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Background Safety culture is considered to be an essential element of patient safety. Several tools are available to assess patient safety culture in hospitals. One of the most common methods of assessing safety culture is the use of safety climate questionnaires. Research question Is there an existing patient safety culture measure that can be demonstrated to be a valid and reliable tool for use with the workforce in hospitals in Saudi Arabia? Aim and objectives This study aims to identify whether there is an existing English language tool that would be suitable for assessing patient safety culture in Saudi context. The objectives of the study are: 1. To select an appropriate questionnaire to assess hospital patient safety culture. 2. To evaluate the face validity of the selected patient safety climate questionnaire. 3. To assess the psychometric properties of the selected patient safety climate questionnaire in hospitals in Saudi Arabia. 4. To develop the most appropriate measure for assessing patient safety culture for use in hospitals in Saudi Arabia. Methods Qualitative methods were used to evaluate face validity (n=12 hospital staft). Quantitative methods were used to assess psychometric properties (n=862 doctors and nurses in three hospitals in Saudi Arabia). Findings Evaluation of face validity identified a need for minor changes to the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire wording before it was used to collect data for psychometric assessment. The results of Confirmatory Factor Analysis (CF A) and reliability analysis showed an unsatisfactory fit for the factor structure of the original HSOPSC questionnaire to the Saudi data. Exploratory Factor Analysis (EF A) was used on one half of the Saudi dataset to produce an optimal model(s). This was followed by CFA of the resulting measurement model on the second (validation) half of the data to test the fit of the resulting optimal factor structure. The result of EF A showed that eight factors (23 safety climate items) is the optimal model to the Saudi data. I All factors consisted of two to four items. The items loading were between 0.43 and 0.97. The result of CF A confirmed the eight factors solution (CF A=O.94, RMSEA=0.045, SRMR=O.040, TLI=O.97). The results of EFA, CFA, correlation and reliability analysis (Cronbach's alpha) showed that the optimal model for the Saudi data consists of eight patient safety culture dimensions (23 safety climate items). Conclusion This is one of very few studies to provide an assessment of an American patient safety culture tool using data from Saudi Arabia. The results indicate the importance of appropriate validation of patient safety climate questionnaires prior to applying them to populations outside contexts in which they were developed. The validated Saudi English language version of the HSOPSC questionnaire is an appropriate patient safety climate questionnaire to assess patient safety culture in Saudi hospitals.

The kingdom of Saudi Arabia, like the rest of the world, has a growing older population with urgent health care needs. However little prior research has been undertaken on this topic. In the light of this, the aim of this study was to explore the attitudes, knowledge, willingness and intentions to work with older people among nursing students, and to consider the effects of clinical nursing practice on such factors in the first year and the final (pre-registration) year of training in three major university hospitals. The study was underpinned by the theory of planned behaviour (Fishbein and Ajzen, 1975) which was used as a conceptual framework to explore the relationships between attitudes, subjective norms, perceived behavioural control and behavioural intentions amongst 566 nursing students. The study used a mixed methods design comprising of surveys with the nursing students and 132 faculty members and three focus groups with faculty members to explore their feelings about gerontological education in-depth. The questionnaires contained a range of previously validated instruments including Kogan's Attitude Towards Older People scale, Palmore's Facts on Ageing Quiz, a measure of students' willingness to work with older people and a measure of their perceived intention to work with them. Openended questions were also included. Data were analysed using both multivariate statistics and content analysis. The results provided some interesting and important insights into the complex factors potentially shaping students intentions to work with older people. For example the 566 nursing students who participated in this study displayed a lack of basic knowledge of the physical and behavioural aspects of ageing but held largely positive attitudes towards older people. Despite such positive attitudes a majority of the participants indicated that they would prefer not to work with older people after graduation, although those students who indicated that they would prefer to work with them had the most positive attitudes and the strongest willingness and intent to take care of older people. The data also highlight the potential of clinical training experience with older adults to improve the previous variables (attitudes, willingness and intentions). The qualitative data from both students and teachers highlighted a range of complex factors that in part explained some of the quantitative findings. These related to the influence of subjective norms and perceived control. Therefore at a cultural level Saudi students are exposed to strong positive norms in relation to older people but on entering training may be exposed to negative professional norms as to the status and desirability of gerontological nursing as a career. This, together with students' limited perceived control due to inadequate preparation for practice offer potential explanations as to the disparity between attitudes and behavioural intentions. The qualitative data also highlight the need for greater attention to the preparation of nursing students, with the provision of integrated skills and knowledge on the care of older people. The study also provides a limited critique of the theory of planned behaviour, which whilst supported in part cannot account fully for the complex cultural and professional factors shaping students future career intentions. The thesis, the first of its kind undertaken in Saudi Arabia, concludes with some reflections and suggestions for further research and the actions needed if the preparation of students to work with older people is to improve in the future.

