A case study examination of the influence of cultural diversity in the multicultural nursing workforce on the quality of care and patient safety in a Saudi Arabian hospital

The purpose of the study: The purpose of this study is to investigate the influence of cultural diversity, in a multicultural nursing workforce, on the quality and safety of patient care and the work environment at King Abdul-Aziz Medical City, Riyadh region. Study background: Due to global migration and workforce mobility, to varying degrees, cultural diversity exists in most health services around the world, particularly occurring where the health care workforce is multicultural or where the domestic population comprises minority groups from different cultures speaking different languages. Further complexities occur when countries have a multicultural workforce which is different from the population for whom they care, in addition to the workers being from culturally diverse countries and with different languages. In Saudi Arabia the health system is mainly staffed by expatriate nurses who comprise 67.7% of the total number of nurses. Study design: This research utilised a case study design which incorporated multiple methods including survey, qualitative interviews and document review. Methods: The participant nurses were selected for the survey via a population sampling strategy; 319 nurses returned their completed Safety Climate Survey questionnaires. Descriptive and inferential statistics (Kruskal–Wallis test) were used to analyse survey data. For the qualitative component of the study, a purposive sampling strategy was used; 24 nurses were interviewed using a semi-structured interview technique. The documentary review included KAMC-R policy documents that met the inclusion criteria using a predetermined data abstraction instrument. Content analysis was used to analyse the policy documents data. Results: The data revealed the nurses‘ perceptions of the clinical climate in this multicultural environment is that it was unsafe, with a mean score of 3.9 out of 5. No significant difference was detected between the age groups or years of experience of the nurses and the perception of safety climate in this context; the study did reveal a statistically significant difference between the cultural background categories and the perception of safety climate. The qualitative phase indicated that the nurses within this environment were struggling to achieve cultural competence; consequently, they were having difficulties in meeting the patients‘ cultural and spiritual needs as well as maintaining a high standard of care. The results also indicated that nurses were disempowered in this context. Importantly, there was inadequate support by the organisation to manage the cultural diversity issue and to protect patients from any associated risks, as demonstrated by the policy documents and supported by the nurses‘ experiences. The study also illustrated the limitations of the conceptual framework of cultural competence when tested in this multicultural workforce context. Therefore, this study generated amendments to the model that is suitable to be used in the context of a multicultural nursing workforce. Conclusion: The multicultural nature of this nursing work environment is inherently risky due to the conflicts that arise from the different cultural norms, beliefs, behaviours and languages. Further, there was uncertainty within the multicultural nursing workforce about the clinical and cultural safety of the patient care environment and about the cultural safety of the nursing workforce. The findings of the study contribute important new knowledge to the area of patient and nurse safety in a multicultural environment and contribute theoretical development to the field of cultural competence. Specifically, the findings will inform policy and practice related to patient care in the context of cultural diversity.

Factors affecting antihypertensive treatment adherence : a Saudi Arabian perspective

Hypertension is a global health issue among the adult population. Adherence to antihypertensive medications is an effective step for better control of blood pressure and preventing the risk of complications. Several factors support or hinder hypertensive patients’ adherence. Objectives: This article reviews the factors affecting adherence to antihypertensive treatments, and reflects on these factors from a Saudi Arabian perspective. Methods: Papers and studies about antihypertensive medication adherence were reviewed from different databases including MEDLINE, PubMed, ScienceDirect and Google scholar. Results: Factors affecting antihypertensive treatments adherence are classified into three domains: Patient (e.g. sociodemographic, individual knowledge and skills), Health System, and Provider related factors.

Who is more susceptible to phishing emails? : a Saudi Arabian study

Phishing emails cause enormous losses to both users and organisations. The goal of this study is to determine which individuals are more vulnerable to phishing emails. To gain this information an experiment has been developed which involves sending phishing email to users and collecting information about users. The detection deception model has been applied to identify users’ detection behaviour. We find that users who have less email experience and high levels of submissiveness have increased susceptibility. Among those, users who have high susceptibility levels and high openness and extraversion are more likely to carry on the harmful action embedded in phishing emails.

