Culture and language differences as a barrier to provision of quality care by the health workforce in Saudi Arabia

The relationship between organizational justice and bullying behaviors among nurses: the role of nurse managers' caring behaviors

BACKGROUND

Organizational justice is pivotal in fostering a fair and supportive workplace culture, which strengthens the connections between managers and nurses, among nurses themselves, and ultimately, between nurses and their patients. Assessing the perceived levels of organizational justice and managerial behaviors can identify key areas for improving nurses' commitment and loyalty, while simultaneously reducing incidents of workplace bullying.

PURPOSE

This study aims to investigate how bedside nurses perceive organizational justice, nurse managers' caring behaviors, and their exposure to workplace bullying. Additionally, it seeks to explore the relationship between organizational justice, nurse managers' caring behaviors, and nurses' perceived exposure to workplace bullying.

METHODS

A descriptive-correlational study was conducted in the inpatient care unit of a Saudi hospital. A convenience sample of 256 nurses participated, completing the Organizational Justice Questionnaire (OJQ), the Caring Factor Survey: Caring of the Manager (CFS-CM), and the Negative Acts Questionnaire-Revised (NAQ-R). The collected data were analyzed using descriptive statistics and regression analysis.

RESULTS

Descriptive statistics revealed moderate levels of perceived organizational justice and managerial caring behaviors among nurses, alongside low reported exposure to workplace bullying. Significant correlations were found among the studied variables, indicating that higher perceived organizational justice was associated with higher managerial caring and lower workplace bullying (p < 0.05). Mediation analysis demonstrated a significant indirect effect of organizational justice on workplace bullying through the mediating role of nurse managers' caring behaviors (a×b = -0.0652, p < 0.001). Furthermore, the direct effect of organizational justice on workplace bullying remained significant even when accounting for the mediator (c = -0.5509, p < 0.001).

CONCLUSION

This study highlights the vital role of organizational justice and managerial caring in cultivating a positive work environment and mitigating workplace bullying. Implementing clear policies and procedures while promoting fairness and equality in resource allocation, decision-making processes, and interactions are essential strategies for fostering positive attitudes and work behaviors among nurses.

Association between language discordance and unplanned hospital readmissions or emergency department revisits: a systematic review and meta-analysis

BACKGROUND AND OBJECTIVE

Studies conflict about whether language discordance increases rates of hospital readmissions or emergency department (ED) revisits for adult and paediatric patients. The literature was systematically reviewed to investigate the association between language discordance and hospital readmission and ED revisit rates.

DATA SOURCES

Searches were performed in PubMed, Embase and Google Scholar on 21 January 2021, and updated on 27 October 2022. No date or language limits were used.

STUDY SELECTION

Articles that (1) were peer-reviewed publications; (2) contained data about patient or parental language skills and (3) included either unplanned hospital readmission or ED revisit as one of the outcomes, were screened for inclusion. Articles were excluded if: unavailable in English; contained no primary data or inaccessible in a full-text form (eg, abstract only).

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently extracted data using Preferred Reporting Items for Systematic Reviews and Meta-Analyses-extension for scoping reviews guidelines. We used the Newcastle-Ottawa Scale to assess data quality. Data were pooled using DerSimonian and Laird random-effects models. We performed a meta-analysis of 18 adult studies for 28-day or 30-day hospital readmission; 7 adult studies of 30-day ED revisits and 5 paediatric studies of 72-hour or 7-day ED revisits. We also conducted a stratified analysis by whether access to interpretation services was verified/provided for the adult readmission analysis.

MAIN OUTCOMES AND MEASURES

Odds of hospital readmissions within a 28-day or 30-day period and ED revisits within a 7-day period.

RESULTS

We generated 4830 citations from all data sources, of which 49 (12 paediatric; 36 adult; 1 with both adult and paediatric) were included. In our meta-analysis, language discordant adult patients had increased odds of hospital readmissions (OR 1.11, 95% CI 1.04 to 1.18). Among the 4 studies that verified interpretation services for language discordant patient-clinician interactions, there was no difference in readmission (OR 0.90, 95% CI 0.77 to 1.05), while studies that did not specify interpretation service access/use found higher odds of readmission (OR 1.14, 95% CI 1.06 to 1.22). Adult patients with a non-dominant language preference had higher odds of ED revisits (OR 1.07, 95% CI 1.004 to 1.152) compared with adults with a dominant language preference. In 5 paediatric studies, children of parents language discordant with providers had higher odds of ED revisits at 72 hours (OR 1.12, 95% CI 1.05 to 1.19) and 7 days (OR 1.02, 95% CI 1.01 to 1.03) compared with patients whose parents had language concordant communications.

DISCUSSION

Adult patients with a non-dominant language preference have more hospital readmissions and ED revisits, and children with parents who have a non-dominant language preference have more ED revisits. Providing interpretation services may mitigate the impact of language discordance and reduce hospital readmissions among adult patients.

PROSPERO REGISTRATION NUMBER

CRD42022302871.

Language and Communication Barriers in Emergency Departments in Makkah: Physicians' Perspective

Background Communication is essential in the medical sector, particularly in the emergency departments (ED), to provide appropriate patient care. Lack of patient history and large patient numbers, cultural variations, inadequate health literacy, and language difficulties can impact effective communication. Aim This study aims to examine language and communication barriers experienced by ED physicians in Makkah, Saudi Arabia, as well as to determine the effect of language barriers on patient care and explore possible methods to deal with language and communication barriers. Methods This cross-sectional study was conducted from April 8 to June 6, 2023. A total of 136 responses were collected from ED physicians at the six Ministry of Health Hospitals (MOH) in Makkah through a validated online survey. The data analysis was implemented using RStudio (R version 4.1.1). Result In this study, 136 participants' data were examined. Of note, one-quarter of ED physicians (25%; n=34) under study stated that they always experienced language barriers, whereas 64.7% (n=88) of them sometimes experienced these difficulties. More than half of the ED physicians (54.4%; n=74) stated that their patients had poor outcomes because of poor communication. Among those who responded positively to poor outcomes, ED physicians' suggestions to improve communication with patients included providing labels of the common scientific terminologies in different languages (59.6%; n=81) and providing courses to communicate in foreign languages (48.5%; n=66). Conclusion Exposure to language barriers among ED physicians in Makkah was slightly high. This may impact the patient's outcomes. Therefore, strategies to improve patient-physician communication are needed.

"Thai Nurses' and Midwives' Perceptions Regarding Barriers, Facilitators, and Competence in Neonatal Pain Management"

BACKGROUND

Effective neonatal pain management is reliant upon the expert care of nurses and midwives working in neonatal intensive care units (NICUs). Previous research has explored barriers, facilitators, and some aspects of nurse competence in managing neonatal pain; however, this research has been predominantly performed in Western countries. To date, little is known about the barriers, facilitators, and perceived competence of Thai nurses and midwives in relation to neonatal pain management in NICUs. Exploring Thai nurses' and midwives' perceptions in these areas is crucial for understanding the contextual nuances of neonatal pain management, which can guide the provision of care for these high-risk neonates.

PURPOSE

To investigate nurses' and midwives' perceptions of barriers, facilitators, and competence regarding effective neonatal pain management in Thai NICUs.

METHODS

Data were collected using virtual one-to-one, semistructured interviews with 12 neonatal nurses and midwives between July and August 2021 in 3 units of 2 tertiary hospitals in Southern Thailand. Inductive thematic analysis was used to examine interview data.

RESULTS

These data revealed following 3 major themes: ( a ) barriers to effective neonatal pain management, ( b ) facilitators of effective neonatal pain management, and ( c ) perceptions of competence.

IMPLICATIONS FOR PRACTICE

Assisting nurses and midwives in overcoming barriers and strengthening facilitators while enhancing their competence may result in better neonatal pain management.

IMPLICATIONS FOR RESEARCH

This study adds to our understanding that further research is needed to develop the interventions designed to change at individual, unit, and organizational levels, particularly implementing parent-friendly visitation and ongoing professional development in neonatal pain management.

