, Arabia Saudi. b) Especificos: 1- Explorar las percepciones de las enfermeras que trabajan en centros escolares sobre las ventajas e inconvenientes de sus funciones en el ambito escolar. 2- Explorar las percepciones de los directores y profesores sobre la necesidad de las enfermeras escolares. 3- ldentificar las opiniones de los gestores sobre la necesidad de mcorporar enfermeras escolares en los centros educativos. · 4- Conocer la opinion de los directores, maestros y padres sobre el papel de la enfermera escolar. METODOLOGIA: Metodología cualitativa. Se diseñó un estudio fenomenológico interpretativo. Para la recogida de informaci6n se reaiizaron entrevistas en profundidad a educadores, enfermeros, directores, padres de aiumnos. RESULTADOS: Los resultados confirmaron la necesidad de tener una enfermera escoiar en los colegios de Arabia Saudí. Tanto los participantes de los colegios que disponen de la figura de una enfermera escolar como los que no la tienen, apoyan el rol de la enfermera escolar. Todos los informantes tienen coincidencias en el significado y funciones que ha de tener una enfermera escolar y todos consideran que la enfermera escolar tiene un impacto positivo tanto en los estudiantes como en el profesorado y en las familias; en los estudiantes, mediante su contribución a la promoción de la salud, la prevención de problemas de salud, el cuidado sistematico y a su formación en educación para la salud, al profesorado y dirección de las escuelas les genera seguridad y confianza lo cual les proporciona mayor libertad para realizar su trabajo docente y en las familias genera tranquilidad respecto al cuidado integral en salud de sus hijos. Los problemas que dificultan la inclusion de la enfermera escolar en los colegios son estructurales. CONCLUSIÓN: Los resultados de este estudio proporcionan información relevante sobre las percepciones y expectativas que las madres, profesoras, directoras y enfermeras escolares tienen respecto a las enfermeras escolares. Estos resultados abren las puertas a investigaciones adicionales en esta area en Arabia Saudí. Este estudio ha hecho una contribuci6n positiva y exclusiva para investigar mas sobre las enfermeras escolares, y por tanto tiene un impacto potencialmente positivo sobre el desarrollo en el establecimiento de la figura de una enfermera escolar en Arabia Saudi. El studio. mostró que todas las mujeres participantes que tuvieron experiencia de primera mano con enfermeras escolares reconocieron únanimemente la importancia del papel de las enfermeras escolares. Todas las participantes identificaron los primeros auxilios y tratar con las emergencias, accidentes o enfermedades y la dispensación de medicamentos corno las principales funciones de las enferrneras escolares, especialmente en las escuelas primarias donde los niños más pequeños tienen niveles más altos de hiperactividad y, por lo tanto, existe un mayor riesgo de lesión. Las enfermeras escolares mencionaron muchos beneficios de tener una enfermera en la escuela y ninguna desventaja. Los temas que surgen al abordar estas cuestiones fueron especialmente valiosos en terminos prácticos para los directores de las escuelas saudíes que desean emplear a una enfermera de alta calidad. El tema principal "empleando enfermeras escolares" identificó dos facilitadores de empleo de enfermeras escolares, a saber, la conciencia cultural / idioma y el horario laboral, micntras que surgieron varias barreras económicas para emplear a enfermeras escolares según se tratara de escuelas públicas o privadas.
