paraphrase of 2000 words

202466439

Essa Ahmed Masmali

202462827

Khuloud Saeed Alshahrani

202361368

Introduction

The Emergency Department (ED) serves as the critical frontline of the healthcare system, where nurses are responsible for the immediate stabilization and holistic care of patients with life-threatening conditions (Alzahrani et al., 2018). This high-pressure environment demands advanced clinical competencies, particularly in managing the complex physiological and sensory needs of patients under extreme stress (Alrashedi et al., 2022). Recent literature highlights that caring for the critically ill in this setting is multifaceted, requiring nurses to deliver intensive-care-level interventions, such as precise acute pain management, while navigating the chaotic flow of the emergency room (Akbaş Uysal & Ekiz, 2025; Pavón Rivera et al., 2025).

Beyond traditional technical stabilization, nurses must balance medical urgency with the human aspects of care, including the delivery of person-centered attention and the effective relief of acute pain, often amidst significant resource constraints (Kim et al., 2022; Varndell et al., 2026). However, the ability to prioritize these fundamental care needs alongside life-saving medical interventions remains a constant global challenge (Pavedahl et al., 2022).

In the context of Saudi Arabia, the healthcare sector is undergoing rapid transformation, yet emergency nurses continue to face hurdles that can impede the quality of specialized care (Alsharari et al., 2022; Alshehri, 2016). Local studies indicate that professionals grapple with heavy workloads and occupational stressors that may detract from their ability to focus on essential clinical practices like pain assessment (Alruwaili et al., 2022). Furthermore, the collaborative environment and teamwork dynamics within Saudi emergency departments are critical factors that influence how effectively symptoms like pain are addressed (Alanazi, 2024).

The significance of the current study lies in its potential to uncover the specific nuances of pain management within the Saudi context. By exploring the knowledge and self-reported practices of emergency nurses in this region, this research aims to provide actionable insights that can enhance clinical pain protocols, improve patient safety outcomes, and support the overall quality of nursing care at King Fahd Central Hospital in Jizan.

Statement of the Problem

Despite the critical nature of emergency care in Saudi Arabia, acute pain management remains a consistently neglected aspect of treatment for the critically ill. While stabilization of vital signs is prioritized, pain often goes under-assessed and under-treated, leading to long-term physiological and psychological complications for patients (Varndell et al., 2026). Recent evidence suggests that even when nurses possess core clinical competencies, their specific knowledge regarding analgesia, pain scales, and pharmacological interventions is often insufficient (Varndell, 2023).

At King Fahd Central Hospital in Jizan, the high volume of trauma and medical emergencies necessitates high-level proficiency in pain management. However, there is a lack of empirical data regarding how nurses at this facility perceive and practice pain care. Without addressing this specific gap in knowledge and practice, the quality of person-centered care remains compromised.

Aim and objectives

The primary aim of this study is to evaluate the level of knowledge and self-reported clinical practices of emergency nurses regarding the assessment and management of acute pain in critically ill patients at King Fahd Central Hospital in Jizan.

The objectives of the research are:

1. To assess the level of knowledge regarding acute pain assessment and management among emergency nurses at King Fahd Central Hospital.

2. To determine the self-reported clinical practices for managing acute pain in critically ill patients among emergency nurses.

3. To examine if there are statistically significant differences in the nurses' pain-related knowledge and practice scores attributed to their demographic characteristics.

Research Questions

This research seeks to answer the following questions:

1. What is the level of knowledge among emergency nurses regarding the assessment and management of acute pain in critically ill patients at King Fahd Central Hospital in Jizan?

2. What are the self-reported clinical practices of emergency nurses regarding acute pain management for critically ill patients at King Fahd Central Hospital in Jizan?

3. Are there statistically significant differences in the pain-related knowledge and practice scores of emergency nurses based on their demographic characteristics (age, gender, education, and years of experience)?

Operational Definitions

Critically Ill Patients:

In this study, critically ill patients are defined as those with life-threatening instability, typically classified as Level 1 (Resuscitation) or Level 2 (Emergent). This includes patients with respiratory failure, shock, sepsis, or major trauma. These individuals require high-intensity nursing interventions—such as mechanical ventilation or vasopressor support—creating a complex clinical environment where the assessment and management of acute pain are both essential and technically challenging.