Assessing the Efficacy of a Novel Massive Open Online Soft Skills Course for South Asian Healthcare Professionals

In healthcare professions, soft skills contribute to critical thinking, decision-making, and patient-centered care. While important to the delivery of high-quality medical care, soft skills are often underemphasized during healthcare training in low-and-middle-income countries. Despite South Asia's large population, the efficacy and viability of a digital soft skills curriculum for South Asian healthcare practitioners has not been studied to date. We hypothesized that a web-based, multilingual, soft skills course could aid the understanding and application of soft skills to improve healthcare practitioner knowledge, confidence, attitudes, and intent-to-change clinical practice.In September 2019 a needs assessment observing soft skills practices was conducted in several Indian states. We developed a communication-focused soft skills curriculum that comprised seven 10-minute video lectures, recorded in spoken English and Hindi. Participants consisted of any practicing healthcare professionals and trainees in select South Asian countries age 18 and over. Participant knowledge, confidence, attitudes, and intent-to-change clinical practice were evaluated using pre- and post-course tests and surveys. Statistical analyses were performed using STATA and SPSS.From July 26, 2021 to September 26, 2021, 5750 registered and attempted the course, 2628 unique participants completed the pre-test, and 1566 unique participants completed the post-test. Participants demonstrated small but statistically significant gains in confidence (𝑝<0.001), attitudes toward course topics relevance (𝑝<0.001), and intent-to-change clinical practice (𝑝<0.001). There was no statistically significant gain in knowledge. A digital soft-skills massive open online course for healthcare practitioners in South Asia could serve as a viable approach to improve the quality of soft skills training in low-to-middle income countries.

What Do We Know About Patient Safety Culture in Saudi Arabia? A Descriptive Study

BACKGROUND

Patient safety is described as the prevention and mitigation of medical errors that can result in harm while a patient is receiving care. One important way to improve safety is through improving the patient safety culture in healthcare. The purposes of this study are to evaluate the patient safety culture trend in Saudi Arabia and assess the improvement over time.

METHODS

This study is a descriptive study that used a retrospective analysis of a national data set for 3 cycles from 2019 to 2022. To generate a baseline and allow comparison of the hospital's survey results with the aggregated findings from the database, the 10th, 25th, 50th, 75th, and 90th percentiles were calculated to set the percentage of values.

RESULT

Our results found that one of the barriers to developing a strong patient safety culture in Saudi Arabia is management support of patient safety, which caused a blame culture. This could explain the absence of improvement in the average percentage of reporting patient safety events for all 3 cycles. On the other hand, a decrease was observed in organizational learning/continuous improvement as well as a reduction in the positive percentage of patient safety ratings in the last cycle. Moreover, areas of strength in all 3 cycles did not reach the 75th percentile, whereas staffing and response to error domains remained the lowest-scoring composites in all cycles.

CONCLUSION

Our results have determined the percentile of the positive rate that could guide hospitals to improve their culture survey results. More investigations can focus on change over the years in both patient safety culture and the effectiveness of implementing interventions to measure the impact on quality of care.

Barriers to conducting and publishing research among nursing faculty members at Shaqra University, Saudi Arabia: A qualitative study

AIM

To identify barriers to conducting and publishing research among nursing faculty members at Shaqra University, Saudi Arabia.

DESIGN

A qualitative descriptive design was used.

METHODS

This qualitative descriptive study was conducted on 12 nursing faculty members from two nursing colleges at Shaqra University, a public university located in Riyadh region, SA, under the supervision of the Ministry of Education. Data were collected between September and October 2021 using semi-structured interviews and analysed thematically using content analysis.

RESULTS

Three themes emerged in the study, namely (I) individual/personal barrier, (II) institutional barrier and (III) external factors. Barriers to conducting and publishing research included lack of time due to a high teaching load and lack of administrative and financial support. The present findings suggest that nursing faculty members in SA are facing many barriers hindering them from carrying out and publishing research activities. Such barriers need to be urgently addressed through different strategies, including allocating facilities and funds for research, motivating faculty members towards research, and ongoing education and training on research.

The Challenges in the Care of Immigrant Children in the Clinic: A Phenomenological Study

INTRODUCTION

The aim of this study is to thoroughly examine the challenges experienced by pediatric nurses providing care for the children of immigrant families and to contribute to the solutions that can be provided.

METHOD

Phenomenological research design was used in this qualitative study. Semi-structured interviews were performed with face-to-face technique and individually.

RESULTS

Four categories, ten main themes and twenty-four sub-themes were obtained in the analysis of data. The themes included communication barriers and cultural differences in the category of difficulties that the nurses experienced with immigrant patients or their relatives, nurses' practices, communication barriers and cultural differences in the category of problems that the nurses experienced in the care.

DISCUSSION

It was determined that nurses experienced difficulty, especially in the areas of communication, culture and education. These difficulties were reported to cause disruptions in the care and treatment process of immigrant patients.

A Qualitative Study of Stakeholders' Perspectives of Implementing Interprofessional Shared Decision-Making Education in Palliative Care

Introduction Shared decision-making (SDM) in palliative care is a highly complex process that requires an interdisciplinary team. Interprofessional team members need education on how to facilitate discussion of patient/family wishes at the end of life in hospital settings. So far, interprofessional shared decision-making (IP-SDM) education frameworks have been used to a limited extent in the area of education on palliative care. The aim of this study was to explore policymakers', health professionals', faculty members', and students' perspectives on implementing an IP-SDM educational framework in palliative care to identify aspects that should be prioritized to further develop interprofessional education for SDM in palliative care. Methods We used the qualitative method to capture the micro, meso, and macro factors using Oandasan and Reeves' model for the implementation of IP-SDM education regarding palliative care. Data collection tools included in-depth, face-to-face interviews with individual policymakers and focus group interviews with health professionals, faculty members, and undergraduate health professionals. The interview guide explores the teaching of SDM in palliative care, factors that could facilitate or hinder the implementation of IP-SDM education for health professions students in palliative care, and interventions to facilitate the implementation of this approach. This study was conducted at the Oncology and Palliative Care Department at King Abdulaziz Medical City in the Ministry of National Guard Health Affairs and at King Saud bin Abdulaziz University for Health Sciences in Jeddah, Saudi Arabia. Results The results indicated a high demand for IP-SDM in palliative care. The findings revealed factors that can facilitate or hinder the implementation of IP-SDM education in palliative care for undergraduate health professions students that is going to the local community. Factors include culture, religion, gender, power issues, team hierarchy, and respect among team members. Also, our findings have revealed potential solutions to the hindering factors. Conclusions IP-SDM education in palliative care is a highly relevant topic for improving patient outcomes. However, it might be a complex process to implement, especially given the challenges of palliative care settings. We recommend starting such a course in the early clinical phases of undergraduate health professional education.

Patients' Perceptions of Safety in Primary Healthcare Settings: A Cross-Sectional Study in the Qassim Region of Saudi Arabia

This study assessed patients' perceptions of safety and experiences in primary healthcare in the Qassim region of Saudi Arabia. Between July and September 2022, 730 patients from primary healthcare centers were surveyed using a multi-staged cluster random sampling approach. The Patient-Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) questionnaire was used to measure patients' perceived safety and experience in primary healthcare settings within the past year. Descriptive analyses were performed to report patients' perceived safety experiences. The statistical analysis examined individual items and scales. A considerable proportion of patients reported encountering safety problems, ranging from 11% (vaccine-related) to 27% (diagnosis-related). Diagnostic errors were the most common perceived safety problem (26.7%), followed by communication issues (24.1%) and medication errors (16.3%). Between 26% and 40% experienced harm, including financial problems (40%), increased care needs (32.4%), physical health issues (32%), limitations in activities (30.6%), increased healthcare needs (30.2%), and mental health concerns (26.8%). Patient-reported safety experiences reported in our study offer valuable insights into primary care safety in Saudi Arabia. Collecting routine patient feedback is crucial for addressing identified safety problems and implementing standardized procedures.

Physical workplace violence in the health sector in Saudi Arabia

Physical workplace violence (WPV) occurs worldwide, causing psychological and physical injuries. However, reports from Saudi Arabia investigating which specialty is the most exposed are scarce. This study aimed to determine the prevalence and circumstances related to physical WPV among all healthcare providers in Saudi Arabia in 12 months, as well as the consequences for both attackers and targets of physical WPV. This cross-sectional study included all healthcare providers registered with the Saudi Commission for Health Specialties who had worked for more than 1 year in the health sector in Saudi Arabia until May 2019. Researchers distributed the questionnaire to the participants via email. Descriptive statistics were used to describe the basic features of the data. Correlations between the categorically measured variables were explored using a chi-square test of independence. Overall, 7398 healthcare workers (HCWs) voluntarily participated in the study, 51.3% being men and 48.7% being women. The mean age was 40 ± 8.62 years), and most participants were of non-Saudi origin. Overall, 9.3% HCWs had encountered physical violence. Male HCWs, pharmacists, nurses, and HCWs of non-Saudi origin were significantly more exposed to physical violence. Furthermore, those with direct physical contact with patients and those working with male patients only were more exposed to physical violence. Physical WPV is an important issue faced by HCWs, particularly those who work night shifts or have direct contact with patients. Results showed that more support, specific strategies and policies to reduce violence occurrence, and protection for healthcare providers are required.

