Development of advanced practice nursing core competencies in Saudi Arabia: A modified Delphi study.

BACKGROUND: Advanced practice nursing requires a diverse set of competencies that define what advanced practice nurses need to know and be able to do to deliver safe, effective, and high-quality healthcare. Given the lack of evidence regarding core competencies and the evolution of advanced practice nursing roles in Saudi Arabia, it is becoming increasingly important to develop core competencies to standardize educational and clinical training programs. OBJECTIVE: To define the core competencies of advanced practice nursing in Saudi Arabia. DESIGN: Utilizing a modified Delphi design and snowball sampling technique, data were collected between April and July 2023 using an online questionnaire consisting of 28 core competencies that was developed based on an in-depth literature review and a critical analysis of advanced practice nursing core competencies published by leading professional organizations. Two rounds of Delphi surveys were conducted. SETTINGS: The study was set in clinical and academic settings in Saudi Arabia. PARTICIPANTS: Nursing experts with graduate degrees as advanced practice nurses. RESULTS: In Round 1, 34 advanced practice nursing experts reached full consensus on 24 of the 28 core competencies, and four core competencies reached partial consensus. Based on suggestions and feedback from the experts, the investigators revised ten core competencies to reflect the improvement suggestions and created three new core competencies. A total of 26 core competencies were used in Round 2, which achieved a full consensus among the 34 advanced practice nursing experts, under the following six core competency domains: knowledge of advanced practice nursing, person-centered care, professional improvement, professionalism, communication and interprofessional partnership, and leadership and system-based practice. CONCLUSIONS: Given the need for a standardized competency framework, the 26 core competencies proposed in our study have the potential to guide education and training in academic programs and facilitate the implementation of advanced practice nursing in clinical settings.

Pilot Study of SATELLITE Education on Nurses' Knowledge and Confidence toward Assessing and Caring for Female Victims of Sexual Violence.

Sexual violence (SV) can deeply impact victims' physical and psychosocial well-being. Yet many healthcare providers, including registered nurses (RNs), hesitate to screen patients due to a lack of confidence and knowledge. The SATELLITE Sexual Violence Assessment and Care Guide was developed to address this gap; however, the guide's educational effectiveness remained untested. This pilot study aimed to assess the feasibility, acceptability, and efficacy of an education program based on the SATELLITE guide among RNs in clinical settings (n = 8), using a pre- and post-test design. Results indicated that the education was not only feasible and acceptable, but also demonstrated the effects as desired with significant increases in RNs' knowledge and confidence in SV screening and care. The program's assessment tool was reliable, and participant recruitment was feasible. Based on these findings, it is recommended that the SATELLITE education program be further tested with a larger RN sample and extended to other healthcare providers. Additionally, exploring SATELLITE's use in different regions, cultural contexts, and healthcare settings would enhance understanding of the program's broader applicability and effectiveness.

The impact of comprehensive licensure review on nursing students' clinical competence, self-efficacy, and work readiness.

This study aims to assess the effectiveness of comprehensive licensure reviews and adaptive quizzing assignments on nursing students' clinical competence, self-efficacy, and work readiness-an under-researched topic. Additionally, it seeks to explore the mediating effect of self-efficacy in the relationship between students' clinical competence and work readiness. A quasi-experimental (pre- and post-test), single-group design was employed. The study was conducted in a public university in Saudi Arabia and included a total of 293 senior nursing students in their last year of the bachelor program. An intervention was developed based on the blueprints of the Saudi Nursing Licensing Exam and NCLEX-RN and consisted of a weekly 3-h synchronous comprehensive licensure review bundled with 23 adaptive quizzing assignments over 15 weeks. Data were collected prior to and after the intervention using three scales: clinical competence, self-efficacy, and work readiness. The mean scores of clinical competence, self-efficacy, and two subscales of work readiness (work competence and social intelligence) increased significantly post-intervention. Self-efficacy (ß = 0.353, p < 0.001) and clinical competence (ß = 0.251, p < 0.001) influenced work readiness (F [5, 226] = 21.03, p < 0.001) and accounted for 31.8% of the explained variability in work readiness. In the mediation analysis, clinical competence had a significant and indirect effect on work readiness through self-efficacy (B = 0.464, p < 0.001, 95% CI 0.250 to 0.699). The proportion of mediation indicated that 37.2% of the total effect of clinical competence on work readiness was due to the indirect effect of self-efficacy. Comprehensive licensure review and adaptive quizzing assignments improve students' perceptions of clinical competence and self-efficacy. Such interventions could ease the transition of senior nursing students to clinical practice.

Role delineation of advanced practice nursing: A cross-sectional study.