BACKGROUND: The school is the second environment, after the home, where children develop their lives. Their learning capacity is widely related to their health and wellness. Healthy children attend classes more regularly and are capable to concentrate more in school activities (Murray, 2007). School nurses play multiple roles with regards to the protection and health awareness of the students. The aim of this project is to explore the perspectives directors, tutors and parents have of school nurses, and to find out what they think the role of a nurse consists of in a school environment. OBJECTIVES: General: to identify the factors that hinder the implantation of a school nurse figure in Jeddah, Saudi Arabia. Specific: I.Explore the perceptions of the nurses that work in schools regarding the advantages and disadvantages of their functions in that environment 2. Explore the perceptions of directors and teachers about the need of having a school nurse 3. Identify the opinions of managers about the need to include school nurses in education centres 4. Get to know the opinion of directors, teachers and parents with regards to the role of a school nurse. METHODOLOGY: Qualitative methodology, specifically with an interpretive phenomenological study. For the data collection, interviews will be held in depth with educators, · nurses, directors, parents and students. RESULTS: The findings confirmed the need for a nurse to be present in schools in Saudi Arabia. By comparing participants with and without a school nurse was possible to see that support for the role of school nurse was to be found in both groups. All the informants have coincidences in the meaning and functions that a school nurse must have and all consider that the school nurse has a positive impact on students, teachers and families; In the students, through their contribution to the promotion of health, prevention of health problems, systematic care and training in health education, for teaching staff and school managers generates security and confidence, which provides greater Freedom to carry out their teaching work and in families generates peace of mind regarding the comprehensive health care of their children. The problems that hinder the inclusion of the school nurse in schools are structural. CONCLUSION: The results of this study provide relevant information about the perceptions and expectations that mothers, teachers; principals and school nurses have regarding nurses. These results open the door to further research in this area in Saudi Arabia. This study has made a positive and exclusive contribution to further research on school nurses, and thus has a potentially positive impact on development in establishing a school nurse figure in Saudi Arabia. This study has made a positive and exclusive contribution to further research on school nurses, and therefore has a potentially positive impact on development in establishing a school nurse figure in Saudi Arabia. The study showed that all participating women who had firsthand experience with school nurses unanimously recognized the importance of the role of school nurses. All participants identified first aid and deal with emergencies, accidents or illnesses and dispensing medications as the main functions of school nurses, especially in primary schools w.here younger children have higher levels of.hyperactivity and, therefore, there is an increased risk of injury. School nurses mentioned many benefits of having a nurse at school and no disadvantages. The issues raised in addressing these issues were especially valuable in practical terms for the principals of Saudi schools who wish to employ a high-quality nurse. The main theme "employing school nurses" identified two facilitators of school nurse employment, namely cultural awareness / language and working hours, while several economic barriers emerged to employ school nurses as public or private schools.
ANTECEDENTS: Després de la llar, l'escola representa el segon entorn en que es desenvolupa la vida dels nens. La seva capacitat d'aprenentatge està estretament relacionada amb el seu benestar i salut. Els estudiants saludables assisteixen a classe amb mes assiduïtat i són capaços de concentrar-se millor en les tasques escolars (Murray, 2007). Els infermers escolars exerceixen múltiples funcions en la protecció i la promoció de la salut dels estudiants. OBJECTIUS a) General: Identificar els factors que dificulten la implantació de la figura de la infermera escolar a Jeddah, Aràbia Saudita. b) Específics: 1- Explorar les percepcions de les infermeres que treballen en centres escolars. sobre els avantatges i inconvenients de les seves funcions en l'àmbit escolar. 2- Explorar les percepcions dels directors i professors sobre la necessitat de les infermeres escolars. 3- Identificar les opinions dels gestors sobre la necessitat d'incorporar infermeres escolars en els centres educatius. 4- Conèixer l'opinió dels directors, mestres i pares sobre el paper de la infermera escolar. METODOLOGIA: Metodologia qualitativa. Es va dissenyar un estudi fenomenològic interpretatiu. Per a la recollida d'informació es van realitzar entrevistes en profunditat a educadors, infermers, directors, pares d'alumnes. RESULTATS: Els resultats van confirmar la necessitat de tenir una infermera escolar a les escoles d'Aràbia Saudita. Tant els participants dels col·legis que disposen de la figura d'una infermera escolar com els que no la tenen, donen suport al paper de la infermera escolar. Tots els informants tenen coincidències en el significat i funcions que ha de tenir una infermera escolar i tots consideren que la infermera escolar té un impacte positiu tant en els estudiants com en el professorat i en les famílies; en els estudiants, mitjançant la seva contribució a la promoció de la salut, la prevenció de problemes de salut, la cura sistemàtica i a la seva formació en educació per a la salut, al professorat i direcció de les escoles els genera seguretat i confiança la qual cosa els proporciona major llibertat per realitzar-la docent i en les famílies genera tranquil·litat respecte a la cura integral en salut dels seus fills.. CONCLUSIÓ: Els resultats d'aquest estudi proporcionen informació rellevant sobre les percepcions 1 expectatives que les mares, professores, directores i infermeres escolars tenen respecte a les infermeres escolars. Aquests resultats obren les portes a investigacions addicionals en aquesta àrea a l'Aràbia Saudita. Aquest estudi ha fet una contribució positiva i exclusiva per investigar més sobre les infermeres escolars, i per tant té un impacte potencialment positiu sobre el desenvolupament en l'establiment de la figura d'una infermera escolar a l'Aràbia Saudita. L’estudi va mostrar que totes les dones participants que van tenir experiència de primera ma amb infermeres escolars van reconèixer unànimement la importància del paper de les infermeres escolars. Totes les participants van identificar els primers auxilis i tractar amb les emergències, accidents o malalties i la dispensació de medicaments com les principals funcions de les infermeres escolars, especialment a les escoles primaries on els nens més petits tenen nivells més alts d'hiperactivitat i, per tant, hi ha un major risc de lesió. Les infermeres escolars van esmentar molts beneficis de tenir una infermera a l'escola i cap desavantatge. Els temes que sorgeixen en abordar aquestes qüestions van ser especialment valuosos en termes pràctics per als directors de les escoles saudites que volen donar feina a una infermera d'alta qualitat. El tema principal "emprant infermeres escolars" identificar dos facilitadors d'ocupació d'infermeres escolars, és a dir, la consciència cultural / idioma i l'horari laboral, mentre que van sorgir diverses barreres econòmiques per donar feina a infermeres escolars segons es tractés d'escoles públiques o privades.