Population structure and patterns of genetic variation in a pearl oyster (Pinctada radiata) native to the Arabian Gulf

The study assessed natural levels and patterns of genetic variation in Arabian Gulf populations of a native pearl oyster to define wild population structure considering potential intrinsic and extrinsic factors that could influence any wild structure detected. The study was also the first attempt to develop microsatellite markers and to generate a genome survey sequence (GSS) dataset for the target species using next generation sequencing technology. The partial genome dataset generated has potential biotechnological applications and for pearl oyster farming in the future.

An empirical study of the factors impacting on the involvement of clients in Saudi Arabian construction projects

This thesis is an empirical study of the factors impacting on the client involvement in Saudi Arabian construction government projects. The study investigated the impact of some factors that limited the client involvement and developed a framework called "client involvement interactive" to improve the client involvement practices in Saudi Arabian construction projects through the implementation of an implementable strategy elaborated.

Factors affecting new project delays in Saudi Arabian manufacturing organisations

Delay in the delivery of manufacturing projects is a major problem in manufacturing industries. This research investigates the factors that influence the lead time of new projects in manufacturing organisations. Employing a questionnaire survey and interview methodologies, this study collected data from five leading manufacturing organisations as well as their suppliers and contractors in Saudi Arabia to examine what, how and why the new project implementation delay occurs. Results show that the main factors contributing to manufacturing delays are related to people and material. On the other hand, social, political and cultural factors were the least significant factors as per the outcome of this study. Views of manufacturers, suppliers and contractors regarding causes of delays have also been analysed.

Factors influencing Saudi Arabian optometry candidates' career choices and institution of learning. Why do Saudi students choose to study optometry?

Optometry is a primary health-care profession (PHCP) and this study aimed to elucidate the factors influencing the choice of optometry as a career for Saudi students, the students' perceptions of optometry and the effect of gender. METHODS Two hundred and forty-seven students whose average age was 21.7 ± 1.5 (SD) years and who are currently enrolled in two colleges of optometry in Saudi Arabia--King Saud University (KSU) and Qassim University (QU)--completed self-administered questionnaires. The survey included questions concerning demography, career first choice, career perception and factors influencing career choices. RESULTS The response rate was 87.6 per cent and there were 161 male (64.9 per cent) students. Seventy-nine per cent of the participants were from KSU (males and females) and 20.6 per cent were from QU (only males). Seventy-three per cent come from Riyadh and 19 per cent are from Qassim province. Regarding the first choice for their careers, the females (92 per cent) were 0.4 times more likely (p = 0.012) to choose optometry than males (78.3 per cent). The males were significantly more likely to be influenced by the following factors: the Doctor of Optometry (OD) programs run at both universities, good salary and prospects (p < 0.05, for all). The women were significantly less likely to be influenced by another individual (p = 0.0004). Generally, more than two-thirds of the respondents viewed the desire to help others, professional prestige and the new OD programs as the three most influential factors in opting for a career in optometry. CONCLUSION Females were more likely to opt for a career in optometry and males were more likely to be influenced by the new OD programs, good salary and job prospects. Service provision to others in the community was a primary motivation to opt for a career in optometry among young Saudis.

Saudi Arabian adult intensive care unit pressure ulcer incidence and risk factors: A prospective cohort study

The purpose of this study was to identify pressure ulcer (PU) incidence and risk factors that are associated with PU development in patients in two adult intensive care units (ICU) in Saudi Arabia. A prospective cohort study design was used. A total of 84 participants were screened second daily basis until discharge or death, over a consecutive 30-day period, out of which 33 participants with new PUs were identified giving a cumulative hospital-acquired PU incidence of 39·3% (33/84 participants). The incidence of medical devices-related PUs was 8·3% (7/84). Age, length of stay in the ICU, history of cardiovascular disease and kidney disease, infrequent repositioning, time of operation, emergency admission, mechanical ventilation and lower Braden Scale scores independently predicted the development of a PU. According to binary logistic regression analyses, age, longer stay in ICU and infrequent repositioning were significant predictors of all stages of PUs, while the length of stay in the ICU and infrequent repositioning were associated with the development of stages II-IV PUs. In conclusion, PU incidence rate was higher than that reported in other international studies. This indicates that urgent attention is required for PU prevention strategies in this setting.

