Holistic nursing care among operating room nurses: Strengthening the standard of practice in Saudi Arabia

Hamdan Mohammad Albaqawi, Vincent Edward Butcon, Bander Saad Albagawi, Richard Dennis Dayrit, Petelyne Pangket

DOI: https://doi.org/10.33546/bnj.1279


Background: Holistic practices have been found beneficial for patients as well as nurses. They increase both the nurses and the patients’ health-promoting behaviors, spirituality, and interpersonal relationships.

Objective: This study aimed to determine holistic nursing care and compare its differences based on individual characteristics.

Methods: This study employed a quantitative-cross sectional approach. It was conducted at the hospitals of Hail region, Kingdom of Saudi Arabia, from February 2020 to March 2020. Selected through convenience sampling, 154 operating room nurses participated in the study. Frequency and percentages were used to analyze the demographic information, and t-tests and analysis of variance were used to test for differences.

Results: Holistic nursing dimensions such as physiological (4.72 ± 0.40), socio-cultural (4.53 ± 0.45), psychological (4.66 ± 0.32), and spiritual aspects (4.22 ± 0.73) were consistently carried out in the operating room. On the physiological dimension, no significant differences were found in years of experience [(t) -0.073; p > 0.942], gender [(t) -1.113; p > 0.27], or age [(F) 0.558; p > 0.57), but there was a significant difference with nationality [(t) -3.328; p < 0.001]. On the socio-cultural dimension, the length of experience [(t) 0.599; p > 0.550], gender, [(t) -1.420; p > 0.158], and age [(F) 0.148; p > 0.862] were not significant, but a significant difference was found with nationality [(t) -7.516; p < 0.001]. Regarding the psychological dimension, the length of experience [(t) -1.101; p > 0.276], gender [(t) -1.545; p > 0.129], and age [(F) 1.259; p > 0.287] were not significant, but there was a significant difference with nationality [(t) -5.492; p < 0.001]. Finally, with the spiritual dimension, no significant difference was found on length of experience [(t) -1.101; p > 0.276] or age [(F) 0.584; p > 0.559], but there were significant differences on gender [(t) -3.890; p < 0.001] and nationality [(t) -3.653; p < 0.001].

Conclusion: Nationality is a causal factor to physiological, socio-cultural, psychological, and spiritual dimensions, while gender is significant to spiritual aspect. Regardless of nationality or gender, nurses must be knowledgeable regarding the significance of adopting holistic care to improve the quality of their care to their patients.

Funding: Scientific Research Deanship of the University of Ha’il  Saudi Arabia (RG-191236).


holistic nursing; operating room; nursing; spirituality; Saudi Arabia

Full Text:



Al-Mahmoud, S., Mullen, P., & Spurgeon, P. (2012). Saudisation of the nursing workforce: Reality and myths about planning nurse training in Saudi Arabia. Journal of American Science, 8(4), 369-379.

Al‐Mutair, A. S., Plummer, V., Clerehan, R., & O’Brien, A. (2014). Needs and experiences of intensive care patients’ families: A Saudi qualitative study. Nursing in Critical Care, 19(3), 135-144. https://doi.org/10.1111/nicc.12040

Albaqawi, H. M., Butcon, V. R., & Molina, R. R. (2017). Awareness of holistic care practices by intensive care nurses in north-western Saudi Arabia. Saudi Medical Journal, 38(8), 826-831. https://doi.org/10.15537/smj.2017.8.20056

Almutairi, A. F., McCarthy, A., & Gardner, G. E. (2015). Understanding cultural competence in a multicultural nursing workforce: Registered nurses’ experience in Saudi Arabia. Journal of Transcultural Nursing, 26(1), 16-23. https://doi.org/10.1177/1043659614523992

Alshammari, M., Duff, J., & Guilhermino, M. (2019). Barriers to nurse–patient communication in Saudi Arabia: An integrative review. BMC Nursing, 18(1), 1-10. https://doi.org/10.1186/s12912-019-0385-4