Literature Review

The emergency department is a fast-paced and high-pressure environment where nurses must provide urgent care to patients with life-threatening conditions (Alzahrani et al., 2018; Alshammari et al., 2022). Caring for critically ill patients in this setting requires high levels of skill, quick decision-making, and emotional resilience (Alshehri, 2016). Currently, a vast amount of international and local research explores how emergency nurses manage these difficult situations and the competencies they require.

Starting with recent research, Varndell et al. (2026) explored how emergency nurses perceive and manage acute pain in critically ill patients. Through a qualitative descriptive design involving 46 nurses in Australia, the study revealed that while nurses feel responsible for pain control, their confidence varies and is often limited by heavy workloads and communication difficulties. In a similar context of critical care, Akbaş Uysal and Ekiz (2025) explored the experiences of 21 nurses providing intensive care-level treatment in Turkey’s "red zones." They identified major challenges in clinical judgment and role conflicts, concluding that adherence to intensive care standards and proper education significantly improves nursing competence.

Regarding advanced competencies, Pavón Rivera et al. (2025) conducted interviews with 15 nurses in Honduras. The analysis revealed that while many nurses were unclear about the definition of advanced practice nursing, they identified cognitive and procedural skills as essential for success. In terms of care quality, Labrague et al. (2024) examined 164 nurses in the Philippines using a cross-sectional study. They found that a higher "caring ability" directly correlates with improved quality of care and fewer adverse patient events.

Further research into core skills by Trisyani et al. (2023) identified eight core competencies for emergency nurses, including caring for acute patients and leadership. This qualitative study suggested that nursing education should focus on these areas to prepare for "extended nursing practice."

Communication remains a central theme (Alrashedi et al., 2022; Alsharari et al., 2022). Panchuay et al. (2023) found that using the AIDET framework in Thailand helps build trust and positive relationships with patients. Conversely, Shin and Yoo (2023) analyzed how the COVID-19 pandemic created new communication barriers in South Korea, necessitating greater organizational support for nurses.

Looking at the human side of the profession, Kim et al. (2022) found that while providing person-centered care is difficult in a crowded ED, it significantly improves job satisfaction. However, Pavedahl et al. (2022) noted in a Swedish study that care is often task-oriented and based on checklists, frequently neglecting the psychosocial fundamental needs of life-threateningly ill patients.

Within the Kingdom of Saudi Arabia, Alanazi (2024) explored teamwork practices using a qualitative case study. The results showed that while a shared goal encourages teamwork, it is often hindered by staff shortages and language barriers among expatriate staff. Alqahtani et al. (2024) investigated safety culture among 210 nurses in Riyadh, identifying that while teamwork within units is strong, the fear of punitive responses for reporting errors remains a major challenge.

Addressing the psychological impact, Alshammari et al. (2024) investigated Secondary Traumatic Stress (STS) among 181 nurses in Saudi Arabia. They found severe stress levels, particularly among female and older nurses, highlighting a need for better psychological support systems. This aligns with findings by Dowdell et al. (2022) regarding "compassion fatigue," where specific patient populations, such as those with substance use disorders, create negative emotional stressors for staff.

Finally, Daheshi et al. (2023) assessed the quality of communication between 250 nurses and physicians in Jizan and Hail, finding it generally unsatisfactory. Similarly, Alruwaili et al. (2022) investigated stressors among 296 nurses in Saudi Arabia, citing work overload and low pay as primary burdens, with many nurses relying on prayer and social support as coping mechanisms.

Research Gap

A critical review of the literature reveals a significant gap in the quantitative assessment of clinical competencies regarding acute pain management for critically ill patients. While international studies have extensively explored the qualitative experiences and emotional challenges of emergency nursing (Akbaş Uysal & Ekiz, 2025; Varndell et al., 2026), there remains a scarcity of objective, quantifiable data that benchmarks what nurses actually know (theoretical knowledge) versus what they do (self-reported practices) at the bedside.

In the Saudi Arabian context, existing research is fragmented and focuses largely on environmental variables rather than clinical proficiency. For instance, studies have investigated safety culture (Alqahtani et al., 2024), occupational stress (Alruwaili et al., 2022), and teamwork dynamics (Alanazi, 2024). Even localized research within the Jizan region has prioritized organizational factors, such as nurse-physician communication (Daheshi et al., 2023), without assessing the specific knowledge levels and procedural practices required for high-acuity pain intervention.

