Background: Chronic heart failure (CHF) in older adults requires sustained self-management and close follow-up, yet day-to-day care is often carried out by families with support from primary healthcare nurses. In Saudi Arabia, where family caregiving is culturally normative, collaboration between nurses and patients’ families may be pivotal to effective CHF management, but remains insufficiently understood in primary healthcare contexts. Methods: A qualitative study informed by an interpretive phenomenological approach was conducted. Participants (n = 24; 12 nurses and 12 family caregivers) were recruited using purposive sampling from primary healthcare centers in Riyadh, Saudi Arabia. In-depth, semi-structured interviews were conducted in Arabic or English, audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis following Braun and Clarke’s six-phase framework. Strategies to enhance trustworthiness included member checking, peer debriefing, maintenance of an audit trail, and reflexive journaling. Results: Twenty-four participants (12 nurses and 12 family caregivers) were interviewed. Four interrelated themes were generated from both nurses’ and family caregivers’ accounts. (1) “We Are Caring Together”: Collaboration was experienced as shared responsibility for daily CHF management, grounded in trust; (2) Navigating Roles and Boundaries: Participants described unclear expectations, role overlap, and tension between professional authority and family knowledge; (3) Communication as the Engine of Collaboration: Effective partnerships depended on clear information exchange, caregiver-tailored education, and continuity of contact, while communication gaps created uncertainty and delayed support-seeking; and (4) Cultural and System Constraints Shaping Collaboration: Strong family obligation motivated caregiving but also intensified moral pressure and limited help-seeking, while time pressure and fragmented services constrained meaningful engagement and continuity across settings. Conclusions: Nurse–family collaboration in CHF management is relational, shaped by trust, role negotiation, and communication, and constrained by cultural norms and system pressures. This study contributes to the literature by demonstrating how moral obligation, hierarchical professional norms, and system fragmentation distinctively shape collaboration in the Saudi primary care context, extending existing conceptualizations derived primarily from Western individualist settings. Strengthening collaboration requires explicit role clarification, health literacy–informed caregiver education, continuity of contact, and organizational supports. Findings are limited by purposive sampling, single-city context, and exclusion of patient perspectives.

Background: Internet Gaming Disorder (IGD) is a growing mental health concern among university students, often linked to impulsivity and low resilience. However, traditional regression-based research often fails to evaluate latent measurement structures or simultaneously test indirect pathways within a single analytic framework. This study applied structural equation modeling (SEM) to examine the direct and indirect associations between impulsivity, resilience, and IGD symptom severity among Saudi university students, evaluating resilience as a potential mediator and testing measurement equivalence across sex. Methods: Data from 207 students (58.9% male) were analyzed using the lavaan package in R. Confirmatory factor analysis (CFA) evaluated the measurement model for the IGDS9-SF, CD-RISC-10, and S-UPPS-P. Structural paths were tested with indirect effects estimated via bootstrapping (5000 resamples), alongside multi-group invariance testing to examine equivalence across sex. Results: The measurement model demonstrated acceptable fit (CFI = 0.93, TLI = 0.91, RMSEA = 0.058 [90% CI: 0.044, 0.069], SRMR = 0.063). Significant direct associations were observed: impulsivity with IGD severity (β = 0.38, p < 0.001) and resilience with IGD severity (β = −0.26, p < 0.001). The bootstrapped indirect association of impulsivity with IGD through resilience was statistically significant (β = 0.083, 95% CI [0.031, 0.149]), consistent with partial mediation in this cross-sectional sample. Factor loadings were equivalent across sex (metric invariance supported); the impulsivity–IGD association was stronger in males (β = 0.46) than females (β = 0.27; χ²(1) = 4.65, p = 0.031), though this comparison should be treated as preliminary. Conclusions: Impulsivity was associated with IGD both directly and indirectly through lower resilience. These SEM-based findings are consistent with resilience as a partial mediator of the impulsivity–IGD association, suggesting potential value in multi-target mental health interventions in university nursing and counseling settings. Longitudinal research is needed to establish causal ordering.

Background: Effective nurse–patient communication is fundamental to quality care delivery, yet language barriers pose significant challenges in multicultural healthcare environments. In Saudi Arabia’s diverse healthcare landscape, nurses frequently encounter patients who do not speak Arabic, potentially compromising care quality and patient safety. Objective: To explore multilevel factors influencing communication between Saudi nurses and non-Arabic-speaking patients, using Bronfenbrenner’s ecological systems theory as a conceptual framework. Design: A qualitative descriptive study employing semi-structured interviews analyzed through reflexive thematic analysis. Setting: Four healthcare facilities (two governmental and two private hospitals) across Saudi Arabia. Participants: Eighteen Saudi registered nurses with experience caring for non-Arabic-speaking patients, recruited through purposive sampling. Methods: Semi-structured interviews (n = 18) were conducted in Arabic or English between November 2025 and February 2026. Data were analyzed using Braun and Clarke’s reflexive thematic analysis, organized within Bronfenbrenner’s ecological levels. Collaborative reflexive coding and member-checking with six participants supported analytical rigor. Results: Five main themes emerged: (1) Individual-level competencies and preparedness (microsystem), (2) Interpersonal dynamics and cultural sensitivity (microsystem), (3) Unit-level resources and organizational support (mesosystem), (4) Institutional policies and language services (exosystem), and (5) Healthcare system and societal influences (macrosystem). Participants identified language proficiency gaps, cultural misunderstandings, inadequate interpreter services, and systemic barriers as primary challenges affecting communication quality. Conclusions: Communication between Saudi nurses and non-Arabic-speaking patients is influenced by complex, interconnected factors across multiple ecological levels. Interventions should address individual competency development, organizational support systems, and policy-level changes to ensure equitable, safe, and effective communication for all patients.

