The role of human resource management and governance in addressing bullying, burnout and the depersonalization of junior and senior psychiatric nurses in Saudi Arabia.

This study examined the level of perceived responsibility junior and senior psychiatric nurses have for human resources and governance in Saudi Arabia. Bullying is a significant issue in nursing and an entrenched cultural practice that highlights a failure in governance and human resource responsibilities. A total of 90 responses (43.1%) to a 5-point Likert Scale survey that sought respondent perceptions on leadership, governance and human resources. This study is reported using EQUATOR network recommendations (SQUIRE 2.0). This survey revealed that junior and senior nursing respondents weakly agree with all statements. Neither nurse rank, educational status nor nationality affected the answers of the respondents; there were age, gender and experience effects. There is a significant correlation between all responses to the statements implying there is a social desirability bias to the responses. If bullying, and its derived consequence of burnout, is to be addressed there needs to be a cultural shift in the attitudes of junior and senior nurses towards more acceptance of their HR and governance responsibilities. Furthermore, there needs to be an increased focus on shared leadership responsibilities, with greater nurse-manager interaction and cooperation on transformational practices that will bring cultural change to the clinical space.

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.

Compassion fatigue in critical care nurses and its impact on nurse-sensitive indicators in Saudi Arabian hospitals.

AIM: To examine the previously untested relationship between the level of compassion fatigue (CF) in critical care nurses and the rates of three nurse-sensitive indicators in four critical care units in hospitals in Saudi Arabia. BACKGROUND: CF can manifest in nurses who provide direct, intimate care to patients with different levels of illness including nurses working in specialty areas such as critical care where they care for patients experiencing challenging illnesses. Pressure injuries, patient falls, and medication errors are key nurse-sensitive indicators that identify critical care nurses as the primary causal agent. These indicators also correlate with burnout and poor multidisciplinary team communication, both factors that govern CF. METHODS: A multisite survey was conducted to collate and examine the number of reported pressure injuries, falls, and medication errors over 3 months at four hospitals in two Saudi Arabian cities during 2018 to determine the relationship between the occurrence of these nurse-sensitive indicators and the level of CF in critical care (intensive care unit [ICU]) nurses. A survey of 516 critical care nurses was undertaken; analysis was performed using the Professional Quality of Life Scale, version 5 (ProQol-5), and results were further analysed using Pearson's correlations and three-way analysis of variance. RESULTS: The results of the regression analysis indicated resilience as a predictor explained 66% of the compassion satisfaction (CS) variance (B = 0.318, R2 = 0.436, F(2, 12.495) = 123.013, p < 0.001) and 26% of the burnout (BO) variance (B = 0.152, R2 = 0.067, F(2, 11.500) = 3.279, p < 0.001). In addition, the level of resilience as a predictor explained 15.4% of the secondary traumatic stress (STS) variance (B = 0.063, R2 = 0.024, F(2, 7.758) = 2.785, p = 0.006). Conversely, coping strategies did not predict CS, BO, or STS (p > 0.05) at a statistically significant level. The concurrent measure of CF, BO, and STS found that almost 20% of the critical care nurse participants reported having very low CS, indicating increased potential for the development of CF. In addition, male nurses reported experiencing higher levels of stress and BO than female nurses. This study also found that neither the number of patients being treated nor the number of beds in the care setting affected the rate of the nominated nurse-sensitive indicators. The results for rates of pressure injuries did vary among the hospitals, with the worst performing hospital reporting pressure injury rates of one in every 40 patients and the better performing hospital reporting no cases of pressure injuries after treating more than 100 patients. Patient falls and medication errors were rare occurrences and did not vary between hospitals. SIGNIFICANCE: This study indicates that there is a possible issue contributing to the differential level of care between hospitals. The mode and length of time nurses spend on handover may also reflect communication issues that increase both the rate of nurse-sensitive indicators and the level of CF reported by nurses. Therefore, the implications of this study, in terms of improving nursing practice, occurs in handover to ensure that information on aspects of nonpatient critical care are fully covered, such as time of patient turning to avoid pressure injuries.

Personal characteristics, coping strategies, and resilience impact on compassion fatigue in critical care nurses: A cross-sectional study.