Access to Medicines and Pharmaceutical Policy in Saudi Arabia: A Scoping Review

Introduction

This scoping review includes studies on pharmaceutical access, shortages, generics, availability, pharmacoeconomics, and pricing restrictions. The study's findings may aid in developing excellent pharmaceutical and access policies in the country.

Objective

To conduct a scoping review documenting access to medicines and Pharmaceutical Policy in Saudi Arabia.

Methodology

The PRISMA-ScR guidelines were used to perform a scoping review. The articles were screened using databases from Google Scholar, EBSCO, Science Direct, and the University of Huddersfield Library. The selection, aims, results, and conclusion of each original research publication published between 2010 and 2022 were evaluated. To categorize the articles, a theme analysis was done.

Results

This study includes nineteen publications. The chosen articles revealed four themes. Among these topics were: Access to medications 36.84% Pharmacoeconomic 36.84%), which were the predominant theme followed by Generic Medicines 15.80%, and Cancer drug financing 10.54%. There are myriad challenges related to high-cost medicines. Access restrictions to medications have significant effects on patient morbidity and mortality; as a result, policy decision-makers frequently consider this issue. Access to medicines suffers budgetary limitations and the increasing cost of innovative medicines. Access to medicines for all patients could be significantly impacted by delays in patient access to new therapies.

Conclusion

The available evidence revealed that Saudi Arabia's healthcare system has numerous issues ranging from cancer drug financing, medicine shortages, and access issue. In order to achieve the highest health standards possible, it is crucial that each individual has access to medicines and has the financial, physical, and social means to do so. However, the price of some medications can be prohibitive for people who need to obtain them. The study's outcomes could help the country develop pharmaceutical and access policies related to medicines.

Mothers' Involvement in Pediatric Postoperative Pain Care in a Tertiary Healthcare Setting in Saudi Arabia

Background Many children feel moderate to intense pain in the hospital following surgery. Untreated pain can have deleterious physical and psychological effects. Mothers' involvement in child pain care and management postoperatively has been shown to be important in improving the outcomes and experiences of children, mothers, and health professionals. Aims To explore mothers' involvement in postoperative pain care and management of their children during hospitalization and following discharge and identify approaches to improve management and participation activities. Methods We used a qualitative single case study design with thematic analysis. The analysis included 20 mother-child dyads and 21 nurses, involving observation of participants and semi-structured interviews of mothers and nurses. The analysis also incorporated a review of documents from the pediatric surgical department (hospital policies and forms).  Findings The following main themes and sub-themes were generated from the data: (i) provision of pain information (expected type, frequency, and duration of pain after surgery, pain intensity score, pain relief medication, and pain management methods), (ii) communication deficiency (language barrier and breakdown in communication between health professionals), (iii) emotional and physical support (family support, environmental comfort, and sleep and meal requirements), (iv) social and cultural influences (patriarchal society, cultural and religious beliefs, and work status), and (v) hospital facilities, provisions, and services (entertainment, follow-up programs, education courses on pain management for nurses, and materials and services). Conclusions The study examined mothers' participation in postoperative pain care and management in a cohort of children admitted to a tertiary care setting in Saudi Arabia, highlighting key factors that influence involvement and suggesting approaches for improving participation.

Culture, religion, language and the assessment and management of children's pain by expatriate nurses in Saudi Arabia: A qualitative study

PURPOSE

Unrelieved pain among hospitalized children is a common problem that affects all aspects of children's health and their quality of life. Cultural and language differences between nurses and patients have been shown to impact the quality and safety of nursing care and management for children with pain. The aim of this study was to identify the cultural factors, barriers, and facilitators impacting the assessment and management of children's pain by expatriate nurses in Saudi Arabia.

DESIGN AND METHODS

A qualitative descriptive design was employed in this study. A sample of 16 nurses was conveniently recruited and interviewed through face-to-face semistructured interviews. Each interview lasted between 30 and 60 min and was audio-recorded. Content analysis was used to analyze the transcripts. Transcripts were carefully read, significant statements were highlighted, coded, categorized, and clustered thematically.

RESULTS

Three main themes were identified, namely, (I) low priority of children's pain, (II) culture and religious challenges, and (III) communication challenges.

PRACTICE IMPLICATIONS

Cultural and language differences described by expatriate nurses hindered their care of children with pain. A systematic education for expatriate nurses, children, and families is urgently needed to enhance inter/cross-cultural understandings and improve childcare in Saudi Arabia. This study identifies the unique challenges faced by expatriate nurses in Saudi Arabia. The findings reveal how a lack of knowledge about cultural values and beliefs can lead to misunderstandings and conflicts between nurses, children, and families and can have an impact on childcare and pain. It also highlights the need to improve pain management practices in multicultural healthcare settings, similar to those of Saudi Arabia and neighboring Arab nations, and across the globe.

Beyond challenges and enrichment: a qualitative account of cross-cultural experiences of nursing patients with an ethnic minority background in Norway

BACKGROUND

Substantial mass migrations to the Scandinavian countries have made them heterogeneous and multicultural societies. Migration has also influenced the workforce, especially the healthcare system that has had to accommodate a culturally diverse population. This qualitative study aimed to explore nurses' experiences in caring for patients with an ethnic minority background.

METHODS

Focus group interviews with a total of 21 nurses were conducted. Thematic analysis was performed on the transcribed and translated interviews.

RESULTS

The findings of this study revealed three major themes: various experiences concerning language barriers and the use of interpreters, the impact of religious and cultural values, and caring for patients with an ethnic minority background is professionally interesting but demanding.

CONCLUSIONS

Caring for culturally diverse patients offers both challenges and opportunities to enhance cultural competence and cultural sensitivity among nurses. Various culturally divergent needs of patients such as family visits, food preferences, expression of pain, and gender sensitivity are interlinked and depend on effective communication during encounters with nurses and the healthcare system at large.

The Perceptions of Non-native Medical Students Towards Language Barrier on Clinical Teaching and Learning: a Qualitative Study from Saudi Arabia

BACKGROUND

Patient-doctor communication is essential for achieving the best healthcare quality for the patients. Saudi Arabia hosts a variety of healthcare providers from diverse cultures and languages, making language barriers distinctive towards effective communication for a predominantly Arab population. There is limited research on the challenges associated with language barriers among non-native medical students. The current qualitative study aims to explore the perceptions and experiences of non-native medical students during clinical encounters with Arabic speaking patient population at a private university in Riyadh, Saudi Arabia.

METHODS

This is a qualitative case study employing non-native medical students in clinical years to explore their perceptions and experiences towards language barriers. Participants attended four focus group discussions, following a brief regarding the concept of the challenges that language barriers pose. All interviews were recorded and transcribed verbatim. A thematic framework analysis was employed to analyze the data.

RESULTS

Twenty-two non-native medical students participated in the study. We identified four broad themes constituting problems in patient interaction, development of clinical skills, managing and overcoming language barriers, and student recommendations to overcome language barrier. Participants suggested improvements in available Arabic language courses and the introduction of a professional skills course in Arabic for non-native students.

CONCLUSION

Non-Native medical students perceived language barriers as an obstacle to a meaningful clinical experience. They identified implications for clinical learning environment, professionalism, empathy, and patient care. Recommendations for advanced occupation-related Arabic language courses to facilitate doctor-patient interactions were made to improve patient-student interactions between native patients and non-native medical students.

Investigation of the Experience of Immigrant Nurses in a Diverse Cultural Setting

BACKGROUND

Work-related stress (WRS) is one of the most common stressors in healthcare workplace settings.

PURPOSE

This research study was designed to examine and discuss perceived WRS, job performance, social support, and the desire of immigrant nurses to work in a multicultural workplace.

METHODS

A case research mixed-methodology approach, a quantitative survey, and semistructured qualitative interviews were used in this research study. Three hundred twenty-one respondents were invited, of which 246 (76.6%) returned valid questionnaires. A purposeful sampling technique was used in the qualitative portion of the study. A semistructured interviewing system was used on 20 nurses.

