Regie Buenafe Tumala

Background: Artificial intelligence (AI) is increasingly integrated into nursing practice, yet nurses often demonstrate low to moderate AI knowledge, mixed attitudes, and inconsistent practice behaviors. Although individual studies have examined these domains, no review has comprehensively examined AI-related knowledge, attitudes, and practice (KAP) together with the emerging evidence on patient safety culture among nurses. This gap is significant because safe AI adoption in nursing depends on both technical competence and a strong safety culture across diverse clinical settings. Objective: To systematically map international evidence on nurses’, nursing students’, and other included participants’ AI-related KAP, and to examine how these factors may relate to patient safety culture. Because several eligible studies included multidisciplinary samples in which nurse-specific quantitative data were not reported separately (China, Bangladesh, Pakistan, and three studies from the Kingdom of Saudi Arabia [KSA]), only studies with extractable nurse-specific results were used to inform nurse-focused conclusions, and multidisciplinary findings were not attributed solely to nurses. Methods: This scoping review followed Arksey and O’Malley’s framework and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Searches of PubMed, CINAHL, Scopus, Web of Science, and ScienceDirect (2021–2026) identified studies examining AI-related perceptions among nurses and other healthcare participants when nurse-specific data were reported separately or extractable. Data extraction and narrative synthesis were conducted using Joanna Briggs Institute guidance. Results: Ten studies met the inclusion criteria and were included in the final review. Studies from China, Bangladesh, Pakistan, the KSA, Turkey, and the United Arab Emirates showed variable AI knowledge but predominantly positive attitudes. Ethical concerns—privacy, job displacement, and reduced empathy—were common. Younger age, higher education, and prior AI exposure were associated with more favorable perceptions. Nurses across regions emphasized the need for structured AI training. Only one study examined patient safety culture, and it reported that AI knowledge and attitudes significantly predicted patient safety culture, with attitude showing the stronger effect. However, because this evidence comes from a single cross-sectional study conducted in a multidisciplinary sample without nurse-specific results, it is insufficient to establish causal conclusions, and its findings cannot be generalized specifically to nurses. Conclusions: Nurses are generally receptive to AI but lack sufficient knowledge, training, and organizational support for safe implementation. Preliminary evidence suggests a positive association between AI-related knowledge, attitudes, and patient safety culture, but this relationship remains uncertain due to the extremely limited evidence base and the reliance on evidence that is not exclusively nurse-specific. Available studies indicate generally favorable attitudes toward AI alongside variable knowledge, limited formal training, and persistent ethical and organizational concerns, with only one eligible cross-sectional study linking these factors to patient safety culture. The conclusion regarding this association should not be attributed exclusively to nurses because the patient safety culture evidence was derived from a multidisciplinary sample. Future research should explore how AI competencies may interact with safety-related behaviors and organizational systems. Strengthening AI training, ethical guidance, and organizational support remains essential for safe adoption.

Introduction: This cross-sectional study examined associations between Social Media Use (SMU), Body Shape Concern (BSC), and Self-Esteem (SE) among Saudi student nurses. We assessed demographic differences in these variables and tested whether SE moderated the SMU–BSC relationship. Methods: We conducted a cross-sectional correlational study with 324 student nurses recruited through convenience sampling at King Khalid University. Data were collected via Google Form between January and February 2025 using the SMU Questionnaire, BSQ-8A, and Rosenberg Self-Esteem Scale. Results: Higher SMU and greater BSC were each associated with lower self-esteem (ρ = −0.334 and −0.492, p < 0.001, shared variance = 11.2% and 24.2%). SMU and BSC were positively correlated (ρ = 0.393, p < 0.001). Female students reported marginally higher SMU and BSC than males, but effect sizes were negligible (Cohen’s d = 0.07 and 0.02). Second-year students scored highest across all three variables, with small effect sizes (η² = 0.02–0.03). SE did not moderate the SMU–BSC relationship (interaction term: p = 0.113), though both SMU and SE independently predicted BSC. Conclusions: Among Saudi student nurses, higher social media use and greater body shape concern were associated with lower self-esteem. Female and second-year students showed marginally higher scores, though effects were small. Contrary to the vulnerability-stress hypothesis, self-esteem did not moderate the social media–body concern relationship. Interventions may need to combine media literacy with self-esteem enhancement rather than relying on self-esteem approaches alone.