Alshammari, M. H., Pacheco, H., Pasay-an, E., Alshammari, F., Alsharari, A., Felemban, E., & Dayrit, R. D. (2020). Nurses’ perspectives on the degree of missed nursing care in the public hospitals in Hail City, Kingdom of Saudi Arabia. Belitung Nursing Journal, 6(6), 190-195. https://doi.org/10.33546/bnj.1233

Alshehry, A. S. (2018). Spirituality and spiritual care competence among expatriate nurses working in Saudi Arabia. Religions, 9(12), 384. https://doi.org/10.3390/rel9120384

AlYami, M. S., & Watson, R. (2014). An overview of nursing in Saudi Arabia. Journal of Health Specialties, 2(1), 10-12. https://doi.org/10.4103/1658-600X.126058

Arora, S., Hull, L., Sevdalis, N., Tierney, T., Nestel, D., Woloshynowych, M., . . . Kneebone, R. (2010). Factors compromising safety in surgery: stressful events in the operating room. The American Journal of Surgery, 199(1), 60-65.

Atanga, J., & Ayong, Q. (2017). Overcoming nursing care challenges in a multicultural health care setting: Literature review. (Bachelor Degree in Nursing Thesis), Yrkeshögskolan Arcada, Finland.

Cohen, S. (2008). Critical thinking in the operating room. Marblehead, USA: HCPro, Inc.

Dossey, B. M. (2009). Integral and holistic nursing: Local to global. In B. M. Dossey & L. Keegan (Eds.), Holistic nursing: A handbook for practice (5th ed., pp. 3-46). Sudbury, MA: Jones and Bartlett Publishers

Gore, J. D. (2013). Providing holistic and spiritual nursing care. (Senior Honors Thesis), Liberty University, Virginia.

Gunawan, J., Aungsuroch, Y., Fisher, M. L., McDaniel, A. M., & Marzilli, C. (2020). Managerial competence of first-line nurse managers in public hospitals in Indonesia. Journal of Multidisciplinary Healthcare, 13, 1017. https://doi.org/10.2147/JMDH.S269150

Hadziabdic, E., Lundin, C., & Hjelm, K. (2015). Boundaries and conditions of interpretation in multilingual and multicultural elderly healthcare. BMC Health Services Research, 15(1), 1-13. https://doi.org/10.1186/s12913-015-1124-5

Halverson, A. L., Casey, J. T., Andersson, J., Anderson, K., Park, C., Rademaker, A. W., & Moorman, D. (2011). Communication failure in the operating room. Surgery, 149(3), 305-310. https://doi.org/10.1016/j.surg.2010.07.051

Hart, P. L., & Mareno, N. (2014). Cultural challenges and barriers through the voices of nurses. Journal of Clinical Nursing, 23(15-16), 2223-2233. https://doi.org/10.1111/jocn.12500

Henry, D. (2018). Rediscovering the art of nursing for nursing practice. (PhD Dissertation), East Tennessee State University, Tennessee, USA. Retrieved from https://dc.etsu.edu/etd/3470/

Higgins, B. L., & Macintosh, J. (2010). Operating room nurses’ perceptions of the effects of physician‐perpetrated abuse. International Nursing Review, 57(3), 321-327. https://doi.org/10.1111/j.1466-7657.2009.00767.x

Holt-Waldo, N. Y. (2011). The lived experience of being a holistic nurse educator: A heuristic inquiry. (PhD Dissertation), Harold Abel School of Social and Behavioral Sciences, Capella University, United States.