International students' perceptions of their experience of higher education in Australia: A focus on Saudi Arabian students in their first year of a business course in a major Australian university

This study examined perceptions of international students from Saudi Arabia living and studying in Australia. As a qualitative study that featured case study methodology, the thesis discusses the experiences of Saudi Arabian students in the light of two important factors: students' expectations prior to coming to Australia and the impact of intercultural competency on students' experiences. The study found that while study participants reported mostly positive experiences, there were challenges faced such as coping with English language and culture shock. The thesis culminates in a comprehensive list of implications for educators in the light of the study's findings.

Integration of clinical information systems in Saudi Arabian health care contexts: A grounded theory exploration

This research examined the implementation of clinical information system technology in a large Saudi Arabian health care organisation. The research was underpinned by symbolic interactionism and grounded theory methods informed data collection and analysis. Observations, a review of policy documents and 38 interviews with registered nurses produced in-depth data. Analysis generated three abstracted concepts that explained how imported technology increased practice and health care complexity rather than enhance quality patient care. The core category, Disseminating Change, also depicted a hierarchical and patriarchal culture that shaped the implementation process at the levels of government, organisation and the individual.

Optical, radiative, and source characteristics of aerosols at Minicoy, a remote island in the southern Arabian Sea

Extensive measurements of aerosol radiative and microphysical properties were made at an island location, Minicoy (8.3 degrees N, 73.04 degrees E) in the southern Arabian Sea. A large variability in aerosol characteristics associated with changes in air mass and precipitation characteristics was observed. Six distinct transport pathways were identified on the basis of cluster analysis. The Indo-Gangetic Plain, along with the northern Arabian Sea and west Asia (NWA), was identified to be the region having the highest potential for aerosol mass loading at the island. This estimate is based on the concentration weighted trajectory as well as cluster analysis. Dust transport from the NWA region was found to make a substantial contribution to the supermicron mass fraction. The black carbon mass mixing ratios observed were the lowest compared to previous measurements over this region. Consequently, the atmospheric radiative forcing efficiency was low and was in the range 10-28 W m(-2).

Mechanisms of formation of the Arabian Sea mini warm pool in a high-resolution Ocean General Circulation Model

An Ocean General Circulation Model of the Indian Ocean with high horizontal (0.25 degrees x 0.25 degrees) and vertical (40 levels) resolutions is used to study the dynamics and thermodynamics of the Arabian Sea mini warm pool (ASMWP), the warmest region in the northern Indian Ocean during January-April. The model simulates the seasonal cycle of temperature, salinity and currents as well as the winter time temperature inversions in the southeastern Arabian Sea (SEAS) quite realistically with climatological forcing. An experiment which maintained uniform salinity of 35 psu over the entire model domain reproduces the ASMWP similar to the control run with realistic salinity and this is contrary to the existing theories that stratification caused by the intrusion of low-salinity water from the Bay of Bengal into the SEAS is crucial for the formation of ASMWP. The contribution from temperature inversions to the warming of the SEAS is found to be negligible. Experiments with modified atmospheric forcing over the SEAS show that the low latent heat loss over the SEAS compared to the surroundings, resulting from the low winds due to the orographic effect of Western Ghats, plays an important role in setting up the sea surface temperature (SST) distribution over the SEAS during November March. During March-May, the SEAS responds quickly to the air-sea fluxes and the peak SST during April-May is independent of the SST evolution during previous months. The SEAS behaves as a low wind, heat-dominated regime during November-May and, therefore, the formation and maintenance of the ASMWP is not dependent on the near surface stratification.

Warm pool thermodynamics from the Arabian Sea Monsoon Experiment (ARMEX)