Background: Pressure injuries (PIs) remain a major and escalating global patient safety concern, affecting 12.8% of hospitalized patients worldwide and contributing to rising prevalence and mortality rates from 5.63 to 8.18 and 0.31 to 0.47 per 100,000 population, respectively. The economic burden of PIs is substantial, amounting to $26.8 billion annually in the United States and $9608 per patient in the Kingdom of Saudi Arabia (KSA). However, adherence toward pressure injury prevention (PIP) guidelines among registered nurses (RNs) remains critically inconsistent. Objectives: The aim of this study was to examine whether attitude and practice function as parallel mediators in the relationship between knowledge and adherence to PIP guidelines among RNs, adjusting for age and years of experience. This aim was addressed through three-fold objectives: to assess RNs’ knowledge, attitude, practice (KAP) and adherence to PIP guidelines, evaluate the direct knowledge–adherence relationship, and quantify the two mediated pathways. Methods: A cross-sectional mediation study recruited 166 RNs from 52 clinical units at Prince Sultan Military Medical City in Riyadh, KSA, using convenience sampling with data collected from 5 to 15 March 2026. Validated instruments assessed KAP and adherence to PIP guidelines. Pearson correlations, multiple linear regression, and parallel mediation (Hayes PROCESS macro, model 4; 5000 bootstrap resamples) were performed with age and years of experience as covariates. Results: Mean scores indicated low knowledge (7.31/25; 29.2%), negative attitude (28.20/52; 54.2%), poor practice (36.10/110; 32.8%), and low adherence (28.40/90; 31.6%). Regression explained 36.8% of the variance in adherence to PIP guidelines (Adjusted R² = 0.35), with knowledge (β = 0.22; p < 0.003), attitude (β = 0.30; p < 0.001), practice (β = 0.20; p = 0.006), and years of experience (β = 0.12; p = 0.04) emerging as significant predictors. Both attitude (unstandardized indirect effect = 0.40; 95% Boot CI [0.20, 0.64]) and practice (indirect effect = 0.30; [0.10, 0.60]) significantly mediated the knowledge–adherence relationship, while knowledge retained a significant direct effect (B = 0.70, p = 0.003), indicating partial mediation. Conclusions: This study was the first to employ a parallel mediation analysis to examine KAP as concurrent predictors of adherence toward PIP guidelines within a tertiary military healthcare setting in the KSA. The mediating roles of attitude and practice, together with the direct effect of knowledge, indicated that adherence to PIP guidelines is shaped by interconnected cognitive and behavioral mechanisms. Persistently low KAP levels and low adherence, along with the predictive influence of all KAP domains and RNs’ years of experience, underscored the urgent need for integrated interventions that strengthen KAP to improve adherence and prevent PIs.

Background: Parents of children with cerebral palsy (CP) experience several challenges in providing care, which can impact the child’s quality of life. CP is one of the most common neurological conditions that demand a great deal of time and effort from caregivers. Purpose: To explore the psychological and social effects experienced by Saudi families while rearing children with CP. Methods: This research utilizes qualitative research methods. The purposive sampling method was used to select 13 caregivers of children with CP from the Children with Disability Association in Riyadh, Saudi Arabia. Personal interviews were conducted with a group of parents, then these interviews were analyzed to derive the experiences of the participants. Results: The findings highlighted the difficulties that these families go through from the moment the diagnosis was made, as well as other care burdens, including costs, isolation, and continuous anxiety and worries about the future of the children. Conclusions: This study identifies the need for organized psychological and social support, which has a significant impact on enhancing adaptability and the lives of the children.