The UGT1A gene complex encodes nine enzymes responsible for converting endogenous molecules such as bilirubin and a range of drugs to soluble glururonides for physiological elimination. Reduced UGT1A1 activity, mainly due to a promoter variant, UGT1A1 *28, underlies mild hereditary hyperbilirubinaemia (a familial jaundice known as Gilbert‟s syndrome) and deficiencies of UGT1A1 and the other UGT1A isoforms may increase risk of adverse drug reactions (ADRs). On the other hand moderately raised bilirubin levels appear to protect against cardiovascular disease in humans, which is purportedly due to the potent antioxidant properties of serum bilirubin. The major aims of this thesis were to: 1) report the prevalence of Gilbert‟s syndrome recorded in GP practices in the UK and identify factors associated with clinical recognition, 2) evaluate the association between bilirubin levels and respiratory diseases, 3) examine the influence of UGT1A1 variants on cardiovascular risk factors, lung function and neonatal jaundice, 4) compare the prevalence of clinically relevant genotypes and haplotypes of the UGT1A gene complex in different human populations. The main findings were: although around 5% of the primary care sample with bilirubin levels recorded had a phenotype consistent with Gilbert‟s syndrome, only 4% of these patients had a medical record of the condition, and factors other than genetics, in particular gender, smoking status, social deprivation and time period can influence clinical diagnosis. In a cohort of over half a million UK primary care patients with bilirubin levels recorded but with no evidence of hepatobiliary disease, each 1.7μmol/L (0.1mg/dL) increase in bilirubin was independently associated with an 8% decrease (95%CI; 5-11%) for males and an 11% decrease (95%CI; 7-14%) for females in the incidence of lung cancer. Each 1.7μmol/L increase in bilirubin was associated with a 6% decrease (95%CI; 5-7%) in COPD and a 3% decrease (95%CI; 2-3%) in mortality for males. The results for COPD and mortality in females were very similar. The UGT1A1*28 allele was not associated with neonatal jaundice, blood pressure or cholesterol levels in a cohort of 2,691 people from the UK followed since birth in 1946. However, there was an association with lung function. Cardiovascular events will be important to study when available. While around 10% of a UK population is homozygous for UGT1A1 *28, the allele frequency was even higher in equatorial African regions. But haplotype diversity was much greater than in Europe where the low activity alleles of the UGT1A gene complex are in most cases present on the same haplotype. These population differences have important implications for pharmacogenetic diagnostics such as those approved for use in the USA.

