The psychological experience of nursing students in their internship year during the COVID-19 pandemic in Saudi Arabia.

The COVID-19 pandemic produced challenges and troubling issues in Saudi Arabia and worldwide. During the height of the pandemic, the psychological status of nursing students was complicated by challenges that affected their educational future. We used qualitative approach to explore the psychological status of 20 Saudi nursing students from Nursing College in their internship program during the COVID-19 pandemic by investigating their perceptions, experiences, and challenges. Thematic analysis methods were used to present the data as themes and subthemes. Themes that emerged during interviews revealed: Interns' experiences from the outbreak; Perceptions of students toward COVID-19; Mental distress associated with the situation; Level of support from either or both university authorities or hospital education and training departments; Financial challenges; and Readiness to complete a nursing internship. COVID-19 presented several challenges to Saudi nursing students in internship year including psychological distress in several aspects such as fear of infection for themselves and their families. However, this study findings do not apply to all nursing students as it only included nursing interns actively engaged in clinical practice. Additional studies are required to examine how the clinical practice of internships varied across the country during any epidemic situation.

The relationship between nurses' risk assessment and management, fear perception, and mental wellbeing during the COVID-19 pandemic in Saudi Arabia.

During this pandemic, it is crucial to implement early interventions to help nurses manage their mental wellbeing by providing them with information regarding coping skills, preventive risk assessment approaches (such as hospital preparedness and rapid risk assessment), and the ability to respond. This study evaluated the effect of fear and risk assessment management on nurses' mental wellbeing during the COVID-19 pandemic in Saudi Arabia. A total of 507 nurses who worked in tertiary public hospitals were asked to take a descriptive design survey. Three survey scales were used to assess the survey: the Risk Assessment Scale, the Fear of COVID-19 Scale, and the Warwick-Edinburgh Mental Wellbeing Scale. Independent t-tests and a one-way ANOVA were used to examine the association between fear of COVID-19 and nurses' demographic characteristics on their mental wellbeing. A multiple regression analysis was performed to examine the predictors associated with mental wellbeing. Findings revealed that almost half of the participants showed moderate positive mental wellbeing, 49.7%, while only 14% had low levels of fear on the Warwick-Edinburgh Mental Well being Scale. Most of the respondents had low levels of fear on the Fear of COVID-19 Scale, 45%, while only 15% had high levels of fear on the scale. Then, some demographic variables, such as "age," "nationality," "total years of experience in the current hospital," and "region you work at" had statistically significant differences with p < 0.5. Meanwhile, risk assessment is also associated with mental wellbeing scores. All items on the Fear of COVID-19 Scale showed no significant difference with a P > 0.05. In conclusion, most nurses providing direct patient care to a patient with COVID-19 emphasized the importance of wearing PPE and performing hand hygiene before and after any clean or aseptic procedure. Meanwhile, although almost all nurses were vaccinated, they were still afraid of a COVID-19 infection. Additionally, the results reported that the older the nurses are, the better their mental wellbeing scores. Non-Saudi nurses had higher perceived mental wellbeing scores than Saudi nurses, and different working environments corresponded to different mental wellbeing scores. Finally, nurses' risk assessment was associated with mental wellbeing scores.

Nurses' Perception of Safety Culture in Medical-Surgical Units in Hospitals in Saudi Arabia.

Introduction: Patient safety captures the essence of the primary principle of medical ethics, primum non nocere, first do no harm; this is an important concern in the health care system. Nurses are indispensable members of this system and are the largest group of health care providers involved in the direct delivery of patient care. As an integral part of the health care system, it is important to know nurses' opinions on patient safety culture. Objectives: First, to evaluate and measure the existing safety culture and safety of patients in medical-surgical wards (MSW) in hospitals located in the Qassim region, in the Kingdom of Saudi Arabia. Second, to survey the opinion of registered nurses and supervisors/managers about safety culture and issues concerned with safety in hospitals in the region. Materials and Methods: A validated cross-sectional survey, namely the Hospital Survey on Patient Safety Culture (HSOPSC), was used. This survey queried 300 nurses in different MSWs in four hospitals in the Qassim Region. Results: Overall, a positive culture of safety exists in MSWs, with 69% of RNs rating their wards as having great/excellent safety culture. Notably, some participants felt it was problematic that blame was assigned to nurses for reported errors. While 55.9% of participants noted that all errors or narrowly avoided errors had been reported, less than half actually reported errors in the last year. Conclusion: The perceived safety culture was largely positive; however, the results also indicated that a culture of safety comes with some risk and blame.