Introduction: Registered nurses’ attitudes are integral to ensuring stringent adherence with pressure injury prevention (PIP), making their attitudes and adherence to PIP critical to patient outcomes, yet require comprehensive assessment to evaluate their relationship and effectiveness. Nevertheless, there is a notable absence of national prevalence data in the Kingdom of Saudi Arabia (KSA), indicating a shortfall in the application of established PIP strategies. Hence, research focused on evaluating the impact of nurses’ attitudes and adherence to PIP within the KSA has been limited. Objective(s): The aim of this study was to assess the attitudes of nurses towards PIP and their adherence with its recommendations, and how sociodemographic factors and attitudes influence their adherence to the recommendations for PIP. Methods: A descriptive–correlational design was used. The study was conducted in a military medical city in Riyadh, KSA. Data were collected between 26 February and 03 March 2026, and analyzed using IBM SPSS Statistics (version 30). Multiple linear regression analyses were performed separately for the attitudes towards and adherence to recommendations for preventing pressure injuries (PIs) as dependent variables. For the first two regression models, the sociodemographic variables were considered predictor variables of attitudes towards and adherence to recommendations for PIP, and the level of attitudes was assigned as the predictor of adherence for the third model. Results: A total convenience sample of 524 nurses participated and demonstrated overall positive attitudes towards PIP and positive adherence to PIP recommendations. Three sociodemographic variables were found as significant predictors of attitudes towards PIP, including age, highest education, and having read an article, book, or guideline pertaining to the PIP within the last year or less. In addition, two sociodemographic variables also demonstrated as significant predictors of adherence to the recommendations for PIP, namely: gender, and having read an article, book, or guideline pertaining to PIP within the last year or less. Conclusions: The findings demonstrated that registered nurses displayed favorable attitudes towards PIP alongside positive adherence to its recommendations. These findings may suggest a shared commitment and consistent engagement in PIP practices. Numerous sociodemographic factors and attitudes towards PIP emerged as significant predictors of nurses’ adherence to the recommendations for PIP.

Global demand for health economics/pharmacoeconomics (HE/PE) has significantly increased, leading to a greater need for competent and skilled healthcare professionals in this field. However, the current literature indicates a lack of research regarding HE/PE among healthcare professionals, including those in the Kingdom of Saudi Arabia (KSA), particularly among registered nurses. Hence, this study assessed registered nurses’ levels of awareness and knowledge of HE/PE and their sociodemographic and HE/PE-related predictors. A descriptive–correlational, cross-sectional design was used. The study was conducted on a convenience sample of 324 registered nurses working at the three hospitals within King Saud University Medical City, Riyadh, KSA. Data were collected from May 2025 to June 2025, and analyzed using SPSS v.30. Binary logistic regression analyses were conducted for HE/PE awareness, and multiple linear regression analyses were performed for knowledge about HE/PE. The significance level was established at p <0.05. Registered nurses demonstrated an overall low level of knowledge (2.39/5), while showing a good level awareness about HE/PE across four awareness items (52.8% to 84.6%) but suboptimal for the remaining two items (38.6% and 38.9%). Several sociodemographic and HE/PE-related factors were identified as significant predictors of the registered nurses’ awareness and knowledge regarding HE/PE. Notably, four out of the six awareness items: “have heard about HE/PE” (p =0.040), “read articles related to HE/PE regularly” (p <0.001), “participate in HE/PE decisions at work” (p <0.042), and “implement HE/PE techniques to make decisions” (p <0.001) were revealed as significant predictors of registered nurses’ knowledge about HE/PE. The findings indicate that the knowledge level regarding HE/PE among registered nurses was low; nevertheless, their awareness was acceptable. It is crucial to develop and implement targeted educational strategies and interventions aimed at enhancing both awareness and knowledge about HE/PE among registered nurses in the KSA, while meticulously considering pertinent sociodemographic and HE/PE-related factors.