The reliance on qualitative narratives in recent pain-related studies (Varndell et al., 2026; Kim et al., 2022) leaves a void in the literature for statistically generalizable evidence that can inform hospital-wide educational protocols. Consequently, there is no current data to determine whether emergency nurses at King Fahd Central Hospital possess adequate knowledge of analgesia or if their clinical practices align with evidence-based standards. This study addresses this gap by providing a targeted, cross-sectional analysis of knowledge and practice scores, allowing for the identification of specific deficiencies that can be addressed through structured clinical training.

Methodology

Study Design

This study employs a descriptive, cross-sectional research design to quantify the current levels of knowledge and self-reported clinical practices among emergency nurses.

Study Setting

The research will be conducted at King Fahd Central Hospital (KFCH) in Jizan, Saudi Arabia, a tertiary referral center. The Emergency Department (ED) at KFCH utilizes the Emergency Severity Index (ESI) triage system. The department includes dedicated resuscitation bays (Red Zone) equipped for mechanical ventilation and advanced hemodynamic monitoring. The patient mix primarily consists of high-acuity cases, including major trauma and severe medical emergencies (ESI Levels 1 and 2), where the management of acute pain is a critical clinical priority.

Sampling Method

A Total Population Sampling (Census) approach will be utilized. Because the total population of registered nurses in the KFCH Emergency Department is small (N = 150), a census is the most appropriate method to eliminate sampling error and provide a comprehensive representation of the staff. While a Raosoft calculation indicates a minimum of 109 responses is required for a 95% confidence level, the survey will be distributed to all 150 eligible full-time registered nurses.

· Non-response Strategy: To maximize the response rate, follow-up reminders will be sent via departmental communication channels at the end of weeks one, two, and three. A non-response bias check will be performed by comparing the early and late respondents' demographic characteristics.

Data Collection Instrument

The instrument is a structured survey adapted from Varndell (2023). It is organized into three distinct sections:

· Section 1: Demographic Data (Items 1–10): Gathers professional characteristics (age, gender, education, years of ED experience, and previous pain management training).

· Section 2: Practice Domain Survey (Items 11–31): Measures self-reported clinical practices regarding the assessment and management of acute pain. Respondents use a 5-point Likert scale (1 = Never to 5 = Always).

· Section 3: Knowledge Assessment (Items 32–55): Utilizes the Knowledge and Attitudes Survey Regarding Pain (KASRP) and clinical vignettes. It employs True/False and Multiple-Choice questions to evaluate theoretical understanding of analgesia and assessment protocols.

Measurement Map and Scoring Protocol

Reliability and Validity

The original tool demonstrated a Cronbach’s alpha of 0.788. For this study:

1. Pilot Test: Conducted with 10 nurses (excluded from the final data) to ensure cultural and linguistic clarity.

2. Reliability by Section: Reliability will be calculated separately. Section 2 (Likert items) will be assessed using Cronbach’s alpha. Section 3 (Dichotomous/MCQ items) will be assessed using the Kuder-Richardson Formula 20 (KR-20), which is the appropriate measure for objective knowledge tests.

Ethical Considerations

Ethical approval will be obtained from the Jizan Health Affairs Institutional Review Board (IRB). The survey will be administered via Google Forms. A cover letter will state that participation is voluntary and anonymous, and no identifying information (names or employee IDs) will be collected.

Data Analysis

Data will be analyzed using SPSS version 26. Descriptive statistics (means, SD, and frequencies) will describe the population and score distributions. Independent T-tests will compare scores between two groups (e.g., Gender), and One-way ANOVA will be used for variables with three or more groups (e.g., Years of Experience). Statistical significance is set at p < 0.05.

References

Akbaş Uysal, D., & Ekiz, E. (2025). Emergency nurses' experiences of caring for critically ill patients requiring intensive care in the emergency department.  International emergency nursing,  83, 101697.

