Saudi Population Perceives Communication Barriers in Emergency Departments in Saudi Arabia

ABSTRACT


INTRODUCTION
Effective communication is one of the most essential aspects of nurse care in the emergency room (Sibiya, 2018). In Saudi Arabia, the emergency department must exert considerable effort to surmount communication barriers. A common objective to be able to surmount the communication obstacles in the ER is to catalog these obstacles, characterize the essential components of communication, particularly with elderly and young patients, and attempt to develop solutions. People use a shared system of signs, symbols, and actions to exchange information, thoughts, and emotions during the complex process of communication. The sender, the recipient, the context, the medium, the message, and the feedback are just a few of the many components of this process. A message (information, thoughts, and sentiments) must be transmitted from a sender (also known as an encoder) to a receiver (also known as a decoder) over an acceptable medium in a particular context for communication to occur. The National Standards for Hospital Accreditation mandate effective nursing tasks related to communication and education, so nurses can hone their communication skills as a valuable resource for assessing patient needs and providing appropriate physical care, emotional support, knowledge transfer, and information exchange (Shafipour et al., 2014). In addition, the communication process is complex, dynamic, and diverse (Alosaimi and Ahmad, 2016).
When devising effective communication, it is crucial to consider the needs of patients, as doing so can improve nursepatient interactions and substantially influence patients' perceptions of the quality of care and treatment outcomes (Al-Shamsi et al., 2020). Despite the potential benefits of patient-centered communication, communication barriers have been identified in a variety of clinical settings around the world. It has been demonstrated that a patient's lack of familiarity with and comprehension of a health system's culture and language can hinder patient-doctor communication (Fleischer et al., 2009). A number of variables, including cultural and linguistic diversity, influence these obstacles. These communication barriers may impact patient safety, patient satisfaction, healthcare quality, and health outcomes. As many nurses in the Saudi Arabian healthcare system are non-Arabic-speaking expatriates, communicating with patients can be difficult. This is not a simple matter. Due to the increased rates of immigration into industrialized nations like the United States, Saudi Arabia is in a unique position. Expanding cultural connections exist between Australia and the United States. Both attendants and patients speak multiple tongues. According to recent studies, such barriers to communication exist in a number of nations and have a negative impact on the overall standard of healthcare. Despite an increase in interest in both quantitative and qualitative research on nursepatient communication, no study has specifically examined patient communication experiences in Saudi Arabia, despite an expanding corpus of data on the topic. In addition, no studies have investigated whether a patient's communication experience influences their satisfaction with nursing care.

Study designs
The study had a descriptive community-based survey design and was conducted between August and November 2022. The study population consisted of 1,510 participants over the age of 18 who were selected from various communities in Saudi Arabia and agreed to participate in order to determine the Communication barriers in the Emergency department among the Saudi Arabia population.

Setting
The totality of the Kingdom of Saudi Arabia, which consists of 13 administrative regions, 46 cities, of which 20 are considered significant cities, and a variable number of governorates within each region.

Study population
The study is conducted on all inhabitants of the Kingdom of Saudi Arabia, which, according to the most recent figures, has a population of 48 million, including citizens and residents. According to a report issued by the General Administration of Statistics, the total number of Saudi citizens is 35,013,414, or 35 million people.

Sample
Multiple sampling stages were utilized. The Central Region (Riaydh, Qasim) was the most affected region, followed by the Western Region (Mecca, Medina, Jeddah), Eastern Region (Damam, Khafji, Alhasa), Northern Region (Tabuk, Jouf, Hail), and Southern Region (Asir, Najran, Jizan)), and a random number of clusters were selected by the researchers for inclusion in the study. Cluster sampling will be used to identify samples from four regions (Figure 1). Simple random sampling was used to determine samples of respondents from each group (cluster). Saudis over the age of 18 who exhibited a propensity to participate in the study were considered eligible participants.

Data collection plan
A standardized, closed-ended and open-ended questionnaire was used to collect data. An electronic questionnaire has been sent. At the outset of the questionnaire, participants are asked, "Do you consent to participate in the study?" If you consent to share, he or she will proceed to answer the questionnaire's inquiries. Three sections comprise the questionnaire: The first assesses biographical information, the second ED Communication Barriers knowledge and awareness, and the third ED Communication Barriers attitudes and dispositions. By concentrating on two aspects of the questionnaire, we were able to make it more accessible. The first provides biographical information, while the second provides knowledge and awareness regarding ED Communication Barriers. To meet the objectives and outcomes of the study, a few attitude queries have been modified. In order to ascertain the breadth of our participants' perceptions, we also made a number of the questionnaire's questions more specific.

Ethical consideration
No identifying information such as name, email, or phone number. At the beginning of the survey,participants were asked to indicate their accord. In order to provide participants with clarifications regarding the research, a message describing the primary purpose of the study was created at the beginning of the survey. By consenting to complete the survey, participants have indicated their consent to participate in the study. Additionally, all collected data were retained by the researchers in order to safeguard the privacy of the individuals who participated in this study.