RESULTS

"Workload" was the most common traumatic occurrence, whereas "treatment" and "death and dying" were the least common traumatic occurrences. Similarly, the mean of the social support scale, as defined using the McCain and Marklin Social Integration Scale, was moderate to high, suggesting that most of the participants received strong social support from their colleagues. The qualitative research found that the participants faced high pressures related to work and have struggled to acquire cultural skills, while having difficulties meeting their patients' cultural and spiritual needs and sustaining high-quality nursing care.

CONCLUSIONS

The findings of this study support that immigrant nurses working in the Kingdom of Saudi Arabia are stressed. A significant difference between the qualitative and quantitative results was found. The findings further contribute to our understanding of WRS, social support, job performance, and intention to stay among immigrant nurses in the Kingdom of Saudi Arabia.

Cultural Factors and Social Changes Affecting Home Healthcare in Iran: A Qualitative Study

In Iran, home healthcare (HHC) is provided in a diverse socio-cultural context. Health professionals’ inadequate knowledge of the socio-cultural factors of the society can lead to poor quality HHC. Even so, the ways these factors influence HHC remain unclear. This study aimed to explore the effects of cultural factors and social changes on HHC in Iran. This qualitative study which follows a conventional content analysis approach was conducted in Tabriz, Iran. Eighteen individuals including nurses, home health directors, physicians, policy-makers, patients, and their families participated in the study. Participants were selected using purposive sampling. Data collection involved focus group discussion (FGD) and 16 semi-structured in-depth interviews. In order to analyze the data, Graneheim and Lundman’s techniques were used and data collection continued until saturation was reached. Five main themes emerged from the data analysis including cultural diversity issues, society’s understanding of HHC, shifting demographics affecting healthcare needs, transitioning from traditional to modern lifeways, and increasing unaffordability of healthcare. Health managers can improve the accessibility and acceptability of HHC services by identifying the socio-cultural needs of the society. Future research should develop and test patients and families’ cultural care models in the HHC setting.

Health Status and Barriers to Healthcare Access among "Son-in-Law Westerners": A Qualitative Case Study in the Northeast of Thailand

The northeast of Thailand is well-known as a popular destination where many male Westerners marry Thai women and settle down there. However, little is known about their health and well-being. This study aims to explore the Western husbands’ health status and identify barriers hindering their healthcare access. A qualitative case study was conducted from November 2020 to May 2021. In-depth interviews and focus group discussions with 42 key informants who were involved with social and health issues among these expatriates were carried out. The social determinants framework was adapted for guiding the interviews. Data were triangulated with field notes, document reviews, and researchers’ observations. Inductive thematic analysis was applied. Results showed that most male expatriates who married Thai women in the northeast were in their retirement years and had non-communicable diseases, health risk behaviors, and mental health problems. Most of them did not purchase health insurance and held negative impressions toward Thai public hospitals’ quality of care, which was denoted as the main barrier to accessing healthcare services. Other significant barriers consisted of high treatment costs commonly charged by private hospitals and language issues. While the improvement of healthcare quality and the provision of friendly health services are important, public communication with foreign residents, especially male expatriates, is recommended to increase understanding and improve perceptions of the Thai healthcare systems. A regular population-based survey on the health and well-being of expatriates in Thailand, a cost study of a health insurance package, a survey study on willingness to pay for health insurance premiums, and a feasibility survey exploring the opportunity to establish either voluntary or compulsory health insurance among this group should be undertaken.

Protocol for a scoping review to evaluate the extent of utilisation of healthcare services by asthma patients in sub-Saharan African countries

INTRODUCTION

Health systems in sub-Saharan African (SSA) countries are fragile and centralised. Consequently, majority of people have restricted access to healthcare services. Given the rise in the prevalence and burden of asthma in SSA, it is imperative to scrutinise the utilisation of healthcare services by people with asthma. We aim to understand, through this review, the extent of utilisation of healthcare services by asthma patients in SSA countries.

METHODS AND ANALYSIS

Arksey and O'Malley's scoping review methodology framework will be used to guide the conduct of this scoping review. We will conduct a search of the literature on the electronic databases: Medline, (using PubMed interface), EMBASE, EBSCOHOST, Web of Science and Google Scholar, grey literature sources and the reference lists of key studies to identify studies appropriate for inclusion. Two reviewers will independently screen all abstracts and full-text studies for inclusion. Registration of the proposed scoping review on the PROSPERO has indicated that no similar work has been or is being done elsewhere. We will review studies published on the subject from January 2009 to May 2020 in SSA.

ETHICS AND DISSEMINATION

The proposed scoping review will contribute towards the knowledge base on utilisation of healthcare services particularly for people with asthma. This will provide a better understanding of the extent of utilisation of healthcare services by asthma patients and ultimately contribute to improvement of quality of care for people suffering from asthma. The results from the review will enlighten and guide healthcare practitioners and researchers on developing appropriate and feasible interventions to increase the utilisation of healthcare services by asthma patients in resource-constrained settings in SSA countries. Results of this scoping review will be disseminated through a peer-reviewed publication, conference presentations and a 1-day stakeholder meeting.

PROSPERO REGISTRATION NUMBER

CRD42020154127.

Factors that influence the preceptor role: a comparative study of Saudi and expatriate nurses

OBJECTIVES

The aim of this study was to compare expatriate and Saudi nursing staff's perceptions of factors that influence their role as preceptors of nursing students.

METHODS

Descriptive comparative study using a self-administered survey was completed by a convenience sample of eligible nurses (n=285). It was conducted in five different hospitals within the Ministry of Health in the Kingdom of Saudi Arabia.

RESULTS

Most preceptors were expatriate nurses (70.5%), while Saudi preceptors represented only 29.5%. The findings show that there is a difference between Saudi and expatriate nurses in their perception of the role, that cultural factors influence the role of expatriate preceptors and that organisational factors influence both groups.

CONCLUSIONS

Expatriate preceptors felt that there were cultural obstacles that hindered their role. These findings will contribute to the development of a more contemporary and culturally sensitive preceptorship model.

Overcoming communication barriers in a multicultural radiography setting

BACKGROUND

Effective communication between the patients and radiographers can be a daunting task in a multicultural, multilingual environment. With 11 official languages, South Africans experience language barriers amongst themselves, which pose unique communication challenges on a daily basis. It is thus important to explore how radiographers overcome such challenges to provide an effective service to their patients.

AIM

The aim of this study was to explore and describe the experiences of radiographers in Gauteng province in communicating with patients in a multilingual, multicultural healthcare setting and make recommendations towards overcoming such barriers.

SETTING

The focus group discussions were conducted in English and at a private location that was convenient for the participants in Gauteng.

METHOD

The study employed a qualitative phenomenological approach using focus group interviews (FGIs) to solicit the experiences of participants and gain an in-depth understanding of the phenomenon.

RESULTS

The findings showed that patient-radiographer cross-cultural communication is ineffective whilst language barriers are encountered daily. Participants subsequently offered a number of recommendations to enhance communication with patients from different cultural and linguistic backgrounds. These included workshops or short courses to improve language skills, posters to allow for non-verbal communication, the use of professional interpreters or mobile translation technology, employment of a diverse workforce and a focus on cultural sensitivity and learning an additional language at tertiary level.

CONCLUSION

Although a variety of communication strategies are available, the most appropriate combination should be explored for individual radiology practices in order to serve their respective diverse patient base. Recommendations that emanated from this study can, therefore, be used as a guide to radiology practices to facilitate effective patient-radiographer communication.

Experiences of language barriers by homoeopathy student interns providing health services at the University of Johannesburg

Background

South Africa is a multilingual society, and therefore, the likelihood of healthcare providers (HCPs), including students training to be HCPs, encountering language barriers with patients is high.

Aim

To explore and describe the experiences of homoeopathy student interns regarding language barriers in the delivery of health services and to provide guidance towards overcoming language barriers in homoeopathic practice at the University of Johannesburg (UJ).

Setting

The interviews and focus group discussions were conducted in English and at a private location that was convenient for the participants in Johannesburg, Gauteng.

Methods

This qualitative study used a phenomenological approach. Ten individual interviews were conducted with registered homoeopathy student interns (HSIs) from the UJ. The central question: ‘What has your experience been regarding language barriers between you and your patients at the UJ Homoeopathy clinics?’ was asked and responses were recorded and transcribed for later analysis. The interview results were presented to a focus group for discussion to validate findings that arose from the analysis and to provide an opportunity to add any insight, comment or recommendations that were not expressed in individual interviews and verification of emergent themes.

Results

Participants described how language barriers create challenges in understanding between patients and HSIs. Descriptions of the experiences of the intrapersonal and interpersonal effects that are associated with language barriers were provided. Participants also described the influence of language barriers on the various aspects of the health service process. Finally, participants described the mitigation of language barriers through various strategies.

