Recalibrating identity and adapting roles: ageing at work among senior nurses in Saudi Arabia

Abstract

Background

Nursing workforces worldwide are ageing, yet little is known about how senior nurses experience ageing at work and adapt their professional roles within rapidly modernising healthcare systems. In Saudi Arabia, health system transformation and digitalisation have intensified these challenges, making it essential to understand later-career nurses’ experiences to support retention and workforce sustainability.

Methods

An interpretive qualitative design informed by Gadamerian hermeneutic philosophy was employed. Data were analysed using reflexive thematic analysis. In-depth semi-structured interviews were conducted in [specify: primarily Arabic/English], audio-recorded, transcribed verbatim, and translated into English using a meaning-oriented approach where required. Data were analysed using reflexive thematic analysis informed by Gadamerian hermeneutics, supported by NVivo. Trustworthiness was ensured through reflexive journaling, peer debriefing, an audit trail, and attention to negative cases.

Results

Four interrelated themes described ageing at work as an adaptive and relational process rather than a linear decline: (1) Recalibrating professional identity, as nurses shifted from hands-on “doers” to mentors and guides while negotiating value and visibility in digitalised workplaces; (2) Negotiating physical and cognitive transitions, involving pacing, task redistribution, and compensatory learning strategies to sustain safe practice; (3) Bridging generations through informal leadership, where senior nurses mentored junior colleagues and mediated cultural and generational differences; and (4) Adapting to technological and organisational change, experienced as both a challenge and a catalyst for role realignment and strategic repositioning.

Conclusions

Ageing at work in nursing is characterised by active identity work, embodied self-management, and informal leadership. Senior nurses play critical yet often under-recognised roles in mentoring, knowledge transfer, and organisational stability. Workforce policies should formally recognise these contributions, provide inclusive technology training, and enable flexible role redesign to support the retention and flourishing of an ageing nursing workforce.

Clinical trial

Not applicable.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-026-04735-4.

Introduction

The global nursing workforce is undergoing a profound demographic shift, with a growing proportion of nurses reaching mid-to-late career stages. This trend is driven by increased life expectancy, delayed retirement, and workforce shortages that necessitate the retention of experienced nurses beyond traditional retirement ages, The traditional retirement age for nurses is often earlier than the general workforce, with many nurses retiring around 58 years old [1–3]. Senior nurses represent a vital reservoir of clinical expertise, institutional knowledge, and mentorship capacity. However, as they navigate the later stages of their professional lives, they also experience complex psychological, professional, and workplace transitions that influence their well-being, role adaptation, and continued contribution to health systems [4–6]. Understanding these transitions is crucial for sustaining workforce stability and ensuring high-quality patient care.

Psychological ageing refers to the evolving cognitive, emotional, and identity-related changes that occur as individuals grow older, encompassing shifts in self-concept, motivation, adaptability, and resilience [7]. In the nursing profession, psychological ageing is not only shaped by chronological age but also by accumulated professional experiences, exposure to high-stress environments, changing workplace expectations, and evolving personal priorities [8, 9]. For senior nurses, these changes may manifest in diverse ways: a heightened sense of professional identity and wisdom, altered career aspirations, concerns about physical stamina, or anxieties about technological adaptation and role relevance in rapidly modernizing health systems [10, 11]. The intersection between psychological ageing and workplace dynamics can profoundly shape how senior nurses perceive their roles, engage with colleagues, and plan their career trajectories [12].

Globally, nursing workplaces have undergone significant transformation in the past two decades. The expansion of digital technologies, the growing emphasis on interprofessional collaboration, and intensified performance expectations have altered the nature of nursing work [13, 14]. These changes present unique challenges for senior nurses, who must reconcile their extensive clinical experience with evolving care models, new technologies, and organizational cultures that increasingly prioritize innovation and adaptability [15, 16]. For many, this involves navigating tensions between traditional professional norms and emerging expectations, while sustaining a meaningful sense of professional identity and competence [17]. Role adaptation in this context is not merely functional; it involves deep psychological and emotional work as senior nurses renegotiate their place within dynamic healthcare teams [18].

Saudi Arabia’s healthcare system provides a particularly compelling context in which to study these phenomena. Over the past two decades, Saudi Arabia has undertaken rapid health system modernization as part of national transformation programs, including Vision 2030 [19]. These reforms have intensified the introduction of advanced technologies, accreditation standards, and workforce professionalization initiatives [20]. Simultaneously, the nursing workforce remains highly diverse, comprising both Saudi nationals and a large proportion of expatriate nurses, each navigating distinct cultural and organizational expectations [21]. Senior Saudi nurses, in particular, occupy critical bridging roles between traditional care practices and emerging models of technologically enabled, internationally benchmarked healthcare delivery [22]. Their experiences of psychological ageing and workplace adaptation are shaped by both cultural factors, such as respect for elders, gender norms, and collectivist workplace values, and organizational pressures associated with modernization [23].

Moreover, role adaptation among senior nurses is a critical yet underexplored dimension of workforce ageing. As healthcare organizations face growing pressures to retain experienced staff while ensuring role relevance and performance, understanding how senior nurses adapt to changing roles, whether through mentoring, leadership, part-time clinical engagement, or shifting to non-clinical functions, is essential [24, 25]. Psychological ageing influences how individuals perceive these role transitions: some embrace them as opportunities for growth and legacy, while others may experience identity threat, uncertainty, or disengagement [26]. Effective role adaptation requires supportive organizational cultures, flexible role design, and recognition of the unique contributions that senior nurses bring [27].

Within Saudi Arabia, cultural values surrounding ageing and work may shape these adaptations in distinct ways. Older adults traditionally hold respected social positions, yet healthcare modernization may inadvertently marginalize older nurses if policies and workplace cultures favor younger, technologically adept staff [28]. At the same time, the growing national emphasis on Saudi nurse retention and leadership development underscores the importance of understanding and supporting senior nurses’ evolving workplace experiences [29]. Addressing these issues is essential for strategic workforce planning, knowledge transfer, and sustaining morale among an ageing nursing workforce [30].

Given these gaps, there is a pressing need to explore how senior nurses in Saudi Arabia experience psychological ageing and navigate role adaptation within changing workplace environments. A phenomenological approach is particularly appropriate for capturing these complex lived experiences, illuminating how individuals interpret and make sense of their ageing journeys in professional contexts [31]. By examining their narratives, this study aims to deepen understanding of psychological ageing in nursing workplaces, inform supportive workforce policies, and contribute to the development of culturally and organizationally responsive retention strategies.