In this study the ways in which a group of experienced staff nurses defined, understood and accounted for their social relationships with terminally ill patients are explored. Two major bodies of social theory - an actor-oriented micro-sociological perspective, grounded in the work of Alfred Schutz and Peter L. Berger; and a macro-perspective derived from the work of Michel Foucault - are drawn on to argue: (1) That social relationships between nurses and patients are rendered problematic by the ways in which nurses defined them as encompassing an interest in the patient as a 'whole' individual. Attention is drawn to the ways in which this individuation is achieved through the production, collation and distribution of knowledge about the patient as a 'public' social actor, and as a 'private' subject. (2) That the problematic status of this social relationship is resolved through its definition as a site of particular forms of work. Here the patient is designated as more than a sick <i>body</i>; beyond material practices directed at palliating the effects of organic disorder, the patient is the focus of attention directed at penetrating and inspecting the sphere of the private subject. (3) That work directed at the patient's subjectivity offers not only a potent mode of surveillance to reveal psychosocial 'needs' and 'problems'. This work also permits work to adjust the patient's subjective view of social reality and so to integrate him or her into an ideal trajectory that leads to an unproblematic death.

A Nursing Research and Development Programme was implemented in Finland in the years 1977-1983 as a part of the WHO Medium-Term Programme in Nursing/Midwifery in Europe. The purpose of the Nursing Programme was to develop health services through the development of nursing. The Programme was carried out under the auspices of the government authorities. The settings of research and development were health centres, hospitals and schools for health personnel. The Programme had key characteristics: (1) it integrated international and national discussion in nursing; (2) professional aspirations of nurses were confronted with the social realities; and (3) it provided the opportunity for simultaneous analysis of essential elements in nursing practice, education, research and administration. A retrospective evaluation was conducted to investigate: (1) the organizational characteristics of the Nursing Programme and how the organization supported the process of research and development; and (2) how nursing developed during the Programme and how the stated objectives of the Programme related to the actual outcomes. The study had two integrated components, namely the overall organization of the Programme and nursing as promoted through the Programme. Consequently, two conceptual perspectives and two evaluative perspectives were adopted for the study. The organization was analysed using four organizational metaphors: organization as a machine, as an organism, as a brain, and as political system. The evaluation strategy was composed of various models for programme evaluation. Nursing was analysed by employing the metaparadigm concepts man, environment, health, and nursing action, and evaluation was based on structure, process and outcome evaluation. The archive of the Programme provided the major part of the data for the study. The following categories of material were employed: minutes, memoranda, plans, progress reports, educational material, letters, final reports, accounts, test nursing care plans, and patient/client questionnaires. In addition to the Programme archive, other archival sources and published material were used. The study was descriptive in nature and utilized qualitative methods, including content analysis for conceptual clarification and interviews in addition to analysis of multiple data sources.

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The thesis makes an analysis of methods available for scheduling nursing staff on a week by week basis. As illustration it considers the situation pertaining at the Simpson Memorial Maternity Pavilion between 1973 and 1978, where student midwives have to be allocated in order to satisfy staffing requirements on each ward, while simultaneously ensuring that each nurse receives the necessary experience on different wards in the course of her year's training. Section I analyses the constraints governing nurse scheduling at the S.M.M.P. under two separate systems used between 1973 and 1978, and provides an exhaustive survey of alternative course structures and solution formulation methods. Section 2 details the existing solution in 1973 and describes two models of that situation which were formulated in order to permit computer simulation of the problem. In Section 3 the scheduling problem at the S.M.M.P. is put into the context of generalised allocation methods. The suitedness of existing mathematical techniques to this problem is considered, and that of sub-gradient optimisation is tested extensively, with modifications to published techniques being detailed where an improvement has been made in the applicability to the present problem. The method is found to be weak when applied to problems of this scale, so a new method is developed which uses a heuristic algorithm to allocate nurses to a set of acceptable schedules. This approach is more powerful and may have applications in other fields. Section 4 describes changes in the training constraints which make it possible to adopt a cyclically repetitive standard schedule at the S.M.M.P. Drawbacks in the present allocation pattern are pointed out, and a new scheduling system developed which eliminates these. In the Conclusions comparison is made between the above methods of allocation with regard to their suitability to the real situation as typified by that at the S.M.M.P.