Conclusion

Participants reported their experiences of language barriers as challenging. Language barriers were found to adversely affect the various aspects of the health service process as well as the practitioner’s personal feelings and the patient–practitioner relationship. Language acquisition and awareness modules introduced early on in the syllabus is a proposed solution to the mitigation of language barriers.

Cultural competence learning of the health care students using simulation pedagogy: An integrative review

The objective of this literature review was to identify the current evidence available on the learning of cultural competence among health care students using simulation pedagogy. An integrative literature review was conducted systematically. The CINAHL, PubMed and ERIC databases were searched for articles published between 2009 and 2019, resulting in including 17 articles in the review. The data were analyzed using descriptive synthesis. The participants of most of the studies were nursing students. The used simulation methods included low- and high-fidelity simulations, standardized patients, virtual and video-streamed simulations and role-play. The educational contents involved assessing advanced communication skills or focusing on patients' socioeconomic, cultural and environmental needs in care. The learning outcomes included knowledge of cultural competence, culturally competent communication skills, culturally competent nursing skills, self-awareness of cultural diversity and self-efficacy in diverse cultural situations. A variety of simulation methods has been used in the cultural competence education and produced several learning outcomes, including an improved understanding of cross-cultural communication and encouragement to discuss various culturally bound health issues. Further research is needed to find an effective combination of teaching methods using innovative ways to foster learning cultural competence.

["If there is a risk, I should have a choice:" Risk management and risk perception in Italian vaccine hesitancy movements]

In Italy, the passing of mandatory pediatric vaccinations in 2017 was a consequence of increasing vaccine hesitancy in the country, a phenomenon that has largely spread on social networks. This article examines risk management and risk perception regarding pediatric vaccinations through an analysis of online content shared by Italian vaccine hesitancy movements between December of 2019 and April of 2020. Results show that these movements carry out a reinterpretation of risk, scientific evidence, and parental responsibility, especially with regard to the alleged correlation between the measles vaccine and autism. The limitations of political decisions surrounding vaccines are due to the application of punitive measures such as administrative penalties and licensing bans for doctors who express "anti-vax" ideas, aspects which may increase distrust towards the political establishment and the medical profession.

Knowledge and attitudes regarding amblyopia among parents in Jeddah, Saudi Arabia: a cross-sectional study

Objectives

To assess parents’ perceptions about amblyopia and its causes, symptoms, risk factors, treatments, and the importance of follow-up and to evaluate their awareness regarding the consequences and critical complications.

Results

Parents or their companions (n = 401) were surveyed, and 52.9% were mothers, 81.8% of mothers and 85.7% of fathers were highly educated (diploma, college or university degree), and 58 (14.5%) had a child who was afflicted with amblyopia. The knowledge subscale (nine items) showed acceptable reliability. Twenty percent of the participants declared having adequate knowledge about amblyopia, but assessment by item showed low percentages of an adequate knowledge level, ranging from 0% for amblyopia causes, 35.9% for definition, and 59.9% for whether amblyopia is a hereditary disease. Thus, the rate of adequate knowledge (Knowledge Score ≥ 8) was 25.9%, and was associated with parents’ nationality (p < 0.05) and self-declared knowledge about amblyopia (p < 0.001). No significant difference was observed among respondents who had a child with amblyopia. There was a lack of knowledge about basic information and different aspects of the disease, which emphasized the relevance of school-based screening programs and adequate use of trustworthy internet resources using easily understood medical information.

What Do Dentists and Dental Students Think of Oral Cancer and Its Control and Prevention Strategies? A Qualitative Study in Jazan Dental School

Jazan region of Saudi Arabia has a high prevalence of oral cancer: 35% of cases. However, little is known about the view of dentists and dental students on possible factors that contribute to this high rate with scarce efforts regarding prevention. The study investigated possible factors related to oral cancer as perceived by dentists and dental students, using a qualitative approach. Six focus groups conducted in Jazan Dental School (JDS) and participants included dental students, interns, faculty members, and key decision-makers. All participants acknowledged oral cancer a serious public health issue in Jazan affecting all ages. The majority thought that tobacco is a major risk factor in this region, which can easily be obtained by individuals of any age or gender. Further, formal dental education in the country is not focusing on the local related risk factors. Participants agreed that practicing oral cancer examination and its risk factors education is related to clinicians' attitude and skills. Several participants declared that no organized effort established toward oral cancer and its risk factors in the region. Cultural acceptance of oral cancer risk factors was mentioned as one of the challenges for patients. The findings indicate that dental education and training at JDS are not focusing on necessary related oral health issues and their risk factors in the community. Also, it casts a new light on the fact that dentists are not educating their patients because they lack the knowledge and the skill of health education and patients' communication methods.

Demystifying, recognising and combating racism during the pandemic

The increased reports of escalation of social inequalities, xenophobic and racist ideologies during the COVID-19 pandemic presents a growing concern. Nurses are not immune to xenophobia and racism, both as perpetrators and as victims. Although COVID-19 brings a new wave of xenophobia and racism, healthcare organisations have been tackling discriminatory and racist practices for decades. However, racist practice quite often goes undetected or unchallenged due to its associated sensitivity and a lack of understanding of its complexity. There is a need for a more open and non-judgemental discourse around interpretations of racism and its predisposing factors as a means of combating the growing reports. This discussion paper proposes a practice-orientated conceptualisation of racism and outlines some particular and sustainable areas for consideration for nurses to use in their daily practice. Developing self-awareness and nurturing the courage, confidence and commitment to challenge self and others is critical for transforming ethnocentric and racist ideologies.

Prevalence of Workplace Bullying and Its Associated Factors at a Multi-Regional Saudi Arabian Hospital: A Cross-Sectional Study

Background

Workplace bullying (WPB) refers to any form of repeated and unreasonable verbal, physical or sexual harassment that an employee endures by a person or a group. In healthcare settings, practitioners are occasionally victims of WPB incidents. The aim of this study was to survey victims of WPB and determine factors associated with being a victim of WPB at a multiregional health care facility in Saudi Arabia.

Methods

This cross-sectional study was conducted in 2018, by distributing a self-administered questionnaire via a private electronic mail to all fulltime healthcare practitioners within a multi-regional hospital in Saudi Arabia. Healthcare practitioners included physicians, nurses, allied healthcare professionals and pharmacists who reported being exposed to WPB in the past year. Study outcomes were the prevalence rate ratio of WPB and its associated factors, such as victim, perpetrator and incident characteristics.

Results

WPB has been reported by 684 participants. Perpetrators were mainly patients (36.1%), their families/relatives (29.5%), and hospital staff (27.2%) or managers/supervisors (7.2%). The type of WPB incident was mostly verbal abuse (98.1%) followed by physical harassment (11.8%) and sexual connotations (5.8%). WPB was 30% more prevalent among younger nurses and 24% less prevalent among higher educated nurses compared to their counter groups, P<0.001 each. Among technicians and administrative employees, WPB was 54% more prevalent among females, 36% more prevalent among the younger group, and 25% more prevalent among expatriate workers compared to their counter groups P<0.014, P<0.001 and P=0.017, respectively. WPB was 20% less prevalent among higher educated allied health professionals, P=0.002. Among physicians, WPB was 33% more prevalent among females, P=0.041 and was 47% more prevalent among higher educated physicians compared to their counter groups, P=0.018.

Conclusion

WPB might occur any time, anywhere and by any person within health care facilities. The prevalence of WPB varies within health occupational groups. Gender, age, educational level, and nationality were significantly associated factors with WPB.

Factors contributing to the patient safety culture in Saudi Arabia: a systematic review

BACKGROUND

Patient safety, concerned with the prevention of harm to patients, has become a fundamental component of the global healthcare system. The evidence regarding the status of the patient safety culture in Arab countries in general shows that it is at a suboptimal level due to a punitive approach to errors and deficits in the openness of communications.

OBJECTIVES

To identify factors contributing to the patient safety culture in Saudi Arabia.

DESIGN

Systematic review.

METHODS

A systematic search was carried out in May 2018 in five electronic databases and updated in July 2020-MEDLINE, CINAHL, Embase, PsycINFO and the Cochrane Database of Systematic Reviews. Relevant journals and reference lists of included studies were also hand-searched. Two independent reviewers verified that the studies met the inclusion criteria, assessed the quality of studies and extracted their relevant characteristics. The Yorkshire Contributory Factors Framework (YCFF) was used to categorise factors affecting safety culture in the included papers.