Guided by a hermeneutic phenomenological stance and enacted through reflexive thematic analysis, we interrogate where established frameworks (successful ageing, Selectivity, Optimization, and Compensation (SOC), continuity/role identity) elucidate later-career nursing, and where organizational power and visibility regimes require us to extend or revise them.

Aim of the study

the study seeks to understand how senior nurses perceive and navigate workplace transitions as they age, and how these experiences influence their professional identity, role engagement, and adaptation within a rapidly evolving healthcare system.

Research question

How do senior nurses in Saudi Arabia experience psychological ageing and adapt to evolving workplace roles within the healthcare system?

Methods

Design

This study adopted an interpretive qualitative design informed by Gadamerian hermeneutic philosophy, with data analysed using reflexive thematic analysis as described by Braun and Clarke. While hermeneutic phenomenology provided the interpretive lens guiding meaning-making, reflexive thematic analysis offered a systematic yet flexible analytic method aligned with an interpretivist epistemology. This approach enabled the exploration of lived experiences while allowing active researcher interpretation within the hermeneutic circle [32]. We adhered to COREQ reporting guidance for qualitative interviews [33]. This study was grounded in Gadamerian hermeneutic phenomenology, which assumes that understanding emerges through a dynamic interplay between participants’ lived experiences and the researcher’s evolving fore-understandings. The hermeneutic stance guided all phases, from dialogical interviewing and reflexive memoing to iterative theme construction, by treating data not as objective accounts but as co-constructions of meaning. Interview prompts encouraged participants to reflect on shifts in identity, capability, and value recognition, while analytic memoing captured the researcher’s interpretive movements and reflexive insights. Theme development occurred through successive “circles” of engagement, moving between parts (individual meaning units and codes) and the whole (emerging thematic structure), until coherent interpretive syntheses were achieved.

Setting and context

The study took place in the university-affiliated polyclinics of King Faisal University (KFU) in Al-Ahsa, Saudi Arabia. These ambulatory clinics provide primary and selected specialty services to mixed urban/semi-rural populations and operate with interprofessional teams (nursing, medicine, pharmacy, allied health). Clinics use standardized appointment systems and electronic records, with quality governance coordinated at clinic and college levels. Senior nurses function as charge nurses, preceptors, and unit leads, frequently mediating between administrative priorities (e.g., digitalization, accreditation, throughput) and bedside realities. Local workforce features relevant to ageing and adaptation include: a growing cadre of Saudi national nurses alongside expatriate staff; increasing expectations for informatics competence; periodic role redesign linked to service expansion; and culturally shaped norms around seniority, mentorship, and gendered work patterns. This milieu provided a natural laboratory to examine how later-career nurses sustain identity, competence, and belonging amid organizational modernization.

Participants and sampling

Eligibility

We defined senior nurses a priori as registered nurses who met at least one of: (a) ≥ 45 years of age, (b) ≥ 15 years of professional experience, or (c) current role with formal senior responsibilities (e.g., charge nurse, supervisor, educator/preceptor). Additional inclusion criteria: employed in a participating polyclinic for ≥ 6 months, direct involvement in patient care and/or team coordination, and willingness to discuss ageing and role experiences. Exclusion criteria: exclusively administrative roles without clinical/team interface; temporary/agency contracts < 3 months.

Sampling strategy

We used purposive, maximum-variation sampling to capture heterogeneity by clinic, role, years in practice, gender, nationality, and exposure to role transition (e.g., recent redeployment, leadership appointment, part-time/adjusted duties). Recruitment proceeded via email invitations circulated by nursing leadership, study flyers, and snowball referrals. Sampling continued until information power was reached, operationalized as redundancy of experiential categories relevant to ageing and role adaptation across roles and clinics.

Recruitment proceeded via 28 email invitations, supplemented by responses to study flyers (n = 9) and snowball referrals (n = 6), resulting in 43 nurses approached for participation. Of these, 12 participated, 17 declined (primarily due to workload constraints), and 14 did not respond. All approached participants met eligibility criteria. The final sample reflected variation across roles, nationality, gender, and years of experience, consistent with the maximum-variation sampling strategy. The participation rate (~ 28%) is comparable to other studies involving clinical staff and may reflect time constraints inherent in healthcare settings.

Sampling continued until information power was deemed sufficient, following Malterud et al.’s logic that the more relevant and information-rich the participants, the fewer are needed. Sufficiency was operationalized through several analytic signals:

1. Memo flags noting diminishing novelty after the tenth interview (no new experiential categories emerging within existing code families, such as identity recalibration or technology engagement).

2. A saturation grid cross-tabulating clinic × role × theme showing redundancy across at least two clinics per theme.

3. Ongoing peer-debrief reflections confirm that new transcripts refined, but no longer extended, conceptual categories.

This transparent, criterion-based approach ensured that the final sample provided both depth and breadth adequate to the study aim while avoiding unnecessary participant burden.

Data collection

A semi-structured interview guide was developed specifically for this study, informed by literature on ageing at work, identity, and role transition. The semi-structured interview guide was developed specifically for this study and has not been published elsewhere (Additional File 1). An Arabic version was used when preferred by participants; it was produced via forward translation by a professional translator and checked by a second bilingual reviewer, with discrepancies resolved by consensus to preserve meaning equivalence. We conducted in-depth, semi-structured interviews in a private room at the clinics or via secure videoconference, according to participant preference. Interviews lasted approximately 50–90 min, were audio-recorded with consent, and transcribed verbatim. Participants could choose Arabic or English; the bilingual interviewer matched the language of choice.

The guide began with broad prompts to elicit lived experience, then deepened to meaning-making and adaptation work, for example:

• “Tell me about what ‘ageing at work’ feels like for you now compared with earlier in your career.”

• “Describe a recent moment when your role changed, or felt like it needed to change. How did you respond?”

• “How do technology, pace, or policy shifts shape your day-to-day confidence, learning, and relationships?”

• “What supports or constraints help you stay effective and fulfilled?”

• Probes explored identity continuity/disruption, competence and vulnerability, intergenerational dynamics, cultural expectations, health/stamina, career intentions, and mentorship/knowledge transfer.

Translation rigor

Arabic interviews were transcribed in Arabic, then meaning-oriented translated into English by a professional bilingual translator; a second bilingual reviewer checked accuracy against audio. Disagreements were resolved through discussion with the interviewer to preserve experiential nuance. Quotations used for publication were lightly smoothed while retaining participants’ intent.

