The views and experiences of registered nurses in delivering trauma care as a result of the conflict at the Saudi southern border

: findings from a qualitative study

Abstract

Background: Registered Nurses (RNs) provide care and support for patients affected by major traumatic injuries and can be challenged in meeting their physical, cognitive and emotional demands. RNs in trauma care settings are often exposed to threats and fear that affect them personally and professionally. RNs may lack the proper support to meet their emotional needs because of caring for trauma patients. Therefore, it is necessary to gain an understanding of their views and experiences to improve the clinical and personal experiences of trauma RNs serving in the Intensive Care Units (ICU) and Emergency Departments (ED) located in hospitals inthe conflict zones along the Saudi-Yemen border.

Aim: To identify the views and experiences of RNs providing care for patients requiring trauma care at theSaudi southern border because of the conflict.

Methodology: A qualitative method using Thematic analysis (TA) was adopted to gather insights from the respondents. The thematic analysis used a homogeneous purposeful sample from a population of RNs working in the ED and ICU. Semi-structured interviews with 12 RNs were used to collect data while the insights gathered were analysed using the thematic analysis method developed and supported by Braun and Clarke (2006).

Findings: The qualitative study established varied views and experiences of the trauma care RNs provide while working in the ED and ICUs. The RNs offered timely trauma care for the injured patients in the conflict zone along Saudi-Yemen border. The findings showed the views and experiences encompassed trauma care provision, education and practice development of RNs, barriers, and solutions to the barriers to the provision of trauma care. The views and experiences of the RNs about trauma care in the ED implied the existence of different models of trauma care. Their role in providing trauma care and the challenges in the ED such as communication barriers, teams or lines of communication, patient advocacy and support, and practice development for the dedicated intensive care operations. The models of trauma care mentioned by the respondents were ATLS model of trauma care, Canadian triaging system, and the team-oriented system of delivering trauma care. On the other hand, ED RNs faced challenges of organisation and resourcefulness and inadequate use of international trauma protocol standards. Education and practice development needs of the ED RNs were integral to the experience of delivering quality trauma care. Additionally, the primary barriers included professional, environmental, and organisational obstacles. The RNs described solutions to the barriers such as infrastructural changes, proper education and development, holding debriefing sessions, and development of trauma care teams. The analysis gathered that the ICU RNs had diverse views and experiences on trauma care for the patients from the Saudi-Yemen border. The themes from the analysis included building confidence, gathering or sharing knowledge, and understanding of offering trauma care in the ICU. The themes further include nurse-patient ratio, communication, proper organisation, and resource provision to the trauma RNs. Other findings discovered that the organisation and resource encompassed concerns such as staff shortage, excessive workload, and language barriers. Conversely, the key facilitators of trauma care in the ICU included teams or lines of communication, practice development for the RNs, and support from the hospital management through the equipment, and materials. The major practice and development needs found from the respondents included continuous learning and ATLS-based guidelines. However, the key barriers to trauma care delivery in the ICU include insufficient specialist trauma centres, a high number of trauma patients, and security threats. The ICURNs proposed solutions such as access to education and practice development, access to the organisational resources, evidence-decision-making, workforce management initiatives, family and patient involvement, protocol and policy development in the ICU.

Discussion and conclusion: The discussion of the key findings was anchored on moral injury theory. The theory denotes the disturbing social, professional, behavioural, and psychological exposures affecting the trauma RNs’ moral beliefs and individual values. The RNs providing trauma care to patients from the conflict zones faced challenges and experiences that deviated from their moral beliefs, particularly within the context of their nursing practice. The suffering at the patient and professional level altered the nurses’ views, social acceptance, connectedness, belonging, trust, and ability to engage with the practice. The study concludes that RNs in the ED and ICUs need additional courses, resources, security, debriefing sessions, incentives to workin the conflict zones. Future studies should use longitudinal designs to identify the effectiveness of overtime pay and hardship allowances in reducing the turnover rates of RNs serving in conflict zones.

Thesis is embargoed until 31st December 2027.

Date of Award	Dec 2024
Original language	English
Awarding Institution	Queen's University Belfast
Supervisor	Derek McLaughlin (Supervisor) & Michael Brown (Supervisor)