Increasing attention in the social science literature, particularly within the sociology of religion, psychology and gerontology is being given to the role of religion in the lives of older people. Moreover, research has repeatedly identified religion as a significant coping resource throughout human life. Through the use of the biographical narrative method of interviewing, and the subsequent thematic analysis of the data, this study focuses on the role of religious beliefs and practices in the life experiences of older men in two selected Saudi nursing homes. The research demonstrates the positive influence of religion on adjustment processes in later life in general and specifically on adjusting to life in a nursing home. The study shows that religion serves as an important thread of integration in older men's lives. As they grew older, the respondents in this research had become more religious and more involved in religious practices. The study found that religion was an important dimension in their everyday life. All of them had integrated religious beliefs and practices into their lives to help them respond positively to the difficulties which they experienced. Above all, they strongly believed that leading a religious (Islamic) life was their duty as Muslims and this would also lead to their being rewarded by God in the Hereafter, as they believed that a truly happy life would come after death. Based upon its findings, the study highlights the need to acknowledge the importance of religion in the social care provision for older people in Saudi Arabia, for example, in counselling, in social work provision in general and within residential homes for older men in particular.

The purpose of the study: The purpose of this study is to investigate the influence of cultural diversity, in a multicultural nursing workforce, on the quality and safety of patient care and the work environment at King Abdul-Aziz Medical City, Riyadh region. Study background: Due to global migration and workforce mobility, to varying degrees, cultural diversity exists in most health services around the world, particularly occurring where the health care workforce is multicultural or where the domestic population comprises minority groups from different cultures speaking different languages. Further complexities occur when countries have a multicultural workforce which is different from the population for whom they care, in addition to the workers being from culturally diverse countries and with different languages. In Saudi Arabia the health system is mainly staffed by expatriate nurses who comprise 67.7% of the total number of nurses. Study design: This research utilised a case study design which incorporated multiple methods including survey, qualitative interviews and document review. Methods: The participant nurses were selected for the survey via a population sampling strategy; 319 nurses returned their completed Safety Climate Survey questionnaires. Descriptive and inferential statistics (Kruskal–Wallis test) were used to analyse survey data. For the qualitative component of the study, a purposive sampling strategy was used; 24 nurses were interviewed using a semi-structured interview technique. The documentary review included KAMC-R policy documents that met the inclusion criteria using a predetermined data abstraction instrument. Content analysis was used to analyse the policy documents data. Results: The data revealed the nurses‘ perceptions of the clinical climate in this multicultural environment is that it was unsafe, with a mean score of 3.9 out of 5. No significant difference was detected between the age groups or years of experience of the nurses and the perception of safety climate in this context; the study did reveal a statistically significant difference between the cultural background categories and the perception of safety climate. The qualitative phase indicated that the nurses within this environment were struggling to achieve cultural competence; consequently, they were having difficulties in meeting the patients‘ cultural and spiritual needs as well as maintaining a high standard of care. The results also indicated that nurses were disempowered in this context. Importantly, there was inadequate support by the organisation to manage the cultural diversity issue and to protect patients from any associated risks, as demonstrated by the policy documents and supported by the nurses‘ experiences. The study also illustrated the limitations of the conceptual framework of cultural competence when tested in this multicultural workforce context. Therefore, this study generated amendments to the model that is suitable to be used in the context of a multicultural nursing workforce. Conclusion: The multicultural nature of this nursing work environment is inherently risky due to the conflicts that arise from the different cultural norms, beliefs, behaviours and languages. Further, there was uncertainty within the multicultural nursing workforce about the clinical and cultural safety of the patient care environment and about the cultural safety of the nursing workforce. The findings of the study contribute important new knowledge to the area of patient and nurse safety in a multicultural environment and contribute theoretical development to the field of cultural competence. Specifically, the findings will inform policy and practice related to patient care in the context of cultural diversity.

