Designing a Simulation Intervention to Reduce Stress among New Graduate Registered Nurses in the Intensive Care Units in Saudi Arabia: A Mixed Methods Design

Abstract

Introduction: Health care professionals, including registered nurses are prone to stress, with new graduates experiencing high levels of stress in their graduate year. In Saudi Arabia many new graduates are expected to be placed in critical care units due to a range of contextual issues. These units are stressful; effective ways to assist these new graduates are required. Simulation learning is envisaged to be a novel strategy to overcome this issue. Reducing stress levels in new graduates assists them to transition to professional practice and has the potential to improve workforce demands by increasing retention. Thus, this research explored both stressors among new graduate registered nurses (RNs) in intensive care units (ICUs) and the potential use of a complex intervention using simulation to reduce these stress factors. For the purpose of achieving the aim of this study, the research was based in one hospital in Saudi Arabia, the King Saud Medical City- Riyadh (KSMC-R). It is also noteworthy that the complex intervention was designed and will be implemented and evaluated in future research. Objective: This study aimed to design a simulation based learning exercise (SBLE) based on the specific stressors experienced by new graduate RNs working in the paediatric and adult ICUs at KSMC-R. Methods: This research was based on an interventional mixed method design. The research involved the integration of three studies which incorporated both quantitative and qualitative approaches, whereby a sequential exploratory design was employed. Study 1: Survey of new graduate RNs in which 189 Saudi new graduate RNs were surveyed about their experiences of stress in their ICUs units using the Perceived Stress Scale (PSS) to measure the level of stress and the Expanded Nursing Stress Scale (ENSS) that measured the factors/frequency of stressors experienced by new graduate RNs in the ICUs. Study 2: Individual interviews of 10 new graduate RNs further explored their experiences of stressors in ICUs. Study 3: a single group discussion with 5 nurse educators investigated the extent and type of educational support provided for new graduates and educators’ views of and experience with simulation. Results: The results from the three studies were integrated using complementarity and triangulation techniques. From the results a complex intervention based on SBLE was designed to potentially assist new graduates to better manage and overcome these stressors. Conclusion: This research has contributed new knowledge regarding the level and nature of stressors that are experienced by Saudi new graduate RNs working in critical environments such as the ICUs. In addition the study offers a potential intervention to assist new graduates to deal with these stressors. The approach of using multiple data sources to inform the design of an SBLE has the potential to be used in other contexts.