Background: The implementation of shared governance within the nursing practice results in heightened satisfaction among nurses and enhances the quality of care provided. Shared governance fosters collaborative and proactive relationships among nurses and healthcare providers, while also cultivating a sense of confidence among nurses. However, evidence suggests that a lack of awareness, reliance on traditional governance, and inadequate shared governance structures among nurses continue to exist at the unit-based council (UBC) level, including those in the Kingdom of Saudi Arabia (KSA). Purpose: The present study aimed to assess the extent of clinical nurses’ perceptions concerning shared governance at the UBC level, and to examine the variations and relationships in their perceptions based on demographic and work-related characteristics. It further explored the demographic and work-related factors that affect the overall perceptions of shared governance among clinical nurses. Methods: This quantitative study utilized a cross-sectional design and was carried out in three governmental hospitals in the KSA. The sample comprised 669 nurses, who were selected using a convenience sampling method. The Index of Professional Nursing Governance (IPNG) tool was utilized for data collection conducted between February 2025 and April 2025. Descriptive statistics alongside the t-test and analysis of variance (ANOVA), Pearson-r correlation coefficient, and multiple linear regression were utilized for data analysis. Significant findings were drawn when p ≤ 0.05. Results: The average perception of shared governance among clinical nurses at the UBC level was 180.42 out of 430, suggesting that decision-making occurs collaboratively between nurses and management. Significant differences in the average level of clinical nurses’ perceptions of shared governance were noted in relation to their educational qualifications (F = 5.015, p = 0.001) and nursing units (F = 4.157, p = 0.010). The hospital in which clinical nurses were employed (r = 0.098, p = 0.037) and nursing units (r = 0.087, p = 0.020) exhibited significant correlations with their overall shared professional governance. Furthermore, the hospital where clinical nurses were employed (β = 0.406, p = 0.001, 95% confidence interval [CI] = 0.166, 0.646) and nursing units (β = 0.326, p = 0.038, 95% CI = 0.018, 0.314) served as predictors of their overall professional shared governance. Conclusions: Clinical nurses in this study showed an initial or relatively low level of shared governance at the UBC level. The overall finding highlights a critical need for nursing managers and leaders to enhance the level of professional shared governance among clinical nurses, which may result in improved nurse retention and overall quality of nursing care. It is crucial to consider clinical nurses’ educational qualifications and working environment at the UBC level when aiming to enhance their level of professional shared governance.

Background/Objective: Despite the vital role of nurses in health policy development, their involvement and influence in such development remain challenging. The involvement of nurse managers in health policy development in the Kingdom of Saudi Arabia (KSA) is not well examined. This study examined the extent of involvement of nurse managers in health policy development in the KSA and identified related barriers, benefits, confidence, and perceived impacts. Methods: A descriptive correlational cross-sectional design was used to achieve the study aim and objectives. An electronic self-administered questionnaire (Registered Nurses Involvement in Health Policy) was distributed to nurse managers working in the KSA. A total convenience sample of 238 nurse managers willingly and voluntarily agreed to participate. Data were collected from 10 February 2022 to 30 April 2022. Descriptive statistics and the Spearman rho correlation coefficient were used to analyze the data. Results: Among 238 nurse managers surveyed, 58% had received policy-related training, 73% reported high involvement as professionals, and 43% rated their confidence as high. Findings show the high level of involvement in health policy development of the nurse managers and their increased interest in influencing health policies. The policy activity most frequently chosen by the nurse managers is “provided health policy-related information to consumers or other professionals.” Moreover, the participants reported “lack of time, support, and resources” as their most perceived barrier and “improving public health” as their most perceived benefit. The majority of the nurse managers reported receiving information or training on health policies, and more than half of the participants rated their skills as “very good” or “excellent.” Our findings show the participants’ moderate level of confidence in performing health policy activities and moderate level of their perceived impact of their involvement in health policy activities on health outcomes. The results indicate a positive relationship between health outcomes and the ability of the nurse managers to influence health policy activities. Conclusions: The study findings suggest that Saudi nurse managers are increasingly engaged in policy development, but greater institutional support and targeted training are needed to strengthen their policy impact.