RESULTS

14 papers were included and the majority of studies were appraised as being of good quality. Strength and weakness factors that contribute to patient safety culture were identified. Ineffective leadership, a blame culture, workload/inadequate staffing and poor communication are reported as the main factors hindering a positive patient safety culture in Saudi Arabia. Conversely, 'strength' factors contributing to a positive patient safety culture included supportive organisational attitudes to learning/continuous improvement, good teamwork within units and support from hospital management for patient safety. There is an absence of patient perspectives regarding patient safety culture in Saudi Arabia.

CONCLUSION

Policymakers in the Saudi healthcare system should pay attention to the factors that may contribute to a positive patient safety culture, especially establishing a blame-free culture, improving communications and leadership capacity, learning from errors and involving patient perspectives in safety initiatives. Further research is required to understand in depth the barriers and facilitators to the implementation of a positive patient safety culture in Saudi Arabia.

Patient-Centered Health Education Intervention to Empower Preventive Diabetic Foot Self-care

BACKGROUND

Diabetes impairs the body's ability to produce or respond to the hormone insulin resulting in abnormal metabolism of carbohydrates and elevated glucose levels in the body. Because of these factors, diabetes can cause several complications that include heart disease, stroke, hypertension, eye complications, kidney disease, skin complications, vascular disease, nerve damage, and foot problems. Diabetes education allows patients to explore effective interventions into living their life with diabetes and incorporate the necessary changes to improve their lifestyle.

OBJECTIVE

To educate patients diagnosed with diabetes or followed up for diabetes management by other departments with regard to their own responsibility in maintaining preventive foot self-care.

METHODS

Ten patients completed a validated educational foot care knowledge assessment pretest to determine their existing knowledge about their own foot care after a thorough foot assessment. Preventive diabetic foot self-care education was conducted through a lecture, visual aids, and a return demonstration. Patients then took a posttest questionnaire with the same content as the pretest to determine their uptake of the educational content.

RESULTS

Correct toenail cutting was the most identified educational need. It was a limitation in the pretest (30%), and it remained the lowest-scoring item on the posttest (70%). Walking barefoot was thought to be safe by 60% of participants pretest, but with remedial education, all participants identified this as a dangerous activity posttest. Participants also understood the high importance of having corns and calluses looked after by a health professional.

CONCLUSIONS

Effective communication with patients by healthcare providers who can mold educational content to identified patient needs by teaching much needed skills is a key driver in rendering safe, quality healthcare education interventions.

Analysis of Patient-Physician Concordance in the Understanding of Chemotherapy Treatment Plans Among Patients With Cancer

IMPORTANCE

The treatment plans of patients with cancer involve multiple modalities that oncologists need to explain to patients. One such modality is chemotherapy, in which information about the goals, duration, and expected complications of therapy are considered fundamental to achieving optimal patient understanding. Therefore, effective communication between patients and their treating physicians is important to ensure patient adherence to treatment and achieve better outcomes.

OBJECTIVE

To investigate the concordance in the understanding of chemotherapy treatment plans between patients and their treating oncologists and to identify the potential factors associated with concordance.

DESIGN, SETTING, AND PARTICIPANTS

A cross-sectional study was conducted among adult patients (aged >18 years) with cancer who consented to receive chemotherapy between October 4, 2017, and November 8, 2018. The study also included the treating oncologists of patients receiving chemotherapy. An interview-based structured questionnaire was administered in both inpatient and outpatient settings at the Princess Noorah Oncology Center in Jeddah, Saudi Arabia. The demographic data of patients and physicians were obtained from the ARIA Oncology Information System, a chemotherapy-prescribing software database used at the center. Patients who had a personal history of cancer or were unwilling to be involved in the decision-making process were excluded. Data were analyzed from November 15 to December 20, 2018.

EXPOSURES

Patients' comprehension and concordance with their treating physicians regarding the aspects of the intended treatment plan.

MAIN OUTCOMES AND MEASURES

The main outcomes measured were the patient-physician concordance level in the understanding of treatment plans and the identification of patient-related and physician-related factors associated with the level of concordance.

RESULTS

A total of 151 adult patients (77 men [51.0%] and 74 women [49.0%]) were interviewed. Of those, 144 patients (75.5%) were younger than 60 years, and 52 patients (34.4%) had a college or advanced degree. A total of 20 treating oncologists were interviewed, of whom 14 (70.0%) were men and 6 (30.0%) were women. Arabic was the primary language of 19 oncologists (95.0%), and 19 oncologists (95.0%) had medical practice experience outside of Saudi Arabia. Only 20 patients (13.7%) had full concordance with their physicians regarding the aspects of their treatment plans. The remaining 131 patients (86.2%) had discordance with 1 or more aspect of their treatment plans. The most common aspect of discordance was the planned duration of the chemotherapy regimen, with 104 patients (68.4%) having full discordance. Full patient-physician concordance was more likely among patients with college or advanced degrees (χ21 = 17.73; P < .001) and patients with a family history of cancer (χ21 = 15.88; P < .001). In addition, older physicians (>40 years) compared with younger physicians (aged 30-40 years) were more likely to achieve higher rates of full patient-physician concordance, whereas older patients (>60 years) were associated with only partial concordance compared with patients younger than 60 years (χ21 = 5.84; P = .008), with an AR of 2.7.

CONCLUSIONS AND RELEVANCE

Most patients showed suboptimal understanding of aspects of their chemotherapy treatment plans. More effort and time should be dedicated to enhancing the understanding of chemotherapy plans among patients with lower educational levels. In addition, self-report surveys that evaluate patients' understanding of their chemotherapy treatment plans should be developed and added to the informed consent process to objectively assess how much a patient understands and to develop a stepwise patient education program that targets patients with the lowest levels of understanding.

Language of written medical educational materials for non-English speaking populations: an evaluation of a simplified bi-lingual approach

BACKGROUND

Debates have arisen in various non-English speaking countries over the chosen language of instruction in medical education, whether it has to be the English language or the mother tongue. English-based education supporters argue that English is the leading international language of medicine and research, and a crucial tool for Continuing Medical Education (CME), as well as for students who seek practice abroad. On the other hand, mother-tongue-based medical education supporters present it as a way to endorse communication and comprehension between medical practitioners and health care system users, to bridge the gap between practitioners and the paramedical staff, and to overcome linguistic dualism and the language thinking disparity while studying in another. This study aimed to evaluate one of the simplified bi-lingual approaches in terms of medical-educational-written texts for a non-English speaking population: Arabic speaking medical students in specific.

METHODS

1546 Arabic-speaking-medical students from different countries participated in a one-step-interactive-experimental-online test. The test assessed participants' scientific comprehension of three distinct written paragraphs: The first paragraph used conventional mother tongue (Arabic), the second combined English terminology and simplified mother tongue (hybrid), and the third used an English excerpt (English). Two multiple-choice questions (First question in Arabic, second in English) followed each paragraph. Response time was communicated for each paragraph. Participants were asked to select their favorable method. Repeated Measures ANOVA models and Paired Samples t-Test were used for statistical analysis.

RESULTS

Participants scored a mean of [0.10] for the Arabic paragraph, [0.72] for the hybrid paragraph, and [0.24] for the English paragraph (P <  0.001). Results showed a significantly higher mean of points and correct answers within the fastest time for the hybrid paragraph [0.68] compared to the Arabic [0.08] and English [0.18] paragraphs (P <  0.001). Moreover, 50% of participants preferred the hybrid paragraph over the other two paragraphs.

CONCLUSIONS

Taking into consideration the large number of participants and the statistically significant results, authors propose that simplified Arabic combined with English terminology may present a viable alternative method for medical-educational-written texts in Arabic-speaking population.

Influence of workplace incivility on the quality of nursing care

AIMS AND OBJECTIVES

To examine the influence of workplace incivility on the quality of nursing care.

BACKGROUND

Recent evidence describes workplace incivility as a serious concern in the healthcare setting worldwide. Exposure to workplace incivility can alter a nurse's behaviour, thought process and perspective towards the nursing profession. However, there is insufficient evidence to determine whether workplace incivility might be associated with the quality of nursing care in Saudi Arabia.

DESIGN

A quantitative and cross-sectional study.

METHOD

A survey was carried out amongst 378 nurses in two government hospitals in Saudi Arabia from February 2018-May 2018 using the Nurse Incivility and quality of nursing care scales. Multivariate multiple regression was performed to investigate the influence of the uncivil experiences of nurses from different sources on the different aspects of quality of nursing care. The study adhered to STROBE guideline (see Appendix S1).

