The Relationship between Perceived Safety Culture, Nursing Leadership and Medication Errors Reporting (by nurses) in a Saudi Arabian Context: A Sequential Explanatory Mixed Method Design

Abstract Background: Medication errors have significant implications for patient safety and can cause serious harm and even death. Error discovery through an effective leadership and active reporting system uncovers medication errors and encourages safe practices. A positive safety culture and effective leadership likely plays an essential role in improving medication error reporting systems. A review of literature highlighted that no study had previously investigated the effect of safety culture and nursing leadership styles on medication error reporting. Aim: The aim of this study was to explore the relationship between perceived safety culture, nursing leadership and medication errors reporting (by nurses) in adult medical-surgical wards in the Qassim region of Saudi Arabia. Methods: The methodological design adopted for this study was an explanatory sequential mixed methods design; quantitative followed by qualitative in two phases. The first phase began with the collection and examination of quantitative data from four hospitals in the Qassim region using the Hospital Survey on Patient Safety Culture (HSOPSC) (n=218) and the Multifactor Leadership Questionnaire (MLQ 5X) (n=186), along with a prospective audit of type and rates of reported medication errors on these wards. The second, qualitative phase involved face-to-face semi-structured interviews with nurses (n=8) and nurse managers (n=8). Results: The literature review highlighted a lack of studies exploring the relationship between perceived safety culture and nursing leadership styles and medication errors reporting. The findings from surveys showed that 50% of nurses in this study have not made an incident report in the last 12 months. Moreover, less than 10% of nurses report errors in two participant hospitals in the last two years. The qualitative findings revealed that fear was a key causal factor for underreporting of medication errors. Nurses feared punishment and legal action or losing their jobs. In addition, lack of feedback from quality or patient safety offices when nurses did make reports discouraged them from reporting future errors. Further barriers to reporting were personal characteristics, workload or shortage of staff, nursing leadership problems, blame, lack of knowledge or skills, unclear, or noncompliance with policy and safety culture. Conclusion: This is the first study to explore the relationship between perceived safety cultures and nursing leadership styles on medication errors reporting in Saudi Arabia. The findings of the research presented in this thesis contribute new knowledge to the Yorkshire Contributory Factors Framework by evidencing the relationship between nursing leadership and safety culture through statistical methods. Also, the main methodological contribution of the research field has been the first mixed methods study to investigate these relationships. The results of this study offer guidance and present understanding of both the multicultural nurses’ and their managers’ opinions of improving the medication errors reporting system in Saudi Arabia. In addition, provide valuable local evidence that can be built into appropriate professional education and procedures for encouraging both Saudi and international nurses employed in Saudi Arabian hospitals to report errors. Finally the findings will assist policy makers and hospital managements to develop suitable medication safety education and procedures for encouraging nurses to report errors

Leeds sleep evaluation questionnaire in Jordanian university students: A psychometric investigation using comparative confirmatory factor analysis

© 2020 Saudi Arabian Armed Forces Hospital. All rights reserved. Objectives: To analyze the fit of different competing factor models (a one-factor model, 3 2-factor models, and 2 4-factor models) of the Leeds sleep evaluation questionnaire (LSEQ) in the data from a Jordanian student population. Methods: A cross-sectional study was conducted on university students, with 2 sleep-related tools - the LSEQ and the sleep hygiene index (SHI). The students (n=166) at Jordan University of Science and Technology, Irbid, Jordan participated in this study from January-April, 2019. A total of 12 LSEQ models (6 models with all 10-items, and 6 models with one item deleted) were evaluated by using confirmatory factor analysis. The summary statistics of correlation coefficients, descriptive measures of item analysis, the model fit, and Cronbach’s alpha were determined. Results: The findings show that a 4-factor correlated solution was a plausible model for the LSEQ with 9-items, compared to a one-factor, 2-factor, and other 4-factor variant models. The deletion of one item from the original LSEQ improved the data fit significantly in the studied population. Moreover, correlation analysis between the LSEQ and SHI confirmed the divergent validity of the LSEQ. Conclusion: The results support the validity of a 4-factor structure of the LSEQ with 9-items with adequate internal consistency and divergent validity

Quality Improvement Attitudes among Saudi Nurses in Hospitals in Qassim, Saudi Arabia: A Cross-Sectional Survey

Background: This study aimed to provide an overview of perceptions of quality improvement among nurses working in Saudi Arabia. Methods: We conducted a descriptive cross-sectional study of 497 Saudi nurses working in public and private hospitals in Al-Qassim Province. Descriptive statistics were computed for quality improvement nursing attitude items and demographic factors. Results: A total of 497 nurses took part in the study; 29.1% of participants were females, and half of the participants were between the ages of 25–30 years. Most respondents were employed in governmental hospitals (98.7%), and 41.9% of participants had work experience ranging between 1 and 5 years. Nurses involved in providing direct patient care recognize the quality improvement attitudes related to changes in the healthcare delivery processes. Saudi nurses’ quality improvement nursing attitudes were moderate. Female, married, and older age group nurses and nurses who were working fewer hours per week showed better quality improvement attitudes. Conclusions: Saudi nurses’ quality improvement nursing attitudes are found to be moderate. Age, gender, marital status, and working hours of nurses are associated with their quality improvement attitudes. To empower nurses to improve healthcare, nursing administrators need to focus on improving the quality improvement attitudes environment

AWARENESS, ATTITUDES, PREVENTION, AND PERCEPTIONS OF COVID-19 OUTBREAK AMONG NURSES IN SAUDI ARABIA

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

SCOPE OF NURSING PRACTICE AS PERCEIVED BY NURSES WORKING IN SAUDI ARABIA

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

Saudi Nurse Interns’ Experiences during the COVID-19 Pandemic: A Thematic Approach

Background: The learning process for nurses, including internships, was affected during the COVID-19 pandemic, which may have made the nurse internship program more challenging and stressful for participants. Therefore, it is significant to explore the experiences of nurse interns during COVID-19. Aim: This study aimed to explore Saudi nurse interns’ field experiences during the pandemic. Design: The study utilised descriptive phenomenological qualitative research and a thematic approach. Methods: A total of 19 nurse interns participated in the study, which was conducted in Saudi Arabia. Participants undertook an internship program at different government hospitals in five cities in Saudi Arabia. Unstructured individual interviews were conducted to gather data from the participants. Results: The findings revealed five themes: being passionate, lacking knowledge and skills, being concerned about their families, being cautious, and being unoriented. Conclusion: The study findings document that the struggles of nurse interns in their internship programs during COVID-19 were related to their lack of knowledge, their family, and the working environment

Nurses&rsquo; Perception of Safety Culture in Medical&minus;Surgical Units in Hospitals in Saudi Arabia

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