To explore how nurses working in Saudi–affiliated health-care settings experience and negotiate quality indicators within the context of health syste

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.

Rural primary healthcare (PHC) systems face persistent challenges related to access, continuity, and responsiveness, particularly in geographically dispers

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.

Oncology nursing is one of healthcare’s most emotionally demanding specialties, characterized by sustained exposure to patient suffering and mortality. While global burnout rates reach 40–60%, emotional intelligence (EI) is a potential protective resource that remains underexamined in Middle Eastern contexts. Despite growing global evidence, little is known about these relationships in Middle Eastern healthcare systems, where cultural norms and workforce structures may shape emotional processes differently. This study examined whether EI was significantly associated with lower burnout across personal, work-related, and client-related dimensions among oncology nurses in Saudi Arabia. Methods: A cross-sectional correlational study enrolled 172 oncology nurses from three tertiary hospitals in Riyadh. Participants completed validated Arabic versions of the Schutte Self-Report Emotional Intelligence Test (SSEIT) and the Copenhagen Burnout Inventory (CBI). Hierarchical regression analyses examined predictive relationships while controlling for age and experience. Results: EI demonstrated significant inverse correlations with personal (r = −0.41), work-related (r = −0.38), and client-related burnout (r = −0.33, p < 0.001). In hierarchical models, EI emerged as a significant predictor of lower scores across all dimensions, explaining 11–17% of unique variance beyond demographic factors. The strongest association was with personal burnout. Causality cannot be inferred from this cross-sectional design. Conclusion: EI functions as a significant protective factor against burnout. Healthcare organizations should integrate EI development into professional training to strengthen workforce resilience and sustain care quality.