Context notes

Brief contextual fieldnotes (clinic workflow snapshots, relational dynamics) were recorded after interviews to enrich interpretive memos. These notes informed analysis but were not treated as a separate data source.

Data analysis

Analysis followed a hermeneutic phenomenological pathway (Fig. 1), NVivo 12 Plus was used to organize and manage qualitative data rather than to automate interpretation. The software facilitated hierarchical coding, rapid retrieval of meaning units, and visualization of relationships through matrix and co-occurrence queries. It also supported the iterative comparison of codes across participants and clinics, assisting in mapping thematic overlaps and divergences during the hermeneutic cycle:

Fig. 1.

hermeneutic phenomenological pathway

1. Immersion & holistic reading: repeated readings of each transcript to grasp a sense of the whole; reflective memos captured first-impression meanings regarding psychological ageing and role adaptation.

2. Selective and detailed reading: identification of meaning units (expressions that illuminate the phenomenon) at semantic and latent levels; initial codes stayed close to participants’ language.

3. Thematic crafting (hermeneutic circle): iterative movement between parts and whole to articulate essential themes (e.g., “guarding clinical wisdom,” “recalibrating pace,” “technology as dignity threat or bridge,” “mentoring as identity repair,” “negotiating cultural expectations”).

4. Intersubjective testing: constant comparison across cases/roles/clinics; attention to negative cases and tensions (e.g., pride vs. obsolescence anxiety).

5. Writing as method: progressive, analytic writing refined theme boundaries and relationships; exemplar quotations were selected to illustrate variability and commonality.

6. Sensitivity to context: throughout, we situated meanings within Saudi cultural and organizational conditions (e.g., respect for seniority, gendered norms, Saudization) to avoid decontextualized claims.

Reflexivity and research quality

The lead interviewer (MS) is a nurse-academic with more than fifteen years of clinical and educational experience in ambulatory and workforce-development programs. This background facilitated rapport with senior nurses but also introduced interpretive predispositions, particularly valuing staff retention, mentorship, and professional continuity. Before data collection, a written positionality statement articulated these pre-understandings and anticipated benefits of mentorship. Reflexive journaling after each interview captured evolving assumptions, emotional responses, and interpretive shifts.

Reflexivity directly influenced analysis; for example, early interpretations emphasized mentorship as a positive adaptation strategy. However, through peer debriefing and examination of negative cases, this interpretation was refined to acknowledge mentorship as both identity reinforcement and a compensatory response to reduced clinical engagement.

The interviewer had no supervisory role over participants or administrative authority within the clinics. To minimize hierarchical influence, interviews were held in private rooms away from unit managers or, when preferred, via secure videoconference. Participants were reminded that their narratives would remain confidential and would not affect employment evaluations. During interviews, prompts such as “Can you tell me about a situation where mentoring did not work as expected?” were deliberately used to surface counterexamples and avoid confirmatory bias.

Peer debriefs with a qualitative methodologist unaffiliated with the sites helped interrogate assumptions about ageing and adaptation. Reflexive memos documenting these discussions later guided theme construction, e.g., recognizing that “mentoring as identity repair” emerged not from pre-existing expectations but from repeated participant framing of guidance as reciprocal healing. These reflexive checks strengthened the interpretive transparency and trustworthiness of the findings.

This facilitated rapport but introduced interpretive commitments (e.g., valuing retention and mentorship). We managed this through:

• a pre-study positionality statement;

• reflexive journaling after each interview;

• peer debriefs with a qualitative methodologist not affiliated with the clinics to challenge assumptions and explore alternate readings; and.

• explicit discussion of how the professional background shaped questioning and theme emphasis.

Trustworthiness

We addressed trustworthiness using criteria appropriate to interpretive inquiry:

• Credibility: prolonged engagement; iterative questioning; analytic triangulation (interviewer memos + bilingual translation checks); member sense-checking of a short thematic summary with a subset of participants to assess resonance; inclusion of negative cases.

• Dependability: maintained a transparent audit trail (raw data, codebooks, memos, decision logs); documented changes in the guide and coding.

• Confirmability: external peer review of de-identified excerpts and theme logic; reflexive documentation of how interpretations were reached.

• Transferability: thick description of setting, roles, and workflow conditions to help readers judge applicability to comparable ambulatory services.

Ethical considerations

Ethical approval was obtained from the Institutional Review Board of King Faisal University, Al-Ahsa, Saudi Arabia (KFU-2026-ETHICS4244) on January 2026. Written informed consent was obtained from all participants prior to data collection. All procedures were performed in accordance with the ethical standards of the institutional research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Results

Characteristics of participants

A total of 12 senior nurses participated in the study (Table 1). The sample comprised 8 women and 4 men, reflecting the gender distribution of senior nursing staff in the participating polyclinics. Participants’ ages ranged from 45 to 59 years (M = 51.5, SD = 4.3), and years of nursing experience ranged from 17 to 35 years (M = 24.8, SD = 5.9). All participants were working in clinical or supervisory roles within King Faisal University–affiliated polyclinics in the Al-Ahsa region.

Table 1.

Demographic and professional characteristics of senior nurses (n = 12)

Characteristic	Category	n (%)
Age group (years)	45–49	5 (41.7%)
	50–54	4 (33.3%)
	55–59	3 (25.0%)
Years in nursing	15–19	2 (16.7%)
	20–24	3 (25.0%)
	25–29	3 (25.0%)
	30–35	4 (33.3%)
Tenure at polyclinic (years)	5–9	4 (33.3%)
	10–14	5 (41.7%)
	15–18	3 (25.0%)
Clinical role	Senior staff nurse	6 (50.0%)
	Charge nurse / supervisor	4 (33.3%)
	Educator / preceptor	2 (16.7%)
Nationality	Saudi	6 (50.0%)
	Expatriate	6 (50.0%)
Reported role transition (types)	Mentoring / education emphasis	4 (33.3%)
	Leadership/supervisory expansion	4 (33.3%)
	Technology‑focused adaptation	2 (16.7%)
	Workload redistribution/health‑related	2 (16.7%)

Note. To minimize identifiability, gender/sex and unique attribute combinations are omitted. Age and tenure are shown in ranges; experience bands are used for years in nursing

Regarding professional positions, five participants were senior staff nurses, four were charge nurses or supervisors, and three held combined clinical–educational roles (e.g., preceptor, unit educator). Their tenure within the current polyclinic ranged from 5 to 18 years (M = 10.9, SD = 4.5), indicating deep organizational familiarity and long professional trajectories.