AIMS: To identify the roles and activities of nurses, including advanced practice nursing (APN), and to determine nursing practice patterns across health facilities in Saudi Arabia. METHODS: A descriptive cross-sectional design was used to collect data from 207 nurses working in the Saudi health sector between November 2021 and March 2022 through an online questionnaire. The Advanced Practice Role Delineation tool was used to measure and delineate nursing practice patterns and activities. Data were analysed using descriptive statistics and analysis of variance. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology reporting guidelines. RESULTS: Findings showed that participants, regardless of their current role, reported high scores across all domains of practice. The highest average score was obtained for the Clinical Care domain. Except for the leadership domain, findings showed that those reported working as advanced practice nurses had higher average scores across all domains than those working as staff nurses or being in managerial/administrative positions. There were significant differences in the average Clinical Care scores between advanced practice nurses and staff nurses. CONCLUSION: Advanced practice nursing roles and activities are being practised in Saudi Arabia; however, there is no clear delineation of these roles and activities according to a unified and national-level APN scope of practice. IMPACTS: Advanced practice nursing roles are evolving in Saudi Arabia; however, no study has examined the existing patterns of APN activities in Saudi Arabia. This study highlights the practice patterns of advanced practice nurses and adds to the international evidence base on the need for delineating APN activities under a unified scope of practice. The findings of this study are beneficial to practitioners, researchers, and stakeholders as well as the legislative and regulatory bodies. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Comprehensive licensure review and adaptive quizzing assignments for enhancement of end-of-programme exit examination scores in Saudi Arabia: a quasi-experimental study.

OBJECTIVE: This study explores the effectiveness of a comprehensive licensure review and adaptive quizzing assignments intervention in improving the performance of undergraduate senior nursing students on the end-of-programme exit exam. DESIGN: A quasi-experimental single-group design was used to compare pretest and post-test scores through computerised adaptive tests. SETTING: The setting was a nursing college in Saudi Arabia. PARTICIPANTS: The study included 292 senior nursing students enrolled in the Bachelor of Science in Nursing programme. INTERVENTION: A comprehensive licensure review bundled with adaptive quizzing assignments was delivered over 15 weeks in the academic year 2021-2022. The bundle was guided by the elaboration theory, and it included 3-hour synchronous lectures every week and 23 adaptive quizzing assignments that covered weekly content. PRIMARY AND SECONDARY OUTCOME MEASURES: Students' mastery scores and the percentage of correct answers were the primary and secondary measures, respectively. Both measures were collected in the pretest and post-test (exit examination). Additionally, demographic characteristics were collected in the pre-test using an online survey. RESULTS: The overall mean of the mastery score was statistically significantly higher in the exit exam (M=2.51, SD=1.70) than in the pretest (M=1.45, SD=0.44; p<0.001). Although the overall mean of the mastery score in the exit exam did not reach the cut-off score, students who demonstrated the required knowledge and satisfactory performance in the pretest achieved a mastery score above the cut-off. The percentage of correct answers was statistically significantly higher in the exit exam (M=58.59%, SD=9.50) than in the pretest (M=49.32%, SD=9.78; p<0.001). A statistically significant difference in students' performance based on gender, age and grade point average was observed. CONCLUSIONS: A comprehensive licensure review and adaptive quizzing assignments intervention bundle fostered the performance of undergraduate nursing students in the end-of-programme exit exam.

Nurses' readiness to prescribe under supervision in Saudi Arabia: A cross-sectional study.

Aim: To explore nurses' readiness to prescribe medications under supervision and identify associations between prescribing practices under supervision and demographic characteristics in Saudi Arabia. Design: A cross-sectional study. Methods: Using convenience sampling, this study used a 32-item survey to collect data on nurses prescribing medications under supervision between December 2022 and March 2023. Results: A total of 379 nurses were recruited from different regions in Saudi Arabia. Approximately 7% (n = 30) of the participants were prescribing medications independently, and 70% (n = 267) expressed their likelihood of becoming prescribers. The highest motivating factors to become prescribers were improvement of patient care (52.2%) and contribution to the multidisciplinary team (52.0%). Most participants (60%-81%) agreed that prescribing medications under supervision would improve potential outcomes at the system, nurse, and patient levels. Availability of appropriate mentors or supervisors (72.9%) was the highest rated facilitating factor, followed by support of nursing colleagues (72%). Based on demographic characteristics, findings revealed significant differences in the: a) likelihood and motivators of becoming prescribers; b) required minimum qualification, years of experience, and continuing professional education hours to become prescribers; and c) type of organizations delivering educational programs for nurse prescribing. Conclusion: Majority of nurses in Saudi Arabia favored becoming prescribers, and motivating factors were mostly relevant to optimizing patient care outcomes. Having the proper supervision was rated as the most facilitating factor for nurse prescribing. Nurses' views on potential outcomes, facilitating factors, and possible motivators varied based on nurses' demographical characteristics. Implications for the professional and/or patient care: Nurses favored prescribing under supervision to improve patient care outcomes, which is an opportunity to expand the benefits of health services, including easy access to healthcare. Impact: Results revealed that nurses support the implementation of prescribing practice under supervision. Thus, the findings may inform practice change in Saudi Arabia to allow prescribing under supervision, which was perceived to have a positive impact on patient care outcomes. Reporting Method: This study adhered to STROBE guidelines.