RESULTS

The overall mean of the quality of nursing care scale was 3.14 (SD = 0.66) from a scale of 1-5, with patient satisfaction receiving the highest mean dimension (mean = 3.27, SD = 0.72) and health promotion the lowest mean dimension (mean = 3.08, SD = 0.74). Experience in the present hospital and the hospital were associated with the overall quality of nursing care. General and nurse incivility exerted a multivariate effect on overall quality of nursing care and its different dimensions.

CONCLUSION

General incivility and nurse incivility were found to negatively impact quality of nursing care and its different dimensions.

RELEVANCE TO CLINICAL PRACTICE

Stronger policies geared towards eliminating workplace incivility should be implemented as uncivil acts can lead to poor quality of nursing care. Nurse administrators and nurses should be pro-active in recognising, preventing, approaching, reporting and intervening with uncivil acts in the hospital to protect these workers from these types of behaviours and avoid their negative impacts on patient care.

Health-Care Reform in Saudi Arabia: Patient Experience at Primary Health-Care Centers

The aim of this study was to assess the relationship between patients’ demographics, the quality of physician–patient communication, care coordination, and the overall satisfaction rating in primary health-care centers (PHCs). A cross-sectional study was conducted using a patient experience tool. A convenience sample of 157 patients visiting PHCs were retrieved from 10 out of the 13 Saudi regions. A total of 81% of the overall ratings could be attributed to the predictors included in the model. The highest predictor of the overall rating in this model was physicians answering of patient questions, followed by time spent with the physician, type of PHC, and the abilities of the physician to listen carefully, explain things clearly, and show respect. The weakest predictors were follow-up by the health-care provider and physician’s knowledge of the patient’s medical history. Our findings suggest that to improve the overall patient experience and the quality of care at PHCs requires extra attention to physician–patient communication. To improve quality, safety, and efficiency, the Ministry of Health should ensure interpretation service for patients at PHCs either public or private. The Saudi Central Board for Accreditation of Healthcare Institutions should enhance the physician–patient communication as part of their standards for accrediting PHCs.

Building the health workforce: Saudi Arabia's challenges in achieving Vision 2030

BACKGROUND

Saudi Arabia's Vision 2030 represents a major structural shift in all economic sectors. Health care is one of the largest sectors significantly contributing to achievement of the vision OBJECTIVES: To provide an overview of health workforce in Saudi Arabia and identify various critical issues and challenges that need to be addressed in achieving health system goals envisaged in the Vision.

METHODS

This paper is based on extensive review of literature conducted to stimulate pertinent descriptive information on health workforce in Saudi Arabia.

FINDINGS

Saudi nationals constitute 44% of all health workforce and 29.5% of all physicians employed by the health system. Among Saudi nationals, there is a significant underrepresentation of females except in the nursing profession. The health workforce is beleaguered with numerical inadequacy, skill imbalance, gender disparity, and access issues.

CONCLUSION

Health system needs to adopt a rigorous approach by investing heavily on medical, nursing, and other specialized fields of education. Planning for the health workforce needs to adopt appropriate strategies that reflect all aspects including the number, skills, and gender distribution for meeting the future health needs of population to facilitate achievement of Vision.

Exploring nurses' work-related stress in an acute care hospital in KSA

Objectives

This study aimed to assess the perceived work-related-stress of staff nurses and determine the relationship between work-related stress and demographic profile.

Methods

This study used a descriptive cross-sectional design and was conducted in a secondary public hospital (staff nurses = 178, bed capacity = 225) in Riyadh, KSA. The hospital provides medical and surgical services that are important to achieve optimum quality patient care and services. In total, 178 staff nurses were interviewed, but 15 responses were excluded because of missing data (response rate: 92.52%).

Results

Nurses reported a moderately stressful work environment. Nationality was found to be a significant predictor of nurses' stress levels. Indian nurses had higher stress levels compared with nurses of other nationalities. Working hours per week was another significant predictor of stress.

Conclusion

This study highlighted perceived work-related stress of staff nurses and determined the relationship between work-related stress and demographic profile. Most nurses were moderately stressed. Working hours were associated directly with stress level. The study findings can serve as a guide for establishing human resources policies aiming at reducing nurses' stress and, thereby, promoting improved health care and task force work performance.

Patient satisfaction and experience of primary care in Saudi Arabia: a systematic review

Purpose

This systematic review aims to explore patient satisfaction (PS) among patients who used Ministry of Health (MoH) primary care centres in Saudi Arabia, with a focus on their communication with physicians.

Data sources

Medline, CINAHL, Embase, Global Health, the Saudi Medical Journal, Annals of Saudi Medicine, the Journal of Family and Community Medicine and Google Scholar.

Study selection/Data extraction

The review focused on studies concerning PS in Saudi MoH primary care centres published between 2005 and 2017. Two independent reviewers confirmed that the included studies met the selection criteria, assessed the quality of the selected studies and extracted their significant characteristics. All of the articles were examined in terms of the five main domains that determine the patient-physician communication identified by Boquiren, Hack, Beaver et al. (What do measures of patient satisfaction with the doctor tell us? Patient Educ Couns 2015;98:1465-73).

Results

The literature search retrieved a total of 846 studies. Only 10 studies met the selection criteria. All of the studies reported at least one domain of PS. There was a strong relationship between the level of education, income and satisfaction rate. Most of the studies reported PS in terms of the domains of availability and accessibility, and communication. Few of the studies covered the other domains, such as relational conduct, views on the physician's technical skills/knowledge and the personal qualities of physicians.

Conclusion

There was a contradiction between the patients' responses to the surveys on the domains of PS and their actual experience. While the patients reported that they were satisfied with primary care centres, they frequently attended the emergency department directly. This indicated that they were unlikely to be fully satisfied with the primary healthcare centre.

Workplace Spiritual Climate and Its Influence on Nurses’ Provision of Spiritual Care in Multicultural Hospitals

Background: Spiritual care is a growing field of interest in the healthcare industry in Saudi Arabia, one that is largely defined by the religious and cultural context of the country that has a rich and strong backdrop. Workplace spiritual climate may have a significant impact on nurses’ ability and willingness to provide spiritual care. This study aims to examine the influence of workplace spiritual climate on nurses’ provision of spiritual care. Methods: A convenience sample of 918 nurses employed in seven public hospitals in Saudi Arabia was surveyed in this cross-sectional study using the Spiritual Climate Scale (SCS) and the Spiritual Care Intervention-Provision Scale (SCIPS). Results: The overall mean in the SCS was 64.58 (SD = 24.60), whereas the overall mean in the SCIPS was 56.83 (SD = 9.46). Nurses with Saudi nationality, with Islamic faith, with administrative functions, and with higher years of experience as a nurse reported better perceptions of workplace spirituality. Hospital, position, years of experience in the present hospital, and the hospital’s spiritual climate were identified as significant predictors of the nurses’ spiritual care interventions provision. Conclusions: The results of the study support the importance of having good workplace spiritual climate as it impacts the nurses’ provision of spiritual care interventions.

Effect of Health Education on Dengue Fever: A Comparison of Knowledge, Attitude, and Practices in Public and Private High School Children of Jeddah

Objective

More than half of the world’s population live in areas with a potential risk of acquiring dengue fever (DF). Health education interventions are effective, barring a language communication gap. The objective of this study was to estimate the effect of health education in the knowledge, attitude, and practices (KAP) towards DF control and prevention in public and private schools.

Materials and methods

We assessed the DF control and prevention strategy KAP of students of eight public and private schools in Jeddah, Saudi Arabia before the dengue health education intervention sessions (pre-I) and three months following the education intervention sessions (post-I) using the same closed-ended validated questionnaire. Schools and students were selected by a multistage stratified random sample method. Statistical analysis was done using the paired and independent T-test in IBM SPSS Statistics for Windows, Version 22.0 (IBM Corp., Armonk, NY).

Results

We found a significant mean difference in the overall knowledge (pre-I, 7.86 ± 2.61; post-I, 10.94 ± 2.35), attitude (pre-I, 5.16 ± 1.50; post-I 6.23 ± 1.30), and practice (pre-I, 2.96 ± 1.33; post-I, 3.94 ± 1.12) scores. Private schools scored better post-intervention scores in knowledge and practice compared to public schools in local and English language medium.

Conclusions

Health education programs are essential for DF prevention and management. Institutes whose populations consists of students with various language backgrounds should not be ignored. Bilingual educational sessions are important in such private institutes. Our results indicate additional emphasis is required on putting interventional knowledge into practice.