All participants reported perceiving notable shifts in their workplace experiences over the past decade, including changes in technology use, staffing models, cultural expectations, and organizational priorities. Many had actively adapted their roles through mentoring, task redistribution, or shifting responsibilities (e.g., from physically demanding bedside care to coordination, education, or administrative functions).

Thematic findings

Thematic analysis of interview data generated four interrelated themes with corresponding sub-themes that capture how senior nurses at King Faisal University–affiliated polyclinics (Al-Ahsa, Saudi Arabia) experience psychological ageing and adapt their roles within evolving workplace contexts.

Together, these themes trace a trajectory from internal identity recalibration, through personal and organizational adaptation work, to intergenerational bridging, and finally engagement with technological and systemic change. Differences were most pronounced by role (senior staff vs. supervisory/educational) and exposure to recent organizational modernization, rather than age or gender Table 2 summarizes the themes, sub-themes, and brief descriptions.

Table 2.

Themes, sub-themes, and descriptions

Theme	Sub-Theme	Description
1. Recalibrating Professional Identity	1.1 Shifting from “Doers” to “Guides”	Senior nurses redefined their professional identities as they moved from hands-on clinical work toward mentoring, coordinating, or advisory roles, often with mixed emotions.
	1.2 Negotiating Value and Visibility	Participants reflected on tensions between pride in experience and concerns about being overlooked or marginalized within modernized organizational structures.
2. Negotiating Physical and Cognitive Transitions	2.1 Adjusting to Physical Changes	Ageing brought physical stamina changes, leading nurses to redistribute tasks, pace their work, or shift into less physically demanding roles.
	2.2 Evolving Cognitive Confidence	Participants experienced slower adaptation to new systems or information, prompting self-directed learning and strategy development to maintain competence.
3. Bridging Generations Through Informal Leadership	3.1 Mentorship and Knowledge Transfer	Senior nurses often acted as informal mentors, sharing tacit knowledge and supporting junior colleagues in clinical decision-making.
	3.2 Mediating Cultural and Generational Gaps	Participants bridged generational divides, fostering cohesion between younger nurses and institutional expectations through role modeling and storytelling.
4. Adapting to Technological and Organizational Change	4.1 Technology as Challenge and Catalyst	New digital systems and protocols were experienced ambivalently, some embraced technology as a source of growth, others saw it as a stressor or identity threat.
	4.2 Organizational Modernization and Role Realignment	Policy reforms and structural changes prompted senior nurses to reinterpret their roles, sometimes catalyzing leadership development and sometimes producing uncertainty.

Recalibrating professional identity

This theme reflects how senior nurses described an evolving sense of who they are professionally as they aged within the workplace. Participants recounted how psychological ageing, accumulated expertise, and changing organizational contexts prompted a gradual recalibration of their professional identities. Rather than experiencing ageing as a passive process, they narrated it as an active negotiation, shifting from hands-on clinical “doers” to guides, mentors, and coordinators, while simultaneously navigating shifting perceptions of their value and visibility in modernized healthcare settings.

For many, this identity recalibration was both empowering and emotionally complex. On one hand, participants expressed pride in their evolving roles, professional wisdom, and ability to contribute beyond task performance. On the other, some described moments of doubt or marginalization, particularly when technological innovation or changing leadership structures seemed to valorize younger nurses’ competencies over long experience.

Shifting from “doers” to “guides”

Across interviews, participants described a gradual shift in their professional orientation, from being primarily “doers,” who engaged directly in frontline tasks and patient care, to becoming “guides,” who support, advise, and mentor others. This shift was not sudden but emerged through years of experience, changing physical capacities, and organizational transformations.

Many senior nurses reframed their contribution as less about direct action and more about enabling others to act effectively. Some embraced this transition positively, viewing it as a natural progression that allowed them to leverage their accumulated knowledge in meaningful ways:

I used to be everywhere, running, doing everything myself. Now I step back and make sure things are done right. I guide the younger nurses, and honestly, I’m proud of that. (P3, 53 yrs, female)

Several participants compared their current roles to that of “anchors” or “navigators”, emphasizing that their presence stabilized teams, especially during high-pressure moments.

They come to me when something unexpected happens. I may not do the procedures like before, but my judgment is what counts now. (P5, 59 yrs, male)

However, this transition also carried psychological adjustments. For some, stepping back from hands-on work was experienced as a loss of identity and daily engagement, particularly for those who had spent decades defining themselves by bedside expertise:

It’s not easy to stop being the one at the bedside. Sometimes I miss that feeling of being ‘in the action.’ Guiding others is good, but it’s different. (P7, 52 yrs, female)

This dual experience, of empowerment and subtle loss, characterized the shift from doers to guides, underscoring the emotional and identity work involved in ageing at work.

Negotiating value and visibility

Alongside shifting roles, participants described a parallel negotiation of their perceived value and visibility within the workplace. As organizations modernized, introducing new technologies, digital systems, and accreditation frameworks, senior nurses sometimes felt that their experiential knowledge became less visible in performance metrics and managerial narratives.

Before, everyone knew who the experienced nurses were. You were respected for your skills and knowledge. Now, sometimes it feels like if you’re not fast with the new system, you’re invisible. (P12, 54 yrs, male)

Some participants expressed frustration that their institutional memory and clinical intuition, which had once been central to team functioning, were now less formally recognized. Several recounted moments where their suggestions were overlooked in favor of younger staff perceived as more “up-to-date” with technology:

They listen more to the new nurses because they type fast and use the system better. But when it comes to patient care decisions, they still come to us quietly afterward. (P8, 49 yrs, female)

Others, however, found ways to reassert their value strategically by emphasizing their mentorship roles, problem-solving abilities, and clinical judgment during complex cases. In these instances, senior nurses reframed visibility not through speed or technological skill, but through depth of experience and relational authority:

My value is in what I’ve seen and handled over the years. When something serious happens, experience speaks louder than the computer. (P2, 50 yrs, male)

This negotiation of value was situational and dynamic. Some participants experienced moments of affirmation, where their expertise was sought and appreciated, while others reported periods of invisibility or under-recognition, especially in fast-paced or technologically mediated environments.