Scope of Nursing Practice as Perceived by Nurses Working in Saudi Arabia.

The absence of scope of practice guidelines may lead to role ambiguity and legal consequences in nursing practice. This study measures the scope of practice of nurses in Saudi Arabia. The study utilized a descriptive cross-sectional design using an electronic version of the Arabic Actual Scope of Nursing Practice (A-ASCOP) questionnaire among 928 nurses. Descriptive analysis was followed by a t-test and an analysis of variance (ANOVA). Significance was assured through the Bonferroni test; the effect size was measured through partial η2 when appropriate. The A-ASCOP mean score of each dimension ranged from 4.29 to 4.72 (overall mean = 4.59). Significant overall ASCOP score variations were evident, with higher ASCOP among expatriate nurses, females, Hospital Operation Program (HOP) nurses, and nurses with postgraduate qualifications. Partial η2 showed a small effect of <0.016. Low-complexity nursing tasks showed insignificant differences no matter the nurse's position, but were less practiced by Bachelor of Science in Nursing (BSN) and advanced-degree nurses than by those with a diploma education. High complexity of ASCOP was practiced significantly more often by postgraduate-prepared nurses than by diploma-educated nurses. The study showed that there is a range of variation in nursing practice, but that the lack of internal regulations (nursing scope of practice) has no effect on nursing duties. In a country such as Saudi Arabia, where massive national improvement initiatives are frequent, clearly defining the scope of practice for nurses is essential and needs to be done through government mandates. Further studies are essential to define what the scope of practice should include.

Relation between socio-demographic factors and professionalism among nurses in Saudi Arabia: A comparative analysis.

Background: Analyzing how nurses handle professionalism in their careers will help all concerned individuals identify areas of concern to develop and enhance further to achieve or maintain a high degree of professionalism. Objective: This study aimed to determine the level of professionalism among nurses and its differences according to socio-demographic characteristics. Methods: A quantitative cross-sectional approach was utilized in three significant regions of Saudi Arabia. A simple random sampling technique was employed with 305 respondents, resulting in a 95.9% response rate. A Google Form survey was used to collect the data between January and April 2021. Results: Nurses perceived themselves highly in professional organization (Mean = 3.94, SD = 0.17), belief in public service (Mean = 3.91, SD = 0.22), belief in self-regulation (Mean = 3.97, SD = 0.08), sense of calling (Mean = 4.01, SD = 0.13), and belief in autonomy (Mean = 3.71, SD = 0.15). There was no significant difference between gender and professional organization, belief in public service, self-regulation, or belief in autonomy. Still, there was a significant difference in belief in public service (t = 2.794; p = 0.006) and sense of calling (t = 4.290; p = 0.001). As to age, only belief in self-regulation was significant (t = 5.984; p = 0.003). Moreover, the educational qualifications reached an insignificant difference in professionalism. Conversely, the type of facility has been found to have reached significant differences with a professional organization (F = 3.057; p = 0.029), belief in public service (F = 4.130; p = 0.007), beliefs in regulation (F = 3.452; p = 0.017), sense of calling (F = 3.211; p = 0.023), and belief in autonomy (F = 5.995; p = 0.001). Lastly, the current position found no significant difference in professionalism. Conclusion: Nurses in the Kingdom of Saudi Arabia perceived themselves as highly professional, and male nurses were found to have a sense of calling more than their female counterparts. Age, educational qualification, and current position had no significant difference in professionalism. Conversely, the type of facility had a significant difference with the belief in autonomy. These findings support and sustain the role of nurses in this 21st-century health care that is significantly needed to provide the most quality care.

Risk assessment and management among frontline nurses in the context of the COVID-19 virus in the northern region of the Kingdom of Saudi Arabia.