RESULTS
Emergency nurses felt that, of the 1507 domains addressed by the questionnaire, environmental considerations were the greatest barrier to effective nurse-patient communication.
Knowledge-based and psychological factors followed. Male nurses perceived knowledge-related variables to be a greater barrier to communication than female nurses, as well as younger nurses than senior nurses. Languages and educational level are the most influential ambient factors. In the investigation, 1507 questionnaires were included. The mean (SD) age of the participants was 40 (8.2) years; 30.19% of the participants were women and 69.91% were men, with the majority coming from Negran and Makaah; 31% of the participants were university students, 22% had middle school diplomas, 19% had secondary school diplomas, and 9% were illiterate. There were (47%) solitary individuals, (43%) married individuals, and (10) divorced individuals. Table 1 shows that 40% of the participants traveled in the morning, 50% in the evening, and 10% at midnight. The questionnaire assessed the nursing barriers, patientrelated obstacles, common barriers between nurses and patients, and ambient barriers to optimal innervation and environment in emergency departments (Table 2).

Table 2 Common barriers between nurses and patients among Saudi Arabia population Row Labels Common barriers between nurses and patients Mean Std
Slang linguistic differences between a nurse and a patient 690 571 136.41 Cultural differences between nurse and patient 643 Sexual differences between nurse and patient other 380 Grand Total 1507 Participants reported the following proportion of obstacles. While discussing the situation in the ED, 47% of participants mentioned slang linguistic differences between the nurse and the patient (21%), cultural differences between the nurse and the patient (20%), and sexual differences between the nurse and the patient (12%) ( Table 3). (9%) family intervention, (13%) patient ignorance of the nurse's condition and duties, (14% patient anxiety, pain, and physical discomfort, (11% lack of medical history for an unconscious patient, (5%) Alzheimer's patients and consciousness disorders, and (48%) stated grand total and dealing with everyone in the ED were reported as patientrelated challenges (Table 5). 1% of severely unwell patients and 12% of patients overall mentioned environmental factors. 15% of respondents said the workplace is unsuitable, 15% of patients' families interfered with the emergency team's decisions, and 12% reported this. The emergency ward was crowded, with 45% of the total population confronting everyone.

DISCUSSION
There were 1,507 participants in the study, and the majority of them were between the ages of 36 and 56. 30.19% of the contributors were female and 69.91% were male; 31% of the contributors were college students. There were (47%) solitary individuals and (10) divorced individuals. Table 1 shows that 40% of the participants traveled in the morning, 50% in the evening, and 10% at midnight. Prior research indicates communication barriers included job dissatisfaction due to workload, uncontrolled patient family presence (Seijo et al., 2016), mistrust of nurse competency, gender incompatibility, nurse lack of attention, informational delays and negligence, a nurse's lack of responsibility, a language barrier and overwork (Abdulla et al., 2022), patient physical discomfort, physical and psychological complaint, nurse reluctance to communicate, language barrier, and overwork. Communication barriers between the nurse and the patient affected the efficacy of healthcare services.
Eleven papers were discovered, all of which were selfreporting surveys with a combination of open-ended and closed-ended queries. In the United States, Canada, Australia, and Ireland, they first appeared. A variety of healthcare professionals participated in the trials, with nurses obtaining the most attention. Most commonly, a dearth of information and a lack of time are obstacles to advance care planning. According to Douglas, advance care planning appears to have a substantial amount of support, and nurses and other healthcare professionals report feeling competent and confident in their ability to carry out the responsibility. According to other studies, nurses comprise a sizable portion of the healthcare industry, and their behavior may have a negative impact on patient outcomes (both positive and negative). Nurses have frequent interactions with patients and those providing care for them. Consequently, healthy nursepatient and caregiver relationships are therapeutic and essential to treatment (Norouzinia et al., 2015). In addition to providing primary care, nurses frequently advocate for patients or serve as interpreters. Good nursepatient relationships have a positive impact on nurse-patient communication and interaction, despite the fact that studies have demonstrated that a number of factors can impede great nurse-patient relationships, which can have significant implications for care outcomes and quality (Shafipour et al., 2014). Due to these obstacles, it is more challenging for nurses and other healthcare personnel to provide treatment that satisfies both patients' and caregivers' requirements. Four categories of barriers to patient-centered care and communication have been identified: institutional and healthcare-related, environmental, psychological, and behavioral. In clinical practice, despite the fact that these challenges fall under various categories, they are closely related (Alshammari et al., 2019). Participants in our study reported the following proportion of barriers across the 1507 domains covered by the questionnaire. Twelve percent (12%), twenty percent (80%), and eighty percent (80%) of respondents noted sexual and cultural disparities between nurses and patients, and fortyseven percent (47%) of respondents said that these disparities affect everyone in the ED overall. These distinctions were reported by survey respondents in varying proportions ( Table  2). 13% of respondents cited nursing barriers. Table 4 lists as factors the fatigue of nurses, the reported paucity of nurses (22%), the lack of time (17%), and the overall challenges faced by the ED (48%).

CONCLUSION
The study concludes that there are disparities in education, culture, and language between Saudi Arabian patients and nurses. This is owing in part to the large number of immigrant nurses employed in the nation's healthcare system. These differences impair the health outcomes of Saudi Arabian patients and impede effective communication. In addition, the findings of this study indicate that improved patient-provider communication is necessary in Saudi Arabia in order to deliver safe and high-quality practice, which will contribute to the improvement of care quality and patient satisfaction. A comprehensive education for nurses should place a heavy emphasis on research. Improved nurse-patient communication is contingent on a pleasant work environment and regular communication skills training for health care workers.