Nursing faculty perceptions of simulation culture readiness in Saudi universities: a cross-sectional study.

BACKGROUND: Academic programs are increasing simulation-based learning in Saudi Arabia during COVID-19 pandemic; however, there is limited knowledge about these universities' simulation culture readiness. Thus, the purpose of this study was to explore faculty perceptions of the readiness to integrate simulation into nursing programs. METHODS: This cross-sectional correlational study recruited faculty members in four nursing colleges at Saudi universities using the simulation culture organizational readiness survey 36-item questionnaire. A total of 88 faculty members from four Saudi universities were included. Descriptive, Pearson's correlation, independent sample t-test, and analysis of covariance analysis were utilized in this study. RESULTS: Nearly 39.8% and 38.6% of the participants had Moderately and Very Much overall readiness for the simulation-based education (SBE), respectively. There were significant correlations between the summary impression on simulation culture readiness measures and simulation culture organizational readiness survey subscales (p < 0.001). Three simulation culture organizational readiness survey subscales (defined need and support for change, readiness for culture change, and time, personnel, and resource readiness) and the overall readiness for SBE were correlated with age, years since highest degree, years of experience in academia, and years using simulation in teaching (p < 0.05). The sustainability practices to embed culture subscale and summary impression were only correlated significantly with the number of years using simulation in teaching (p = 0.016 and 0.022, respectively). Females had a significantly higher mean in the sustainability practices to embed culture subscale (p = 0.006) and the overall readiness for simulation-based education (p = 0.05). Furthermore, there were significant differences among the highest degree in the overall readiness for SBE (p = 0.026), summary impression (p = 0.001), the defined need and support subscale (p = 0.05), the sustainability practices to embed culture subscale (p = 0.029), and the time, personnel, and resource readiness subscale (p = 0.015). CONCLUSIONS: Favorable simulation culture readiness results suggest great opportunities to advance clinical competencies in academic curricula and optimize educational outcomes. Nurse academic leaders should identify needs and resources to enhance simulation readiness and encourage the integration of simulation in nursing education.

Work readiness of newly graduated nurses transitioning to practice in Saudi Arabia: A cross-sectional study.

AIMS: To explore work readiness among newly graduated nurses transitioning to practice in Saudi Arabia. BACKGROUND: Many challenges encounter newly graduated nurses when transitioning to practice. Higher work readiness has been associated with smooth transitioning to practice. However, little is known about work readiness among newly graduated nurses in Saudi Arabia. METHODS: Cross-sectional convenience sample of 174 participants. RESULTS: The mean score in work readiness was 338.8 (SD = 69.6). Weekly working hours correlated with organizational acumen (r = 0.208, p ≤ 0.01), social intelligence (r = 0. 217, p ≤ 0.01), work competence (r = 0.173, p ≤ 0.05) and the number of weeks since the start of internship training (r = 0.180, p ≤ 0.05). There were significant mean differences in a) personal work characteristics based on the country (t = 5.582, p < 0.001) and university from which they graduated (f = 15.618, p < 0.001); b) organizational acumen based on having a second job (t = -2.18, p = 0.03), university from which they graduated (f = 1.837, p = 0.002) and whether the hospital was the first-choice preference (t = - 2.837, p = 0.005) and nursing was the first choice of study (t = -2.879, p = 0.005); and c) work competence based on the university from which they graduated (f = 5.267, p = 0.006). CONCLUSIONS: The findings showed the work readiness of newly graduated nurses in Saudi Arabia's context. IMPLICATIONS FOR NURSING MANAGEMENT: Findings have important implications for nurse managers to better design and implement a transition to practice programs for newly graduated nurses to improve their preparedness in their nursing careers.

Work Readiness of Newly Licensed RNs.

OBJECTIVE: The aim of this study was to examine the work readiness of newly licensed RNs (NLRNs) based on demographics, education, and work experiences. BACKGROUND: Work readiness is the extent to which new graduates possess qualities and competencies associated with workplace success. Work readiness of NLRNs complements their clinical knowledge and skills and has been shown to predict job satisfaction and work engagement. METHODS: Two hundred ninety-seven NLRNs participating in the nurse residency program of a health system in the southeast region of the United States were surveyed using the Work Readiness Scale-Graduate Nurse. RESULTS: Scores on all readiness dimensions were high. Analysis revealed unexpected differences in readiness dimensions based on race, nursing degree, and completion of a nurse externship program. CONCLUSIONS: Work readiness adds to our understanding of factors that can affect the transition of NLRNs into the work setting. Further research is needed to understand how work readiness develops over time, factors that predict work readiness, and its relationship to NLRN retention and other outcomes.