OBJECTIVE: This study aimed to assess the post-contact risk of nurses who provide care for patients diagnosed with COVID-19. METHODS: This investigation employed a quantitative-descriptive design. The study sample was comprised of the frontline nurses in the COVID-19 center hospitals in the northern part of Saudi Arabia. Snowball sampling was used, resulting in 80 frontline nurses. A survey using a self-administered questionnaire in a Google form was employed to collect the data, which was collected from May 20 through June 25, 2020. RESULTS: Some of the study participants were reported to have a history of both staying in the same household with each other (35%) and of traveling with a confirmed COVID-19 patient (20%). These participants were considered as community exposed to COVID-19. There were 8.8% who were classified as high risk due to failure in removing and replacing personal protective equipment (PPE); 6.3% were at high risk for not performing hand hygiene before and after touching COVID-19 patients, and 5% did not follow the recommended guidelines in performing hand hygiene after touching the patients' surroundings. In addition, 3.8% of the participants had an accident related to biological material, such as with splashes of biological fluid (in the eyes). These nurses were classified as high risk for COVID-19 virus infection, CONCLUSION: This study identifies practices that need improvement in combatting this virus. Since policies and guidelines may not always be optimal in all settings, a tailor-fitted guideline is appropriate. Nurse leaders, for example, need to establish an infection control system that provides real-time monitoring and facilitates immediate correction for nurses. Doing so will provide the nurses with a continuous awareness of predisposing themselves to acquiring the virus.

Holistic nursing care among operating room nurses: Strengthening the standard of practice in Saudi Arabia.

Background: Holistic practices have been found beneficial for patients as well as nurses. They increase both the nurses and the patients' health-promoting behaviors, spirituality, and interpersonal relationships. Objective: This study aimed to determine holistic nursing care and compare its differences based on individual characteristics. Methods: This study employed a quantitative-cross sectional approach. It was conducted at the hospitals of Hail region, Kingdom of Saudi Arabia, from February 2020 to March 2020. Selected through convenience sampling, 154 operating room nurses participated in the study. Frequency and percentages were used to analyze the demographic information, and t-tests and analysis of variance were used to test for differences. Results: Holistic nursing dimensions such as physiological (4.72 ± 0.40), socio-cultural (4.53 ± 0.45), psychological (4.66 ± 0.32), and spiritual aspects (4.22 ± 0.73) were consistently carried out in the operating room. On the physiological dimension, no significant differences were found in years of experience [(t) -0.073; p > 0.942], gender [(t) -1.113; p > 0.27], or age [(F) 0.558; p > 0.57), but there was a significant difference with nationality [(t) -3.328; p < 0.001]. On the socio-cultural dimension, the length of experience [(t) 0.599; p > 0.550], gender, [(t) -1.420; p > 0.158], and age [(F) 0.148; p > 0.862] were not significant, but a significant difference was found with nationality [(t) -7.516; p < 0.001]. Regarding the psychological dimension, the length of experience [(t) -1.101; p > 0.276], gender [(t) -1.545; p > 0.129], and age [(F) 1.259; p > 0.287] were not significant, but there was a significant difference with nationality [(t) -5.492; p < 0.001]. Finally, with the spiritual dimension, no significant difference was found on length of experience [(t) -1.101; p > 0.276] or age [(F) 0.584; p > 0.559], but there were significant differences on gender [(t) -3.890; p < 0.001] and nationality [(t) -3.653; p < 0.001]. Conclusion: Nationality is a causal factor to physiological, socio-cultural, psychological, and spiritual dimensions, while gender is significant to spiritual aspect. Regardless of nationality or gender, nurses must be knowledgeable regarding the significance of adopting holistic care to improve the quality of their care to their patients.

Awareness, Attitudes, Prevention, and Perceptions of COVID-19 Outbreak among Nurses in Saudi Arabia.

The newly discovered coronavirus (COVID-19) has become a pandemic, infecting thousands of people around the world. This study examines nurses' demographic information (age, gender, marital status, area of practice, total years of experience in the current hospital, work region, monthly salary, educational level, workplace, nationality, working hours per day, total nursing experience, and the respondents' main source of information on COVID-19), awareness, attitudes, prevention, and perceptions of COVID-19 during the outbreak in Saudi Arabia. A cross-sectional descriptive design of 500 nurses working at government and non-governmental hospitals in five regions in Saudi Arabia were selected using convenience sampling. The Kruskal-Wallis test was applied and the Mann-Whitney test was utilized as a post hoc test. The majority of nurses in this study, 96.85%, had excellent knowledge of COVID-19. Some (83.2%) of nurses reported significant prevention knowledge and treatment skills about COVID-19, while 7.6% had little knowledge about prevention. More than half of the nurses (60.4%) had high positive attitudes toward caring for COVID-19 patients. In conclusion, female nurses, married nurses, and bachelor's degree nurses had greater awareness, better attitude, and prevention clinical experience towards COVID-19. Meanwhile, non-Saudi nurses had higher self-reported awareness, positive attitudes, optimal prevention, and positive perceptions compared to Saudi nurses. This study provides baseline information immediately needed to enable health authorities to prioritize training programs that support nurses during the COVID-19 pandemic.