Before the onset of the south Asian summer monsoon, sea surface temperature (SST) of the north Indian Ocean warms to 30–32°C. Climatological mean mixed layer depth in spring (March–May) is 10–20 m, and net surface heat flux (Q net ) is 80–100 W m−2 into the ocean. Previous work suggests that observed spring SST warming is small mainly because of (1) penetrative flux of solar radiation through the base of the mixed layer (Q pen ) and (2) advective cooling by upper ocean currents. We estimate the role of these two processes in SST evolution from a two-week Arabian Sea Monsoon Experiment process experiment in April–May 2005 in the southeastern Arabian Sea. The upper ocean is stratified by salinity and temperature, and mixed layer depth is shallow (6 to 12 m). Current speed at 2 m depth is high even under light winds. Currents within the mixed layer are quite distinct from those at 25 m. On subseasonal scales, SST warming is followed by rapid cooling, although the ocean gains heat at the surface: Q net is about 105 W m−2 in the warming phase and 25 W m−2 in the cooling phase; penetrative loss Q pen is 80 W m−2 and 70 W m−2. In the warming phase, SST rises mainly because of heat absorbed within the mixed layer, i.e., Q net minus Q pen ; Q pen reduces the rate of SST warming by a factor of 3. In the second phase, SST cools rapidly because (1) Q pen is larger than Q net and (2) advective cooling is ∼85 W m−2. A calculation using time-averaged heat fluxes and mixed layer depth suggests that diurnal variability of fluxes and upper ocean stratification tends to warm SST on subseasonal timescale. Buoy and satellite data suggest that a typical premonsoon intraseasonal cooling event occurs under clear skies when the ocean is gaining heat through the surface. In this respect, premonsoon SST cooling in the north Indian Ocean is different from that due to the Madden-Julian oscillation or monsoon intraseasonal oscillation.

Aerosol characteristics and radiative impacts over the Arabian Sea during the intermonsoon season: Results from ARMEX field campaign

During the second phase of the Arabian Sea Monsoon Experiment (ARMEX-II), extensive measurements of spectral aerosol optical depth, mass concentration, and mass size distribution of ambient aerosols as well as mass concentration of aerosol black carbon (BC) were made onboard a research vessel during the intermonsoon period (i.e., when the monsoon winds are in transition from northeasterlies to westerlies/ southwesterlies) over the Arabian Sea (AS) adjoining the Indian Peninsula. Simultaneous measurements of spectral aerosol optical depths (AODs) were made at different regions over the adjoining Indian landmass. Mean AODs (at 500-nm wavelength) over the ocean (similar to0.44) were comparable to those over the coastal land (similar to0.47), but were lower than the values observed over the plateau regions of central Indian Peninsula (similar to0.61). The aerosol properties were found to respond distinctly with respect to change in the trajectories, with higher optical depths and flatter AOD spectra associated with trajectories indicating advection from west Asia, and northwest and west-coastal India. On average, BC constituted only similar to2.2% to total aerosol mass compared to the climatological values of similar to6% over the coastal land during the same season. These data are used to characterize the physical properties of aerosols and to assess the resulting short-wave direct aerosol forcing. The mean values were similar to27 W m(-2) at the surface and -12 W m(-2) at the top of the atmosphere (TOA), resulting in a net atmospheric forcing of +15 W m(-2). The forcing also depended on the region from where the advection predominates. The surface and atmospheric forcing were in the range -40 to -57 W m(-2) and +27 to +39 W m(-2), respectively, corresponding to advection from the west Asian and western coastal India where they were as low as -19 and +10 W m(-2), respectively, when the advection was mainly from the Bay of Bengal and from central/peninsular India. In all these cases, the net atmospheric forcing (heating) efficiency was lower than the values reported for northern Indian Ocean during northern winter, which is attributed to the reduced BC mass fraction.

Contribution of sea-salt to aerosol optical depth over the Arabian Sea derived from MODIS observations

Making use of aerosol optical depths (AOD) derived from MODIS (onboard TERRA satellite) and winds from NCEP, and the fact that sea-salt optical depth over ocean is determined primarily by sea-surface wind speed, we examine the contribution of sea-salt to the composite aerosol optical depth ( AOD) over Arabian Sea ( AS), by developing empirical models for characterizing wind-speed dependence of sea-salt optical depth. We show that at high wind speeds, sea-salt contributes 81% to the coarse mode and 42% to the composite AOD in the southern AS. In contrast to this, over the northern AS, share of sea-salt to coarse mode and composite optical depth is only 35% and 16% respectively. Comparison of the sea-salt optical depth and coarse mode optical depth ( MODIS) showed excellent agreement. The sea-salt optical depth over AS at moderate to high wind speed is comparable to the anthropogenic AOD reported for this region during winter.