Jasemi, M., Valizadeh, L., Zamanzadeh, V., & Keogh, B. (2017). A concept analysis of holistic care by hybrid model. Indian Journal of Palliative Care, 23(1), 71-80. https://doi.org/10.4103/0973-1075.197960

Joint Commission. (2009). Sentinel events statistics. Retrieved from http://www.jointcommission.org/SentinelEvents/Statistics/

Jradi, H., Zaidan, A., & Al Shehri, A. M. (2013). Public health nursing education in Saudi Arabia. Journal of Infection and Public Health, 6(2), 63-68. https://doi.org/10.1016/j.jiph.2012.11.002

Kinchen, E. (2015). Development of a quantitative measure of holistic nursing care. Journal of Holistic Nursing, 33(3), 238-246. https://doi.org/10.1177/0898010114563312

Kitchener, B. (2019). Acute care nurses’ spiritual well-being and spiritual care perspectives: Predictors for provision of spiritual care. Retrieved from https://sigma.nursingrepository.org/bitstream/handle/10755/17584/Kitchener_97131_M13.pdf?sequence=1

Mariano, C., American Holistic Nurses’ Association, & American Nurses Association. (2013). Holistic nursing: Scope and standards of practice. Silver Spring, Md: American Nurses Association, nursesbooks.org.

McElligott, D., Leask Capitulo, K., Morris, D. L., & Click, E. R. (2010). The effect of a holistic program on health-promoting behaviors in hospital registered nurses. Journal of Holistic Nursing, 28(3), 175-183. https://doi.org/10.1177/0898010110368860

McFarland, M. R., & Wehbe-Alamah, H. B. (2014). Leininger’s culture care diversity and universality: A worldwide nursing theory. Burlington, Massachusetts, United States: Jones & Bartlett Learning.

Panlican, A. S., Pasay-an, E. A., Gonzales, F. M., Alreshidi, M. S., Ibno, N. L., & Alenzi, S. S. (2020). A survey on the knowledge and attitude on pain management among nurses employed in the government hospitals. Saudi Journal for Health Sciences, 9(2), 97-101. https://doi.org/10.4103/sjhs.sjhs_100_20

Selimen, D., & Andsoy, I. I. (2011). The importance of a holistic approach during the perioperative period. AORN Journal, 93(4), 482-490. https://doi.org/10.1016/j.aorn.2010.09.029

Sevinç, S., Ajghif, M., Uzun, Ö., & Gülbil, U. (2016). Expectations of relatives of Syrian patients in intensive care units in a state hospital in Turkey. Journal of Clinical Nursing, 25(15-16), 2232-2241. https://doi.org/10.1111/jocn.13254

Shiao, T.-H., Wu, C.-Y., Yang, Y.-Y., Chang, S.-C., Shulruf, B., Yang, L.-Y., . . . Lee, F.-Y. (2019). Pilot simulation-based research for evaluation, training and assessment of holistic nursing at four intensive care unit sites. MedEdPublish, 8(1), 40. https://doi.org/10.15694/mep.2019.000040.1

Tjale, A. A., & Bruce, J. (2007). A concept analysis of holistic nursing care in paediatric nursing. Curationis, 30(4), 45-52. https://doi.org/10.4102/curationis.v30i4.1116

van Beuzekom, M., Boer, F., Akerboom, S., & Hudson, P. (2012). Patient safety in the operating room: an intervention study on latent risk factors. BMC Surgery, 12(1), 1-11. https://doi.org/10.1186/1471-2482-12-10

Willemse, S., Smeets, W., Van Leeuwen, E., Janssen, L., & Foudraine, N. (2018). Spiritual care in the ICU: Perspectives of Dutch intensivists, ICU nurses, and spiritual caregivers. Journal of Religion and Health, 57(2), 583-595. https://doi.org/10.1007/s10943-017-0457-2

Zamanzadeh, V., Jasemi, M., Valizadeh, L., Keogh, B., & Taleghani, F. (2015). Effective factors in providing holistic care: A qualitative study. Indian Journal of Palliative Care, 21(2), 214-224. https://doi.org/10.4103/0973-1075.156506


  • There are currently no refbacks.

Copyright (c) 2021 Hamdan Mohammad Albaqawi, Vincent Edward Butcon, Bander Saad Albagawi, Richard Dennis Dayrit, Petelyne Pangket

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.