Background/Objectives: Internet Gaming Disorder (IGD) is included in ICD-11 and poses a substantial risk to Saudi university students, yet no structured nursing intervention framework exists within Saudi higher education health services. This paper presents the Resilience-Based Nursing Intervention Framework (RBNIF), a three-tiered, theory-driven nursing architecture translating evidence on impulsivity, resilience, and IGD into practice specifications for this setting. Methods: Using secondary analysis of a dataset of 207 gaming students from four King Saud University colleges, framework development followed a four-phase Medical Research Council (MRC) process: theoretical identification (I-PACE, Dual Process Theory, COM-B), evidence synthesis, Behavior Change Wheel/Intervention Mapping, and cultural adaptation via Bernal et al.’s Ecological Validity Framework. Results: The sample (58.9% male; 20–25 years, 61.4%; bachelor’s level, 73.9%) yielded three tiers differentiated by a dual-domain screening rule (elevated impulsivity and/or low resilience, rather than a single combined score): Tier 1 (universal psychoeducation); Tier 2 (six-session group program, S-UPPS-P ≥ 52 and/or CD-RISC-10 ≤ 20; 63 of 207 participants [30.4%]); and Tier 3 (10-session RIRDH clinical program, IGDS9-SF ≥ 36, met by 38 of 207 participants [18.4%]). Fifty-two participants (25.1%) met the elevated-impulsivity criterion, and 51 (24.6%) met the low-resilience criterion. Each tier specifies nursing competencies and behavior change techniques, with cultural adaptation integrating Islamic values concepts (sabr, mizan, tawakkul), family protocols, and single-sex delivery. Conclusions: To our knowledge, the RBNIF is the first theory-driven, culturally adapted nursing intervention architecture for IGD in Saudi university health services; a focused, non-systematic search of PubMed, Scopus, and CINAHL identified no directly comparable published framework. It is pre-implementation and requires feasibility testing, pilot evaluation, and a cluster-randomized controlled trial (c-RCT).

Background: Despite the WHO’s recognition of Gaming Disorder in the ICD-11, epidemiological data on its prevalence and neuropsychiatric correlates among Saudi Arabian university students remain limited. Such data are critical for calibrating campus mental health resources and developing evidence-based screening protocols. This study aimed to estimate the prevalence of Internet Gaming Disorder (IGD) in a sample of Saudi university student gamers and evaluate the clinical utility of impulsivity and resilience as case-detection tools. Methods: In a cross-sectional survey of students who engaged in electronic gaming for at least one hour per week (N = 207; 58.9% male), participants completed the IGDS9-SF, CD-RISC-10, and S-UPPS-P scales. Data were analyzed using binary logistic regression and Receiver Operating Characteristic (ROC) curves to identify predictors and compare the discriminative validity of the constructs. Results: Among these student gamers, the overall IGD prevalence was 18.4%, with significantly higher rates in males (24.6%) than females (9.4%; χ²(1) = 7.71, p = 0.006). Significant predictors of IGD included sex, daily gaming hours, higher impulsivity, and lower resilience. ROC analysis revealed that a composite impulsivity-resilience index (AUC = 0.80) outperformed single-construct screening using only impulsivity (AUC = 0.71) or resilience (AUC = 0.68). Cases exhibited markedly higher impulsivity and lower resilience than non-cases. Conclusions: Among Saudi university student gamers, IGD prevalence is clinically significant, particularly among heavier and male gamers. A composite impulsivity-resilience screening index showed superior detection accuracy in this sample and warrants further validation for integration into university mental health assessment protocols.

Economic inequities in healthcare access persist globally, yet the impact of income on palliative care (PC) utilization in Middle Eastern contexts remains empirically understudied. This cross-sectional study of 200 cancer patients in Riyadh, Saudi Arabia, employed a socioeconomic stratification analysis to examine income-stratified differences in PC awareness and access. Using chi-square and linear-by-linear association tests, results revealed pronounced income gradients; awareness increased from 41.9% in the low-income group to 71.9% in the high-income group (p = 0.001), demonstrating a significant dose–response trend. Access disparities were even more striking, with only 35.5% of low-income patients utilizing services compared to 76.1% of high-income patients (p < 0.001), representing a 40.6 percentage-point gap. After multivariable adjustment, after controlling for age, gender, education, and geographic living region, the results of logistic regression analysis showed that cancer patients with high income were more than three times as likely to access PC services compared with lower-income cancer patients (OR = 3.32; 95% CI: 1.83–6.02; p < 0.001). Geographic stratification further indicated that income disparities were significantly amplified in peripheral regions compared to the Central region (p = 0.072 for interaction), where service scarcity exacerbates economic barriers. These findings underscore that economic barriers operate through awareness gaps and structural obstacles like transportation and opportunity costs. Addressing these inequities requires multifaceted strategies, including financial support and geographic service expansion, to ensure equitable PC distribution under the Vision 2030 framework.