Health service utilization, unmet healthcare needs, and the potential of telemedicine services among Korean expatriates

Background

With the significant growth of migration and expatriation, facilitated by increased global mobility, the number of Koreans living abroad as of 2016 is approximately 7.4 million (15% of the Korean population). Healthcare utilization or health problems, especially among expatriates in developing countries, have not been well researched despite the various health risks these individuals are exposed to. Consequently, we identified the health utilization patterns and healthcare needs among Korean expatriates in Vietnam, Cambodia, and Uzbekistan.

Methods

This cross-sectional survey examined 429 Korean expatriates living in Vietnam (n = 208), Cambodia (n = 60), and Uzbekistan (n = 161) who had access to the Internet and were living abroad for at least 6 months. A 67-item questionnaire was used, and feedback was received via an online survey program. Stepwise logistic regression analyses were performed to evaluate factors associated with unmet healthcare needs and preferences of certain type of telemedicine.

Results

We found that 45.5% (195/429) of respondents had used medical services in their country of stay. Among those who visited health institutions > 3 times, the most popular choice was general hospitals (39.4%, 15/38); however, they initially visited Korean doctors’ or local doctors’ offices. The most essential criteria for healthcare service facilities was a “skilled professional” (39.3%, 169/429), 42% wanted a health program for chronic disease management, and 30% wanted specialized internal medicine. A substantial number wanted to access telemedicine services and were willing to pay for this service. They were particularly interested in experts’ second opinion (61.5%, 264/429) and quick, 24-h medical consultations (60.8%, 261/429). Having unmet healthcare needs and being younger was strongly associated with all types of telemedicine networks.

Conclusions

Nearly half of the expatriates in developing countries had unmet healthcare needs. Telemedicine is one potential solution to meet these needs, especially in developing countries.

Spirituality and Spiritual Care Competence among Expatriate Nurses Working in Saudi Arabia

Background: In Saudi Arabia, where the majority of the nursing workforce are foreigners, little is known about perceptions of spirituality and spiritual caregiving among foreign nurses who provide nursing care to patients with varied spiritual and religious beliefs. Therefore, this study was conducted to investigate the spirituality and spiritual care competence and its predictors among expatriate Christian nurses in Saudi Arabia, who provide care for Muslim patients. Methods: A convenience sample of 302 nurses was surveyed in this descriptive cross-sectional study using the Spirituality and Spiritual Care Rating Scale and the Spiritual Care Competence Scale. Results: Results revealed high values on three domains, namely, spiritual care, personal care, and existential spirituality. The majority of the respondents reported competence in all six subscales of spiritual care. The participants’ age, educational level, perception of existential spirituality, and personal care were found to be relevant predictors of their spiritual care competence. Conclusions: The findings suggest that existential spirituality and personal care dimensions of Christian nurses’ spirituality and spiritual care perceptions play critical roles in the provision of competent spiritual care to Muslim patients.

Barriers to effective communication between family physicians and patients in walk-in centre setting in Dubai: a cross-sectional survey

BACKGROUND

Effective communication between family physicians and their patients is crucial to improving healthcare outcomes and patients' satisfaction. However, the barriers to effective communication have been weakly studied in the Gulf region with no reported studies in Dubai. This study aims to identify the main perceived barriers to effective communication between patients and their family physicians in Dubai from both the physicians' and the patients' viewpoints.

METHODS

The study was conducted at 12 primary healthcare centres in Dubai between October 2016 - July 2017. Two self-administered questionnaires were used, one measuring the patients' perceived frequency of encounters with barriers to communication, while the other was for the family physicians' perceived level of risk to communication posed by the barriers. The barriers were assessed in the following four domains: personal characteristics and attitudes, organisational factors, communication of information, and linguistic and cultural factors.

RESULTS

There were a total of 1122 patients and 170 family physicians, with 75% and 85% response rates, respectively. Having a time limitation was the highest ranking barrier, with 23.4% of patients encountering it half of the time-always, and 50.6% of physicians perceiving it as moderate-very high risk. This was followed by barriers in the communication of information domain, especially not checking the patient's understanding and not educating the patient (16.0-16.9%) from the patients' perception and presentation with multiple problems and not following with a treatment plan (51.2% and 35.9%, respectively), from the physicians' perception. Preoccupation with medical records ranked in the second pentile for the physicians, and in the lowest pentile for the patients. Barriers related to the failure of rapport building and linguistic/cultural factors ranked in the fourth and fifth pentiles for both patients and physicians.

CONCLUSION

Time pressure is the major perceived barrier to communication between patients and family physicians. In addition, a greater focus needs to be placed on training the physicians to convey their messages to the patients clearly, checking their understanding and managing poor historians.

The Saudi Arabian 2030 vision and the nursing profession: the way forward

AIM

To examine the outlook of the Saudi Arabian nursing profession in relation to the recently launched Kingdom 2030 Vision.

INTRODUCTION

Nursing in Saudi Arabia has advanced noticeably in education and clinical practice, but challenges remain in building and sustaining a Saudi nursing profession and workforce.

BACKGROUND

Health care in Saudi Arabia is currently experiencing transformation because of population and economic growth. These transformations have been influenced by the Saudi Arabian 2030 Vision.

SOURCES OF EVIDENCE

A literature review here examines the progress in transforming the nursing profession in Saudi Arabia. Relevant studies published between 2001 and 2017 were identified, using databases such as Medline, PubMed and PsychInfo.

RESULTS

Nineteen studies reporting challenges and opportunities that the nursing profession faces in Saudi Arabia were included.

DISCUSSION

The nursing profession in Saudi Arabia faces challenges from nursing shortages, underdeveloped nursing education and unclear scope of practice. However, the new 2030 Vision offers many opportunities for social and economic transformation.

CONCLUSION

Effective strategies must be implemented to accommodate the new outlook the 2030 Saudi Vision in order to advance the nursing profession and to improve healthcare delivery in Saudi Arabia.

IMPLICATIONS FOR NURSING AND NURSING POLICY

Nursing policymakers urgently need to improve nursing care in Saudi Arabia by addressing the nursing shortage, generating strategies to improve nursing education and establishing scope of practice guidelines. These critical issues must be addressed with the context of the 2030 Vision.

Exploring the cultural competence of undergraduate nursing students in Saudi Arabia

PURPOSE

To explore the cultural competence of undergraduate nursing students at a college of nursing, Saudi Arabia.

DESIGN

A descriptive exploratory design was used to explore the Saudi undergraduate nursing students' level of cultural competency.

METHOD

The convenience sample included 205 nursing students affiliated with a college of nursing at a health science university in Jeddah, Saudi Arabia. Data was collected using the Inventory for Assessing the Process of Cultural Competence-Revised (IAPCC-R) consisting of 25 items. The tool reported acceptable reliability of Cronbach alpha 0.89.

RESULTS

The majority of students were culturally aware and dealt with people from different cultures. One-third preferred to have training on culture over a period of time. Half the students preferred studying a special course related to working with people from different cultures. Cultural desire reported the highest mean while cultural knowledge scored the lowest among the cultural competence subscales despite students being exposed to some cultural knowledge content in their training.

CONCLUSIONS

Implementing the guidelines for culturally competent care assure covering all aspects of care with consideration of cultural heritage as a main concept. Comparative study of nurses' and students' perception is further recommended.

Factors influencing nurse-to-parent communication in culturally sensitive pediatric care: a qualitative study

BACKGROUND

To deliver quality healthcare to diverse patients, effective commmunication is key. Little evidence exists about what factors influence nurse-to-parent communication in culturally sensitive pediatric care.

OBJECTIVE

The aim of this study was to explore factors that influence nurse-to-parent communication in the provision of culturally sensitive pediatric care.

DESIGN

This study employed a qualitative content analysis.

METHOD

The participants included 25 nurses and 9 parents from pediatric wards of hospitals located in Northwest and Central Iran. Semi-structured interviews were conducted. Data were analyzed using Graneheim and Lundman's method of content analysis.

RESULTS

Factors that influenced the nurse-to-parent communication in pediatric culturally sensitive care were 1-organizational factors (inefficient policies and professional factors) and 2-human factors (nurse-related factors and unique characteristics of the family). Sub-categories included: lack of definitive policies for delivering cultural healthcare, insufficient cultural healthcare education, professional status of nursing in society, time, individual characteristics, cultural knowledge, cultural differences, and family's health literacy.

CONCLUSION

The Iranian healthcare system requires a paradigm shift regarding the provision of culturally sensitive care.