Background/Objective: Transformational leadership (TL) by nurse managers is a modifiable organizational factor consistently linked to improved staff outcomes. However, evidence from the Arab Gulf region, particularly the Kingdom of Saudi Arabia (KSA), is limited. This study aimed to assess the relationship between nurse managers’ TL and staff nurses’ intent to stay and determine which TL dimensions predict intent to stay. Methods: A cross-sectional online survey was conducted among staff nurses at a three-hospital academic medical city in Riyadh, KSA. A total of 523 eligible respondents successfully completed the survey, utilizing probabilistic cluster sampling to guarantee representation from various nursing units within the medical city. Nurse managers’ TL was assessed across five dimensions by using the multifactor leadership questionnaire, and staff nurses’ intention to stay was measured using intent to stay scale. Descriptive statistics summarized the respondents’ demographic profile, nurse managers’ TL and staff nurses’ intent to stay. Normality was evaluated using Shapiro–Wilk and Kolmogorov–Smirnov tests. Relationships were examined using Spearman’s rank correlation, and multivariable ridge regression modeled the predictive contributions of the overall TL and its five dimensions to intent to stay. Results were considered significant if p < 0.05. Results: Nurse managers’ TL exhibited a positive association with staff nurses’ intention to stay in their current positions (r = 0.22, p < 0.001). Moreover, every dimension of TL demonstrated a strong positive relationship with the intent to stay (all p-values < 0.001). Multivariable ridge regression analysis revealed that the overall TL was a significant predictor of the intent to stay (β = 0.13, p < 0.001). Conclusions: The findings corroborate prior evidence linking TL to retention intentions. This underscores the practical salience of leadership competencies and attributes of nursing leaders, particularly TL, which recognizes the individual needs of staff nurses. This recognition subsequently fosters retention intentions, cultivates supportive nursing work environment, and enhances overall organizational success.

Background: While the privatization of healthcare services holds a potential for better healthcare outcomes, a significant gap remains in understanding its impact on the healthcare workforce, especially regarding nurses’ perceptions, with limited research available in the Kingdom of Saudi Arabia (KSA). Aim: This study aimed to assess nurses’ perceptions of privatization practices in healthcare services in Al-Taif City, KSA. Methods: This quantitative study used a cross-sectional design. The Nurses’ Privatization Perception Scale (NPPS) was distributed electronically to potential respondents in four select hospitals in Al-Taif City, KSA. The random sampling technique was used to recruit a total convenient sample of 237 registered nurses. The IBM SPSS (version 25) was used to analyze the collected survey data. Results: The findings indicated that nurses generally hold a positive perspective of privatization, aligning with their favorable perceptions across three dimensions of the NPPS: (1) privatization in general, (2) privatization in healthcare, and (3) impact of privatization on nursing. Significant differences in the overall perceptions of privatization across all three domains were observed, influenced by factors such as the age, nationality, and working areas of the nurses, as well as to the hospital where the respondents were employed. Discussion: Nurses believed that privatization could yield changes that could positively impact healthcare, the nursing profession and their healthcare practices. This outcome is consistent with the current literature, suggesting that privatization could enable the Saudi government to make decisions more quickly and cut costs. Conclusion: Nurses displayed positive perspective about privatization of healthcare in the KSA. However, more research is required to investigate communication strategies to improve the understanding of the concept of privatization and explore confounding factors influencing nurses’ perceptions. This study showed that nurses believed that privatization could bring about positive changes and positively impact healthcare and nurses’ practices. The results may aid policymakers in identifying gaps in the understanding of nurses’ perceptions of privatization in Al-Taif City and other regions of the KSA, and thus result in awareness programs explaining the value of privatization.