Compassion fatigue is known to impact the well-being of nurses and patient safety outcomes. Currently, there is limited academic understanding of the role of demographic factors in contributing to compassion fatigue in critical care nurses. The aim of this study was to examine the relationship between nurse demographic characteristics and the development of compassion fatigue, as indicated by level of burnout and compassion satisfaction in critical care nurses in Saudi Arabia. The cross-sectional study design included administering three surveys to critical care nurses (n = 321) in four Saudi public hospitals to examine the nurse demographic variables in relation to compassion fatigue, the compassion fatigue coping strategies of nurses, and nurse resilience. The results show both demographic and workplace structural elements, such as length of work shift, education level, and nationality, were all significant factors in resilience to compassion fatigue among Saudi critical care nurses, whereas factors of age and sex were not significant. This study concludes that the demographic characteristics of critical care nurses enable the identification of levels of compassion fatigue and compassion satisfaction, and their resilience to the effects of compassion fatigue.

Compassion fatigue in critical care nurses. An integrative review of the literature.

OBJECTIVES: To provides a critical evaluation of current empirical evidence related to the prevalence, causes and outcomes of compassion fatigue among critical care nurses. Compassion fatigue is characterized the development of emotional, physical, and/or spiritual exhaustion as a result of working with traumatized individuals. METHODS: Data was collected using an integrated review framework via an advanced search of healthcare databases; namely, ProQuest, Science Direct, and CINAHL for research articles on compassion fatigue among nurses in critical care settings. Analysis was performed on the articles which met the inclusion criteria for this review (n=10) to identify the key themes and issues related to the compassion fatigue in critical care situations. Articles were assessed for quality and rigor using the Critical Appraisal Checklist for Analytical Cross-Sectional Studies. The search was limited to research studies undertaken from 2000 to 2018. RESULTS: The main findings to emerge from this integrative review was that the prevalence of compassion fatigue among nurses varied across the range of critical care settings. In terms of the causes and consequences of compassion fatigue, this review found work environment and nurse demographics such as age and years of experience, were predictors of compassion fatigue, and the factors mitigating compassion fatigue affects among critical nurse included leader and administrative support within the clinical setting and the coping strategies employed by the nurses. CONCLUSION: There is inconclusive evidence to identify unequivocal predictors of compassion fatigue among critical nurses. However, it is likely the onset of compassion fatigue among critical care nurses may be reduced with close monitoring of physical and emotional wellbeing in the critical care environment as well as through the provision of education to nurses to assist with the development of coping strategies to avoid compassion fatigue.

Towards an understanding of compassion from an Islamic perspective.

AIMS: To explore the concept of compassion as represented in Islamic virtues and how it influences the practice of nurses. BACKGROUND: Islam is one of the world's major religions. Yet, an Islamic perspective of compassion is not well understood in the Western nursing literature. Current understandings of compassion are largely drawn from a Western or Buddhist perspective. DESIGN: Discursive paper. METHODS: This is a review of literature and Islamic texts on the presence, meaning and practices of compassion that are relevant to our understanding of compassion in the contemporary nursing practice. CONCLUSIONS: A compassionate Muslim nurse is a person who gives without asking for something in return, a person who cares without conditions and a person who seeks to achieve the happiness of others. Therefore, Islam, like many other religions, endorses compassionate care in all aspects, and this is particularly emphasised in nurses. RELEVANCE TO CLINICAL PRACTICE: This paper also provides an insight into how a Muslim patient perceives different experiences of health and illness, supported by quotes from the Islamic contextual heritage, and how a nurse within this culture is expected to behave.

The factors influencing burnout and job satisfaction among critical care nurses: a study of Saudi critical care nurses.

AIM: The aim of the study was to explore the prevalence of burnout and job satisfaction among Saudi national critical care nurses. BACKGROUND: Burnout is caused by a number of factors, including personal, organisational and professional issues. Previous literature reports a strong relationship between burnout and job satisfaction among critical care nurses. Little is known about this phenomenon among Saudi national critical care nurses. METHODS: A convenience sample of 150 Saudi national critical care nurses from three hospitals in Hail, Saudi Arabia were included in a cross-sectional survey. RESULTS: Saudi national critical care registered nurses reported moderate to high levels of burnout in the areas of emotional exhaustion and depersonalisation. Participants also reported a feeling of ambivalence and dissatisfaction with their jobs but were satisfied with the nature of their work. CONCLUSIONS: Saudi national critical care nurses experience moderate to high levels of burnout and low levels of job satisfaction. Burnout is a predictor of job satisfaction for Saudi national critical care nurses. IMPLICATIONS FOR NURSING AND HEALTH POLICY: These results provide clear evidence of the need for nurse managers and policy makers to devise strategies to help nurses better cope with a stressful work environment, thereby also improving job satisfaction among Saudi national critical care nurses.