Overall, this sub-theme highlights how senior nurses actively navigate their professional standing in workplaces that are simultaneously familiar (through years of service) and rapidly evolving (through modernization). Psychological ageing intersects with these organizational shifts to create complex identity work, as senior nurses strive to maintain relevance, respect, and self-worth.

Negotiating physical and cognitive transitions

This theme captures how senior nurses actively manage the embodied and cognitive changes that accompany ageing while continuing to fulfill demanding workplace roles. Participants did not describe ageing as a sudden turning point but as a gradual process of adaptation involving changes in stamina, physical capacity, and cognitive pace. These adjustments were embedded in daily clinical routines, shaped by workplace expectations, and mediated by personal attitudes toward ageing.

While participants consistently emphasized their commitment to professional competence and patient care, they acknowledged that sustaining performance required strategic recalibration of how they worked. Rather than withdrawing from clinical practice, they adapted their physical engagement and cognitive strategies to remain effective and respected team members.

Adjusting to physical changes

Many participants described subtle but meaningful physical changes, particularly in energy levels, stamina during long shifts, and recovery time after busy clinic days. These changes often became noticeable after years of continuous service in physically demanding roles. Nurses responded by modifying their tasks, pacing their activities differently, and shifting responsibilities toward roles that relied more on experience and coordination than physical exertion.

I can’t move as fast as I used to, and standing all day is harder now. But instead of stopping, I’ve adjusted, I supervise more, plan more, and step in when needed. (P5, 59 yrs, male)

Several participants highlighted task redistribution within their teams as a key strategy. Senior nurses often took on coordinating functions, triaging patients, supervising procedures, or mentoring younger nurses, while delegating heavy lifting and rapid bedside interventions to colleagues better equipped physically. Importantly, these adjustments were framed as pragmatic, not defeatist, emphasizing professional sustainability.

I tell the younger ones, ‘You run, and I’ll guide you.’ It’s teamwork. I can’t keep that same physical pace, but my contribution is still critical. (P3, 53 yrs, female)

For some, these physical transitions were accompanied by emotional reflections about letting go of tasks they once mastered effortlessly. A few described initial resistance to change, fearing loss of identity or relevance, before eventually accepting adjustments as necessary and constructive.

At first, I didn’t want to admit it, I thought I should keep up no matter what. But my body tells me otherwise now. I’ve learned to work smarter, not harder. (P7, 52 yrs, female)

Participants consistently underscored that these adaptations were not institutionalized but self-initiated, reflecting personal agency rather than formal workplace accommodations. This self-management often depended on informal teamwork and individual resilience.

Evolving cognitive confidence

Beyond physical changes, participants discussed shifts in cognitive pace and learning confidence. These were not described as cognitive decline, but as differences in how quickly and comfortably they adapted to new information, technologies, and protocols compared to younger colleagues. Many senior nurses reflected on needing more time to familiarize themselves with digital systems and updated clinical guidelines.

When they change the electronic system, the younger nurses pick it up in a week. It takes me longer, and sometimes that makes me doubt myself for a moment.”(P12, 54 yrs, male)

Some participants reported feeling momentary insecurity when faced with rapid organizational change, especially when training was designed with younger, tech-savvy staff in mind. Yet, they also described developing individualized strategies, such as peer learning, deliberate practice, and note-taking, to maintain their competence and confidence.

I stay after my shift sometimes to click through the system slowly, so I can understand it my way. Once I get it, I’m fine, I just need time. (P6, 48 yrs, female)

Several participants contrasted their depth of clinical reasoning with younger nurses’ speed, suggesting that experience compensated for slower adaptation. They positioned their cognitive strengths in terms of judgment, pattern recognition, and clinical foresight rather than technological agility.

Maybe I don’t type as fast, but I can see complications before they happen. That kind of knowledge doesn’t come from manuals. (P2, 50 yrs, male)

For a few, cognitive transitions intersected with psychological ageing, producing a heightened awareness of their position in a multigenerational workforce. These moments sometimes triggered self-doubt but also motivated proactive learning and mentoring as ways to stay engaged and visible.

Sometimes I feel like I need to prove that I still ‘have it.’ So I volunteer to mentor, and it reminds me, and them, of what I bring to the table. (P8, 49 yrs, female)

Overall, participants framed evolving cognitive confidence as a navigable challenge, not an inevitable decline. Their experiences revealed adaptation, resilience, and self-awareness, highlighting the active role senior nurses play in sustaining professional competence amid rapid workplace change.

Bridging generations through informal leadership

This theme reflects how senior nurses at King Faisal University–affiliated polyclinics informally assume leadership roles that bridge generational, cultural, and experiential divides within the nursing workforce. Although these roles are rarely recognized in formal job descriptions or institutional policies, participants described mentoring, guiding, and mediating between younger colleagues and organizational structures as central parts of their daily work.

These bridging activities were often self-initiated rather than formally assigned. Senior nurses framed them as a natural extension of their professional maturity and as an important way of sustaining clinical quality, workplace cohesion, and professional identity. Through mentoring, knowledge transfer, and cultural mediation, senior nurses acted as stabilizing figures within increasingly diverse and fast-changing healthcare teams.

Mentorship and knowledge transfer

Participants consistently described mentorship as a core informal responsibility, arising organically from their seniority and experience. Many younger nurses, often newly graduated or newly recruited, regularly sought advice, feedback, or reassurance from senior colleagues. Senior nurses responded by sharing tacit knowledge, clinical judgment, and practical strategies accumulated over years of practice.

The new nurses come to me when they’re unsure. I don’t just tell them what to do, I explain why. It’s the ‘why’ that makes them confident later. (P3, 53 yrs, female)

This knowledge transfer extended beyond clinical procedures to include navigating complex workflows, managing patient expectations, and handling interprofessional communication. Senior nurses described their mentoring as relationship-based rather than hierarchical, emphasizing trust, accessibility, and teaching through example:

They observe how I talk to families, how I deal with tricky cases. You can’t learn that from a book. I try to model it every day. (P2, 50 yrs, male)

Participants also highlighted the reciprocal nature of these mentoring relationships. While they provided expertise and reassurance, younger nurses often helped them with technological updates or administrative procedures. This mutual exchange reinforced team cohesion and reduced the sense of generational divide.