Alanazi, S. (2024).  An exploration of emergency staff perceptions and experiences of teamwork in an emergency department in the Kingdom of Saudi Arabia (Doctoral dissertation, Cardiff University).‏

Alqahtani, S., AlKhatib, M., Alonizi, E., Alrwashed, R., & Faqihi, R. (2024). Emergency Nurses’ Perception of Patient Safety Culture at King Saud Medical City.  Journal of International Crisis and Risk Communication Research,  7(S8), 3154.‏

Alrashedi, H. N., Alshammari, B., AlOtaibi, M., Alrashedi, F., Alanazi, N., Alotaiby, E., & AlSayed, F. (2022). Self-rated emergency core nursing competencies among emergency nurses in Qassim, Saudi Arabia.  Cureus,  14(12).‏

Alruwaili, M. M., Abuadas, F. H., Maude, P., & Ross, A. (2022). Experiences, perceptions, and coping patterns of Emergency Department Nurses with Occupational Stressors in Saudi Arabian Hospitals: mixed-method study. In  Healthcare (Vol. 10, No. 8, p. 1504). MDPI.‏

Alshammari, B., Alanazi, N. F., Kreedi, F., Alshammari, F., Alkubati, S. A., Alrasheeday, A. & Al-Sadi, A. K. (2024). Exposure to secondary traumatic stress and its related factors among emergency nurses in Saudi Arabia: a mixed method study.  BMC nursing,  23(1), 337.‏

Alshammari, B., Alenzi, A., Alshammari, F., Madkhali, N., & Al-Masaeed, M. (2022). Investigation of the level and factors influencing emergency department nurses fatigue: A case study of the Saudi Arabian context. In  Healthcare (Vol. 10, No. 7, p. 1294). MDPI.‏

Alsharari, A. F., Abu-Snieneh, H. M., Abuadas, F. H., Elsabagh, N. E., Althobaity, A., Alshammari, F. F. & Alatawi, S. (2022). Workplace violence towards emergency nurses: a cross-sectional multicenter study.  Australasian emergency care,  25(1), 48-54.‏

Alshehri, B. (2016). Emergency nurses’ preparedness for disaster in the Kingdom of Saudi Arabia.  Journal of Nursing Education and Practice,  7(3), 101-114.‏

Alzahrani, N., Jones, R., & Abdel-Latif, M. E. (2018). Attitudes of doctors and nurses toward patient safety within emergency departments of two Saudi Arabian hospitals.  BMC health services research,  18(1), 736.‏

Daheshi, N., Alkubati, S. A., Villagracia, H., Pasay-An, E., Alharbi, G., Alshammari, F., & Alshammari, B. (2023). Nurses’ perception regarding the quality of communication between nurses and physicians in emergency departments in Saudi Arabia: A cross-sectional study. In  Healthcare (Vol. 11, No. 5, p. 645). MDPI.‏

Dowdell, E. B., Alderman, S. E., Foushee, N., Holland, E., & Reedy, E. A. (2022). Expressions of compassion fatigue by emergency department nurses caring for patients with opioid and substance use disorders.  Journal of emergency nursing,  48(6), 688-697.‏

Kim, J. M., Kim, N. G., & Lee, E. N. (2022). Emergency room nurses’ experiences in person-centred care.  Nursing reports,  12(3), 472-481.‏

Labrague, L. J. (2024). Emergency room nurses' caring ability and its relationship with patient safety outcomes: A cross-sectional study.  International Emergency Nursing,  72, 101389.‏

Panchuay, W., Soontorn, T., & Songwathana, P. (2023). Exploring nurses’ experiences in applying AIDET framework to improve communication skills in the emergency department: A qualitative study.  Belitung nursing journal,  9(5), 464.‏

Pavedahl, V., Muntlin, Å., Summer Meranius, M., von Thiele Schwarz, U., & Holmström, I. K. (2022). Prioritizing and meeting life‐threateningly ill patients' fundamental care needs in the emergency room—An interview study with registered nurses.  Journal of advanced nursing,  78(7), 2165-2174.‏

Pavón Rivera, M. E., Antunez Martinez, O. F., & Morales, P. S. (2025). Honduran nurses' perceptions of advanced nursing care competencies for adults in emergency and critical care: a qualitative study.  International emergency nursing,  81, 101640.

Trisyani, Y., Emaliyawati, E., Prawesti, A., Mirwanti, R., & Mediani, H. S. (2023). Emergency nurses’ competency in the emergency department context: A qualitative study.  Open Access Emergency Medicine, 165-175.‏

Varndell, W. (2023).  Emergency nurses’ perceptions and practices in assessing and managing acute pain in critically ill adult patients: a mixed-methods study. University of Technology Sydney (Australia).‏

Varndell, W., Fry, M., & Elliott, D. (2026). Emergency Nurses' Perceptions and Experiences in Managing Acute Pain in Critically Ill Adult Patients: A Qualitative Study.  Journal of advanced nursing,  82(1), 791–806.

2