Cultura

Values in Motion: an Axiological Account of Interprofessional Coordination Across Nursing, Social Work, and Medical Supply Services in Saudi Hospitals

VOLUME 21, 2024

The Role of Targeted Infra-popliteal Endovascular Angioplasty to Treat Diabetic Foot Ulcers Using the Angiosome Model: A Systematic Review

VOLUME 6, 2023

Jamelah Ebrahrm Alhawsah, Mona Awad Alhaity, Ahlam Sayah Aljohani, Ahmad Saad Alasmari, Turki Ibrahim Asiri
Muneera Abdulla Almukalas, Mohammed Omar Al-Baqmi, Khalid Omar Albaqami, Mohammed Mubarak Alqahtani, Ahlam Abdulaziz Al-Rashidi

Abstract

This study examines how “ethics-in-action” is produced through routine coordination between nursing, social work, and medical supply functions in Saudi hospitals. Rather than treating ethics as limited to exceptional dilemmas, the study approaches everyday coordination as a site where values are continuously prioritized and negotiated under time pressure and resource constraints. Using a qualitative interpretive design, semi-structured interviews were conducted with nurses, hospital social workers, and medical supply personnel involved in cross-unit coordination. Data were analyzed using reflexive thematic analysis to construct meaning-centered themes that capture how participants interpret and enact value-laden decisions in daily work. Four themes were developed. First, routine scarcity (delays, stock-outs, substitutions) transformed prioritization into moral work, where legitimacy depended on consistent and explainable rationales. Second, boundary ambiguity around ownership and escalation generated ethically consequential friction across roles. Third, workarounds emerged as culturally normalized solutions that sustained care but accumulated ethical costs through reduced documentation and opacity. Fourth, transparency and professional voice shaped whether coordination produced trust and learning or defensive practice and repeated checking. The findings suggest that strengthening ethical coordination requires procedural supports that make prioritization logic explicit, clarify handoffs and escalation pathways, and normalize speaking up across professional boundaries. The study contributes an axiological account of hospital culture by showing how values are operationalized through ordinary coordination practices in Saudi healthcare settings.

Keywords : Axiology; ethics-in-action; hospital culture; interprofessional collaboration; nursing; social work; medical supply; psychological safety; scarcity; Saudi Arabia.
Erin Saricilar
Lecture in accounting. University of Basrah, College of Administration and Economics, Department of Accounting.

Abstract

Atherosclerotic disease significantly impacts patients with type 2 diabetes, who often present with recalcitrant peripheral ulcers. The angiosome model of the foot presents an opportunity to perform direct angiosome-targeted endovascular interventions to maximise both wound healing and limb salvage. A systematic review was performed, with 17 studies included in the final review. Below-the-knee endovascular interventions present significant technical challenges, with technical success depending on the length of lesion being treated and the number of angiosomes that require treatment. Wound healing was significantly improved with direct angiosome-targeted angioplasty, as was limb salvage, with a significant increase in survival without major amputation. Indirect angioplasty, where the intervention is applied to collateral vessels to the angiosomes, yielded similar results to direct angiosome-targeted angioplasty. Applying the angiosome model of the foot in direct angiosome-targeted angioplasty improves outcomes for patients with recalcitrant diabetic foot ulcers in terms of primary wound healing, mean time for complete wound healing and major amputation-free survival.
Keywords : Diabetic foot ulcer, angiosome, angioplasty