Sometimes they teach me shortcuts on the system, and I teach them how to handle patients. It’s a good trade, we both benefit. (P6, 48 yrs, female)

Mentorship was experienced as both personally rewarding and professionally meaningful, giving senior nurses a renewed sense of purpose. Several described it as a key factor that sustained their engagement in the workforce despite ageing-related changes:

Teaching others keeps me motivated. It reminds me why I stayed in nursing all these years. (P11, 58 yrs, female)

However, participants also noted that such mentorship work often went unrecognized by management, with little formal acknowledgment or structured support.

We do a lot of guiding, but it’s not seen in evaluations or titles. It’s invisible work, but crucial. (P7, 52 yrs, female)

Mediating cultural and generational gaps

Beyond one-on-one mentoring, participants frequently described acting as mediators between different cultural and generational groups in the workplace. The nursing workforce in Saudi Arabia is highly diverse, composed of Saudi nationals and expatriate nurses of varying ages, educational backgrounds, and cultural norms. Senior nurses often bridged these differences, helping maintain team cohesion and preventing misunderstandings.

Sometimes the younger Saudi nurses and older expatriate nurses misunderstand each other’s ways of working. I step in to explain both sides, so things don’t escalate. (P8, 49 yrs, female)

These mediating roles were often subtle and interpersonal rather than formal conflict resolution. Senior nurses used their deep familiarity with both organizational culture and local social norms to interpret and translate expectations across groups.

I’ve been here long enough to understand the system and the people. I can explain management decisions to new staff in a way they accept, and also explain staff concerns upward. I’m like the middle link. (P5, 59 yrs, male)

Generational differences also required mediation. Participants noted that younger nurses often brought different attitudes toward authority, work-life balance, and communication styles, which sometimes clashed with older norms. Senior nurses found themselves bridging these perspectives, fostering mutual understanding and encouraging collaboration:

The younger generation speaks up more, they want flexibility. The older nurses value hierarchy and discipline. I try to help each side understand the other, it’s like translating between two worlds. (P4, 45 yrs, female)

For many participants, this mediating role was an important source of professional pride, as it positioned them as culture carriers and team stabilizers during periods of organizational change. However, similar to mentorship, this work often remained invisible in formal structures, relying on personal initiative rather than institutional support.

We hold the team together quietly. Nobody assigns us this role, but without it, misunderstandings would grow. (P9, 55 yrs, male)

Adapting to technological and organizational change

This theme explores how senior nurses navigate the rapid technological advancement and structural modernization of Saudi Arabia’s healthcare system, particularly within university-affiliated polyclinics. Participants experienced these changes as both enabling and disruptive, requiring ongoing psychological, cognitive, and professional adaptation.

While technology and policy reforms were often positioned by leadership as drivers of quality and efficiency, senior nurses described complex emotional and practical responses. Some embraced change as a way to remain current and contribute strategically; others experienced anxiety, frustration, or identity tension, especially when changes were implemented quickly without tailored support. Across interviews, adaptation was not passive but involved active sense-making, learning, and strategic role negotiation.

Technology as challenge and catalyst

Participants consistently identified new digital systems, electronic health records (EHRs), and technology-mediated workflows as major forces reshaping their daily practice. For many, technology represented a “double-edged sword”, simultaneously a catalyst for professional growth and a source of significant challenge, particularly given generational differences in digital fluency.

Every year the system changes. I can learn it, but it takes me time. The younger nurses pick it up in days, and sometimes that makes me feel left behind. (P12, 54 yrs, male)

Some participants embraced technological change, seeing it as a means of staying relevant and enhancing their efficiency. They described making conscious efforts to familiarize themselves with new platforms, sometimes even outside work hours, to maintain confidence and competence:

I stay after work sometimes to click through the new system slowly, so I can understand it. Once I get it, it’s not a problem, I just learn differently. (P6, 48 yrs, female)

For others, technology introduced feelings of vulnerability. Rapid digitalization highlighted differences between younger and older staff, sometimes leading to subtle shifts in team dynamics. Senior nurses occasionally felt that their clinical judgment was undervalued compared to technological proficiency, especially in performance evaluations or during team decision-making:

Before, experience was what made you valuable. Now, it feels like whoever types faster is seen as smarter. (P8, 49 yrs, female)

Despite these tensions, technology also acted as a powerful catalyst for adaptation. Several participants described developing creative coping mechanisms, including peer learning, reverse mentoring with younger colleagues, and informal practice sessions. Importantly, technology pushed many senior nurses to redefine their professional identity, not as digital natives, but as experienced practitioners who could integrate technological tools with clinical insight.

I may not be the fastest, but I use the system wisely. I know what matters clinically, and I make technology work for me, not the other way around. (P2, 50 yrs, male)

Overall, participants’ experiences reveal a nuanced engagement with technology, one that combines challenge, agency, and adaptation, rather than simple resistance or acceptance.

While many participants described successful adaptation, not all experiences were positive. A minority expressed resistance to role transitions and perceived loss of professional identity:

I don’t want to just guide others. I still want to be active, but the system doesn’t allow that anymore. (P10)

This highlights tensions between organizational expectations and personal identity, suggesting that adaptation is not universally embraced.

Organizational modernization and role realignment

In addition to technological change, participants reflected on broader organizational modernization efforts, including accreditation processes, policy reforms, and service expansion, that required role realignment among senior nurses. These systemic shifts, often linked to national transformation initiatives such as Saudi Vision 2030, brought new expectations for leadership, quality assurance, and interprofessional collaboration.

The clinic has changed a lot in the last 10 years. New policies, more reports, more technology, more audits. Our roles changed even if our titles didn’t. (P3, 53 yrs, female)

Many senior nurses adapted by repositioning themselves strategically within these evolving structures. Some assumed more supervisory or educational responsibilities, aligning their expertise with organizational goals. Others took on liaison functions, mediating between frontline staff and administration to ensure smooth implementation of reforms.

I became more of a coordinator between management and the team. They rely on me to explain new policies and make sure they work in real life. (P5, 59 yrs, male)

However, not all participants experienced these shifts smoothly. Some expressed uncertainty or role ambiguity, especially when changes were introduced rapidly without clear communication or structured training. For a few, modernization created a sense of organizational disorientation, where familiar routines were replaced by new expectations that were not always fully articulated:

Sometimes it feels like the ground is shifting under our feet. Policies change, systems change, but nobody explains how our roles are supposed to change with them. (P7, 52 yrs, female)

Participants also described mixed feelings about the pace and top-down nature of modernization. While many valued improved systems and clearer standards, they emphasized the importance of recognizing senior nurses’ contributions and providing meaningful involvement in shaping these changes:

We have experience, and we want to be part of the change, not just receivers of instructions. When they involve us, things work better. (P11, 58 yrs, female)

For some, modernization became a platform for leadership development, as their deep institutional knowledge positioned them as key agents of implementation. For others, it highlighted the fragility of traditional roles, pushing them to either adapt creatively or risk marginalization.