The impact of nurse practice environment on patient outcomes and mediation effects of registered nurse outcomes in Middle Eastern acute care hospitals: A cross-sectional study.

AIMS: Examining associations between unit nurse practice environment and four patient outcomes (catheter-associated urinary tract infections [CAUTIs], central line-associated bloodstream infections [CLABSIs], falls, and pressure injuries) and mediation effects of three RN unit workgroup outcomes (job enjoyment, psychological safety, and intent to stay at 1 and 3 years) on these relationships. METHODS: A cross-sectional correlational design, using the National Database of Nursing Quality Indicators® (NDNQI®) unit-level data from 2018 on inpatient units from seven Middle Eastern hospitals. Ninety units were included, where the sample of units for each patient outcome varied (n = 73-90) based on outcome data availability. RESULTS: Higher unit nurse practice environment scores were significantly associated with higher CLABSIs (exp(b) = 8.181, 95 % CI = [2.204, 30.371], p = .002) and lower pressure injuries (exp(b) = 0.153, 95 % CI = [0.032, 0.730], p = .018). However, mediation analysis showed no significant direct effects of unit nurse practice environment on patient outcomes. Mediation analysis showed that nurses' psychological safety-respect significantly mediated the relationship between unit nurse practice environment and CAUTIs (ß = 2.620, p = .013, 95 % bcb CI = [0.837, 5.070]). Nurses' intent to stay at 1-year and psychological safety-respect had significant direct effects (ß = -4.784, p = .017 and ß = 3.073, p = .012, respectively) on CAUTIs. CONCLUSIONS: Nurse practice environment was significantly associated with two patient outcomes and a mediation role of RN outcomes was supported when examining one patient outcome. Future research should examine these relationships in a larger sample for replication. TWEETABLE ABSTRACT: Although nurse practice environment can impact patient outcomes directly, nurse outcomes play a crucial role in mediating this relationship.

Maintaining Clinical Training Continuity during COVID-19 Pandemic: Nursing Students' Perceptions about Simulation-Based Learning.

BACKGROUND: Simulation-based learning (SBL) in nursing education is an innovative pedagogical approach that has significantly improved nursing education. Adopting SBL provides a controlled environment for meeting educational objectives without the risk of harm to real patients. Given that social distancing is required during the coronavirus disease (COVID-19) pandemic, SBL is a suitable alternative to clinical training for nursing students to learn and acquire the required clinical competencies. The study aimed to describe the effectiveness of SBL as a complete substitute for clinical experience from the perspective of students. This cross-sectional descriptive survey investigated students' perceptions regarding the description of the effectiveness of SBL in four nursing colleges at four different universities across the Kingdom of Saudi Arabia. SETTINGS: Four nursing colleges at four different universities across the Kingdom of Saudi Arabia. Participants included nursing students who attended simulation sessions. Data were collected by distributing a self-administrated online questionnaire, the Modified Simulation Effectiveness Tool (SET-M), which is a 19-item. RESULTS: Approximately two-thirds of the participants were in their third (30.4%) and fourth (44.5%) academic year. The highest student presentation was for Site 1 (39.5%) and Site 2 (32.5%). Significant differences existed in all domains according to sex and university (p ≤ 0.001). There was a significant difference in relation to the level of agreement for pre-briefing, scenario, and debriefing domains (<0.001). CONCLUSIONS: SBL is a valuable teaching strategy that enhances nursing students' self-awareness, self-confidence, clinical performance, and efficiency in performing procedures with considerable gender variation. Female students had more positive perceptions toward simulation effectiveness.

Systemic assessment of depressive symptoms among registered nurses: A new situation-specific theory.

BACKGROUND: A mentally-healthy nursing workforce is vital to providing quality healthcare. While there has been research conducted internationally on depressive symptoms in nurses, most studies have lacked a theoretical framework. PURPOSE: The purpose of this article is to describe the development of a situation-specific theory, the Systemic Assessment of Depressive Symptoms among Registered Nurses (SAD-RN). METHODS: The SAD-RN was developed through theory synthesis using the Roy's Adaptation Model (RAM) as a framework. Sixty-four research articles were selected to abstract relevant concepts based on a priori RAM concepts. FINDINGS: Using depressive symptoms as the anchor concept, related emergent concepts of SAD-RN include context, stressors, protective factors, negative health outcomes, and low patient care quality. DISCUSSION: SAD-RN is an evidence-based comprehensive model that offers researchers a guiding theory to be used in their future research on depressive symptoms among RNs.