Technological innovations have been shown to improve the quality of health information and improve safety in health care systems. The purpose of this project was to offer hospital nurses a more flexible and practical alternative to education and training than the traditional face-to-face method, supporting nurse educators in overcoming many of the obstacles in responding to nurses' needs in the clinical areas. This project used a randomized, 2-group posttest-only experimental design to measure the effect of treatment at a targeted hospital. The experimental group received a new instructional approach using an Electronic Learning Management System (ELMS) and the control group used the site's traditional standard method; both groups completed the Posttest Knowledge Assessment. The study population consisted of registered nurses who had attended the project site's Safe Blood Transfusion Practice program over a period of 1 month. There were no significant differences between the 2 groups' members' gender, age, level of education, or nursing experience. Data analysis showed a significant (p < .00) difference between the 2 groups' posttest scores, indicating that the participants who used the ELMS attained a higher median knowledge (M = 89.39, SD = 9.26) than did participants who received traditional, face-to-face instruction (M = 76.85, SD = 10.628). These results suggest that ELMS-based learning is a more effective method of instructional delivery that could effectively replace many of the traditional face-to-face education programs. Implementing this innovative system will create positive social change on the targeted hospital by improving health care delivery. The application of the finding would support clinical educators to improve educational delivery to their clients at the clinical areas.

Aim: the aim of this study was to assess the prevalence, types and contributing factors of violence against nurses in emergency departments. Background: Violence against health care workers, especially nurses is a significant concern for healthcare internationally. Emergency departments are considered high-risk areas in hospitals. Violence against nurses in EDs is a serious issue that cannot be ignored. Method: A cross-sectional study design was conducted from June to August 2016 using convenience sample of emergency nurses in four major hospitals in Riyadh City in Saudi Arabia. The questionnaire was adapted from Kitaneh and Hamdan (2012). Chi-Square test was used to analyse the data. Results: Four hundred and thirty-six emergency nurses responded to the questionnaire (a response rate of 71.2 %). The results showed 41.7% of respondents were exposed to both physical and non-physical violence in the workplace during the previous 12 months. The results showed that 44.7% of respondents were exposed to physical assault, 29.5% of respondents were exposed to threat, 88.1% of respondents were exposed to verbal abuse and 4.4% of respondents were exposed to sexual harassment in the last 12 months. Patients (67.7%) were identified as the most common perpetrators of physical violence, and visitors and patients’ relatives (67.1%) were identified as the most common perpetrators of non-physical violence. The treatment room was the most common place where the physical and non-physical violence happened. The most common factors contributing to physical violence were mental health or psychiatric patient (38.5%) while waiting to receive service (58.9 %) contributed most to nonphysical violence. Conclusion: Understanding workplace violence is the first phase to develop or improve appropriate strategies to handle this problem. Establishing and enacting suitable laws could enhance workplace safety violence for nurses. Further research on the topic is needed.
Thesis (M.Nurs.Sc.) -- University of Adelaide, School of Nursing, 2017

The purpose of this study was to describe the competencies needed by nursing intern students as identified by their preceptors and nurse educators, who choose to work as registered nurses in intensive care units in Saudi Arabia. The research questions this study investigated were 1) what do nurse preceptors and nurse educators believe are the competencies for new graduates to allow them to work safely in an intensive care unit in Saudi Arabia, 2) what are the competencies they should possess at the end of their internships. 3) Is there a difference between nurse educators and preceptors in the perception of required or expected competencies of the nursing role in the Intensive Care Unit (ICU)? Through the Interpretive Description methodology, data were collected through interviews, the guide for which was developed based on the Canadian Association of Critical Care Nurses standards for critical care nursing practice. The data were analyzed to identify common themes. Themes for intensive care unit competencies included: 1) needed skill competencies; 2) development of knowledge application competencies; and 3) strategies for quality improvement. A notable aspect of this study was the finding that Saudi Arabia, there was agreement among participants that nursing intern students were not prepared to work in ICU immediately after their internship year. Building on participants’ responses, nursing intern students may acquire satisfactory preparation during their internship through continuous evaluation, consistent guidance, extended time period, and orientation. Consequently, it represents a significant contribution to enriching the nursing intern students’ internship outcomes as well as the literature in the context of Saudi Arabia and in advancing the nursing workforce in Intensive Care Units in Saudi Arabia.