Conceptual model of ageing at work among senior nurses

The conceptual model was developed through iterative abstraction during the analytic process. Following theme construction, relationships between themes were examined using constant comparison and reflexive memoing. The hierarchical structure reflects the centrality of identity recalibration, with surrounding processes (embodied adaptation, relational leadership, and organizational context) influencing and reshaping this core construct (Fig. 2). At the core of the model is recalibrating professional identity, representing how senior nurses continuously renegotiate who they are at work as they transition from hands-on clinical “doers” to mentors, guides, and coordinators. This identity work is not linear but evolves in response to embodied changes and workplace demands.

Fig. 2.

Conceptual model of ageing at work among senior nurses

Surrounding this core are physical and cognitive transitions, which reflect age-related changes in stamina, pace, and learning confidence. Rather than leading to withdrawal or decline, these transitions activate adaptive strategies such as task redistribution, pacing, compensatory learning, and selective engagement, enabling sustained safe practice. These embodied adaptations directly influence how nurses reposition themselves professionally and reinforce identity recalibration.

A key relational pathway in the model is bridging generations through informal leadership. As senior nurses adapt their identities and work practices, they increasingly occupy informal leadership roles that support mentoring, knowledge transfer, and mediation between generational and cultural groups. This bridging function both draws upon and reinforces accumulated experience, contributing to team stability and professional continuity while also restoring meaning, value, and visibility for senior nurses.

The outer organisational layer of the model is adapting to technological and organisational change, encompassing digitalisation, policy reforms, and service modernisation. These changes act as both stressors and catalysts, shaping all inner processes. When organisational change is rapid or exclusionary, it intensifies identity threat and adaptation demands; when supportive, it enables strategic role realignment and leadership emergence. The model illustrates reciprocal relationships, whereby successful adaptation and informal leadership can mitigate the disruptive effects of change, while organisational recognition and inclusive practices strengthen identity, engagement, and retention.

Overall, the model conceptualises ageing at work in nursing as an active process of identity work, embodied self-management, and relational leadership, embedded within evolving organisational contexts. Sustainable workforce outcomes—such as continued engagement, professional fulfilment, and retention—emerge when these processes are supported rather than marginalised.

Discussion

The findings were interpreted through established frameworks of aging at work, particularly the Selective Optimization with Compensation (SOC) model and continuity theory. Participants’ adaptive strategies—such as task redistribution, pacing, and reliance on experiential knowledge—reflect processes of selection, optimization, and compensation, supporting the SOC model. However, our findings extend this framework by demonstrating that adaptation is not solely functional but deeply relational and identity-driven. Similarly, continuity theory explains the preservation of professional identity, yet our data suggest that identity is not simply maintained but actively recalibrated in response to technological and organizational disruption. .This qualitative phenomenological study explored how senior nurses working in King Faisal University–affiliated polyclinics in Saudi Arabia experience psychological aging and adapt their professional roles within evolving workplace contexts. The findings revealed four interrelated themes: (1) Recalibrating Professional Identity, (2) Negotiating Physical and Cognitive Transitions, (3) Bridging Generations Through Informal Leadership, and (4) Adapting to Technological and Organizational Change. Collectively, these themes illuminate how ageing is not merely a chronological process but a dynamic negotiation involving identity, bodily change, intergenerational relationships, and systemic transformation.

Psychological ageing and identity work

The study highlights that senior nurses engage in continuous identity work as they transition from being “doers” to “guides,” aligning with previous research that underscores identity reconstruction as a central process in later career stages [34]. Participants described this shift as emotionally complex, balancing pride in accumulated expertise with concerns about declining visibility in technologically driven environments. Similar findings have been documented in Australian, British, and Scandinavian contexts, where senior nurses reported feeling that institutional recognition increasingly favors technological proficiency and managerial roles over clinical wisdom [35, 36].

This identity recalibration reflects broader changes in healthcare, where digitalization, accreditation standards, and new models of care are redefining professional hierarchies and competencies [37]. Psychological ageing intersects with these organizational shifts, leading senior nurses to actively negotiate their sense of value and belonging. Studies from Japan and Canada have similarly found that aging nurses develop new professional identities as mentors and culture carriers, although often without formal role acknowledgment or institutional support [38, 39].

Physical and cognitive transitions: adaptation, not decline

Consistent with previous research, participants reported physical stamina changes, such as increased fatigue and reduced tolerance for long shifts, requiring task redistribution and pacing strategies [40].Rather than withdrawing, they reframed these adjustments as pragmatic adaptations aimed at sustaining performance. This finding echoes studies showing that ageing nurses often remain highly committed but strategically modify their work practices to preserve effectiveness [41, 42].

Cognitive transitions were described not as decline but as differences in learning pace and confidence. Participants emphasized that they required more time to master new technologies but compensated with deep clinical reasoning and situational awareness [43]. Similar patterns have been identified in qualitative studies from the Netherlands and Singapore, which describe senior nurses as relying on experiential knowledge to offset slower technological adaptation [44, 45]. These findings challenge deficit-based discourses of ageing by illustrating agency, resilience, and continued professional competence.

Informal leadership and intergenerational bridging

A striking finding of this study is the extent of informal leadership undertaken by senior nurses through mentorship and mediation. Participants described mentoring younger nurses, transferring tacit knowledge, and bridging cultural and generational divides. This role aligns with evidence that senior nurses play a critical part in team stability, clinical quality, and cultural continuity [46]. However, participants noted that these contributions were largely invisible in formal structures, echoing findings from UK and US studies that mentorship often occurs informally and is undervalued in performance appraisals [47, 48].

The Saudi context adds cultural complexity: the nursing workforce is highly diverse, comprising Saudi nationals and expatriates of different age groups and cultural backgrounds. Senior nurses often acted as mediators between these groups, drawing on their long experience and cultural fluency to maintain team cohesion. Such mediating roles are seldom formally recognized but are essential for minimizing misunderstandings in multicultural healthcare settings [49]. This underscores the need for workforce strategies that acknowledge and support senior nurses as cultural and professional bridge-builders.