Nursing Students' Perceptions, Knowledge, and Preventive Behaviors Toward COVID-19: A Multi-University Study.

Background: Knowledge, perception, and preventive behavior should be considered in the planning of effective educational interventions for the coronavirus disease of 2019 (COVID-19) pandemic and in increasing awareness about the health risks brought about by this disease. This research aimed to assess knowledge, perceptions, and preventive behavior toward the COVID-19 infection among student nurses. Methods: The study has quantitative, descriptive, and cross-sectional design. A convenience sample of 1,226 student nurses from seven universities in Saudi Arabia was surveyed from March 22 to April 4, 2020. A four-part online survey on demographic characteristics, perceptions, knowledge, and preventive behavior of Saudi student nurses was carried out. Results: Nearly all students were aware of the outbreak (99.2%), and most of them received information on COVID-19 primarily from social media (71.0%). Over three-fourths of the students were confident that the government (89.1%) and Ministry of Health (MOH) (86.5%) were doing a good job responding to the COVID-19 outbreak in the country. The overall average score in the knowledge questionnaire was 9.85 (SD = 1.62, range = 0-12), which is equivalent to 82.1%. The majority of the students always performed most of the preventive behavior identified in the survey, except "washing hands with soap and water for at least 20 s after blowing my nose, coughing, or sneezing" (39.2%) and "daily cleaning and disinfecting frequently touched surfaces" (41.6%). Being female, being in the fourth year, and gaining good perceived knowledge were associated with high actual COVID-19 knowledge. University, gender, age, academic level, and perceived COVID-19 knowledge were the associated factors. Conclusions: The findings of this study have provided baseline information on the current state of Saudi nursing students' perceptions, knowledge, and preventive behavior toward COVID-19 as the crisis is happening. The findings revealed some areas that should be focused on by nursing education, as well as health agencies, to ensure that the students have adequate knowledge and correct preventive behavior.

Psychometric assessment of the Spiritual Climate Scale Arabic version for nurses in Saudi Arabia.

AIM: To assess the psychometric properties of the Spiritual Climate Scale Arabic version for Saudi nurses. BACKGROUND: Evidence showed that a high level of spiritual climate in the workplace is associated with increased productivity and performance, enhanced emotional intelligence, organisational commitment and job satisfaction among nurses. METHOD: A convenient sample of 165 Saudi nurses was surveyed in this descriptive, cross-sectional study. Cronbach's α and intraclass correlation coefficient of the 2 week test-retest scores were computed to establish reliability. Exploratory factor analysis was performed to support the validity of the Spiritual Climate Scale Arabic version. RESULTS: The Spiritual Climate Scale Arabic version manifested excellent content validity. Exploratory factor analysis supported a single factor with an explained variance of 73.2%. The Cronbach's α values of the scale ranged from .79 to .88, while the intraclass correlation coefficient value was .90. The perceived spiritual climate was associated with the respondents' hospital, gender, age and years of experience. CONCLUSIONS: Findings of this study support the sound psychometric properties of the Spiritual Climate Scale Arabic version. IMPLICATIONS FOR NURSING MANAGEMENT: The Spiritual Climate Scale Arabic version can be used by nurse managers to assess the nurses' perception of the spiritual climate in any clinical area. This process can lead to spiritually centred interventions, thereby ensuring a clinical climate that accepts and respects different spiritual beliefs and practices.

Awareness of holistic care practices by intensive care nurses in north-western Saudi Arabia.

OBJECTIVES: To examine awareness of holistic patient care by staff nurses in the intensive care units of hospitals in the city of Hail, Saudi Arabia.  Methods: A quantitative correlational study design was used to investigate relationships between intensive care nurse's awareness of holistic practices and nurses' latest performance review. Intensive care staff nurses (n=99) from 4 public sector hospitals in Hail were surveyed on their awareness of variables across 5 holistic domains: physiological, sociocultural, psychological, developmental, and spiritual. Data were collected between October and December 2015 using written survey, and performance evaluations obtained from the hospital administrations. Results were statistically analyzed and compared (numerical, percentage, Pearson's correlation, Chronbach's alpha). Results: The ICU staff nurses in Hail City were aware of the secular aspects of holistic care, and the majority had very good performance evaluations. There were no demographic trends regarding holistic awareness and nurse performance. Further, awareness of holistic care was not associated with nurse performance.  Conclusion: A caring-enhancement workshop and a mentoring program for non-Saudi nurses may increase holistic care awareness and enhance its practice in the ICUs.