Technology and organizational modernization: double-edged transformations

Technological and organizational modernization emerged as both a challenge and an opportunity. Participants experienced technology as empowering when adequate time and peer support were available but alienating when rapid implementation favored younger staff. This ambivalence is well documented in international literature: digitalization can foster inclusion if training is adaptive, but it can exacerbate generational divides if implemented without sensitivity to learning differences [50, 51].

Organizational modernization, including new policies, accreditation standards, and service expansion, required role realignment. Some participants successfully repositioned themselves as coordinators or liaisons, while others experienced uncertainty due to poor communication and lack of structured transition pathways [52]. These findings resonate with research from Europe and East Asia indicating that organizational change often lacks mechanisms to integrate ageing nurses’ perspectives, leading to role ambiguity and disengagement [53].

Importantly, modernization in Saudi Arabia is embedded within Vision 2030, which emphasizes healthcare digitalization, quality improvement, and workforce localization. Senior nurses’ experiences reflect the tension between policy ambitions and everyday clinical realities, highlighting the need to involve ageing nurses in co-designing modernization strategies. Doing so would leverage their institutional knowledge and enhance the sustainability of reforms.

Implications for workforce policy and practice

The findings of this study have several important implications for nursing workforce development, organizational policy, and health system modernization. First, there is a clear need to formally recognize psychological ageing and identity transitions as integral aspects of workforce planning. Senior nurses’ shifting roles from “doers” to “guides” reflect a valuable reorientation toward mentorship, coordination, and cultural mediation. Policymakers and administrators should incorporate structured pathways for mentoring and knowledge transfer into workforce strategies, recognizing these contributions in job descriptions, promotion criteria, and performance evaluations.

Second, technological transformation must be implemented inclusively. Senior nurses expressed both motivation and anxiety toward rapid digitalization. Differentiated, paced training programs that build digital confidence, rather than assuming uniform learning speed, can reduce generational divides and support sustained engagement. Embedding peer-to-peer learning and reverse mentoring can further enhance technological adaptation across age groups.

Third, role flexibility and redesign are essential for supporting ageing nurses. Task redistribution, hybrid clinical–educational roles, and opportunities for leadership can enable senior nurses to remain active contributors while managing physical and cognitive transitions. Workforce models should allow for gradual role evolution rather than abrupt shifts, ensuring both retention and quality of care.

Fourth, informal leadership and intergenerational bridging roles should be formally acknowledged. Senior nurses play pivotal, though often invisible, roles in maintaining team stability, mediating cultural differences, and supporting junior staff. Integrating these functions into leadership development programs and recognizing them in institutional policies can strengthen workforce cohesion and organizational resilience.

Finally, the findings emphasize the need to actively involve senior nurses in shaping modernization initiatives, particularly in the Saudi context of Vision 2030 reforms. Their experiential insights can help align technological and organizational changes with on-the-ground realities, improving both implementation success and workforce satisfaction.

Strengthsand

A major strength of this study is its use of phenomenological methodology, which allowed for a rich, in-depth exploration of senior nurses’ lived experiences rather than relying solely on quantitative indicators of ageing. By focusing on psychological ageing and role adaptation, the study offers a nuanced understanding of identity, physical and cognitive transitions, intergenerational dynamics, and modernization pressures within real workplace contexts.

The research also makes an important contribution to a sparsely studied regional context, Saudi Arabia, where nursing workforce ageing intersects with rapid health system reforms. Including participants from university-affiliated polyclinics offered insight into outpatient care settings, which are often underrepresented in ageing workforce research that tends to focus on acute hospital environments.

Limitations

However, some limitations must be acknowledged. Snowball recruitment may have introduced network-based similarities among participants. The study was conducted within a single institutional and geographical context, which may limit the transferability of findings to other settings such as rural clinics or private hospitals. Additionally, the sample size (n = 12), while appropriate for phenomenological depth, may not capture the full diversity of senior nurses’ experiences nationwide. Language translation (Arabic–English) may have also introduced subtle nuances in meaning, although rigorous translation and verification strategies were applied to minimize this. Finally, as with most qualitative research, findings reflect participants’ subjective experiences rather than generalizable prevalence estimates.

Conclusion

This study demonstrates that psychological ageing among senior nurses is not a passive process of decline, but rather a dynamic negotiation involving professional identity, physical and cognitive adaptation, informal leadership, and responses to technological and organizational change. Senior nurses actively recalibrate their roles, mentor younger colleagues, bridge cultural and generational gaps, and engage with modernization processes in strategic and meaningful ways.

These findings highlight that senior nurses represent a critical human resource for sustaining clinical quality, team cohesion, and organizational adaptability in a rapidly evolving healthcare system. However, their contributions often remain under-recognized and insufficiently supported by current workforce structures.

To harness the full potential of this experienced cohort, workforce policies must shift from deficit-based views of ageing toward supportive, inclusive, and strategic frameworks. This involves formalizing mentoring roles, adapting technology training, enabling flexible role redesign, and including senior nurses in shaping modernization initiatives.

As Saudi Arabia advances its Vision 2030 healthcare transformation, understanding and supporting the experiences of ageing nurses is essential for building a resilient, inclusive, and sustainable nursing workforce capable of meeting future healthcare challenges.

Supplementary Information

Below is the link to the electronic supplementary material.

Abbreviations

COREQ

Consolidated criteria for reporting qualitative research

EHR

Electronic Health Record

IRB

Institutional Review Board

KFU

King Faisal University

Author contributions

SIA and MNA contributed to study design, participant recruitment, and data interpretation. FAA contributed to methodological oversight, translation validation, and manuscript review. MS led data collection and analysis and drafted the manuscript. All authors reviewed and approved the final manuscript.

Funding

This work was supported by the Deanship of Scientific Research, Vice Presidency for Graduate Studies and Scientific Research, King Faisal University, Saudi Arabia [Grant: KFU262225].

Data availability

The datasets generated and/or analysed during the current study are not publicly available due to confidentiality, but are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

Ethical approval was obtained from the Institutional Review Board of King Faisal University, Al-Ahsa, Saudi Arabia (KFU-2026-ETHICS4244) in January 2026. Written informed consent was obtained from all participants prior to data collection. All procedures were conducted in accordance with institutional standards and the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Consent for publication

Not applicable. No individually identifiable information is presented. In line with journal guidance, Table 1 reports only aggregated, banded descriptors; direct quotations were reviewed to avoid disclosing unique attribute combinations.

Competing interests

The authors declare no competing interests.