Professional Development of Nursing in Saudi Arabia

Purpose: To describe the development of nursing in Saudi Arabia and to recommend further directions for development of professional nursing in that country.
Organizing Construct: A comprehensive needs assessment was performed in 1996 by an onsite consultant to: (a) evaluate the existing nursing system at the ministry, regional, and hospital levels, (b) describe the functional interrelationships of a nursing division within the Ministry of Health, and (c) prepare a work plan outlining the program elements that a nursing division could address to foster high-quality health care in the public sector.
Methods: The needs assessment was conducted through direct observation, interviews, and review of existing documents in the Ministry of Health and representative hospitals, health centers, and health institutes. Data were collected about six factors as they pertained to the Ministry of Health Nursing Services: (a) key organizational and managerial activities, (b) the external environment, (c) the social system, (d) employees, (e) nursing services and research, and (f) formal organizational arrangements.
Findings and Conclusions: The data showed a young country and an equally young nursing profession struggling to meet the needs of a growing population. The highest priority for the advancement of nursing in Saudi Arabia is the creation of a kingdom-wide system of nurse regulation. Pressing needs include regulation of professional standards, licensure of all nurses practicing in the Kingdom, accreditation of educational programs, and formation of a national nurses association.     

The nursing profession in Saudi Arabia: an overview

ALMALKI M., FITZGERALD G. & CLARK M. (2011) The nursing profession in Saudi Arabia: an overview. International Nursing Review 58 , 304–311 Aim: The study aims to provide an overview of the nursing profession in Saudi Arabia, including its history, educational development, workforce and professional practice. Background: Saudi Arabia is faced with a chronic shortage of Saudi nurses, accompanied by high rates of turnover. Expatriate nurses form a large proportion of the nursing workforce in Saudi healthcare facilities, with Saudis comprising only 29.1% of the total nursing workforce. Despite the fact that the proportion of Saudi nurses is very low in general, this rate is lower in the private health sector where local nurses comprise only 4.1% of the total. Methods: Data relating to the nursing profession in Saudi Arabia were extracted from published literature identified through search of a range of publically available databases such as Medline, CINAHL, Google Scholar, Saudi health databases, Saudi health journals, government reports and relevant texts. Obtained information was evaluated for relevance and grouped on a thematic basis. Conclusion: The status of nursing in Saudi Arabia should be enhanced in order to make it a worthwhile career. The media should engage in helping to promote a positive image of the nursing profession. The education sector should reconsider the length of nursing training (5 years compared with 3 years in many developed countries) while maintaining competent and safe practice. Reducing the financial burden on the nursing student through provision of additional financial support would encourage more students. In particular, nurses should be paid a full salary during the intern year as currently occurs with medical students.     

Primary health care in Saudi Arabia: applying global aspects of health for all, locally

Primary health care in Saudi Arabia: applying global aspects of health for all, locally This paper describes the application of primary health care principles in the Islamic Kingdom of Saudi Arabia. It arose from a doctoral supervisory experience on a joint programme for women students, operating between a British and Saudi Arabian University. The research looked at nutritional advice given by diploma-level nurses to pregnant women attending primary health care centres in Saudi Arabia. The supervisor supported research that drew on internationally recognized trends in nursing research (the reflexive learner) whilst attending to local requirements and conventions of the culture. The student was encouraged explicitly to site the research within the framework of Islamic teaching and Saudi culture. The Qur'an was used as an overarching framework within which the tenets of primary health care were explored. This was seen to be crucial in addressing World Health Organisation and the International Council of Nurses' views on contextualizing nursing for the greatest benefit of the population. This was of particular relevance in Saudi Arabia where research carried out in the community by women is novel, and as yet there are no nurse theorists from within Saudi culture.     

Historical, cultural, and contemporary influences on the status of women in nursing in Saudi Arabia

Global nursing shortages have necessitated closer scrutiny of recruitment and retention initiatives of nurses both locally and internationally. For many decades the nursing workforce of Saudi Arabia has relied on international expatriates to be the backbone of the industry. In recent years however, Saudi women have been recruited into nursing preparation courses conducted at degree level. The many twists and turns of providing a local Saudi Arabian nursing workforce has paralleled Saudi's own history and this paper follows that journey. Our research has enabled us to provide some insights into nursing pre and post the enlightenment that accompanied the Prophet Mohammed's influence. We emphasize the influences of women leaders who emerged in Mohammed's time and bring lasting authority to the development of nursing in Saudi Arabia. The cultural issues that bind women in this society are explicated and related to recruitment and retention issues in nursing. Education matters, both past and present, are highlighted emphasizing the gains that nursing as a distinct occupation has made. Finally the paper concludes with a summation of contemporary achievements in Saudi Arabia moving nursing towards the much needed professional status and parity with other careers in health care.     

Retention of nurses in the primary and community care workforce after the age of 50 years: database analysis and literature review

Title.  Retention of nurses in the primary and community care workforce after theage of 50 years: database analysis and literature review.
Aim.  This paper is a report of a study conducted to explore strategies for retaining nurses and their implications for the primary and community care nursing workforce.
Background.  An ageing nursing workforce has forced the need for recruitment and retention of nurses to be an important feature of workforce planning in many countries. However, whilst there is a growing awareness of the factors that influence the retention of nurses within secondary care services, little is known about those that influence retention of nurses in primary and community care. Little is known about the age profile of such nurses or the impact of the ageing nursing workforce on individual nursing specialities in the England.
Methods.  Nursing databases were analysed to explore the impact of age on nursing specialities in primary and community care. The nurse retention literature was reviewed from 1995 to 2006.
Findings.  Workforce statistics reveal that primary and community care nurses have a higher age profile than the National Health Service nursing workforce as a whole. However, there are important gaps in the literature in relation to the factors influencing retention of older primary and community care nurses. Specific factors exist for older nurses within primary care that are unique. Implications for their retention are suggested.
Conclusion.  Particular attention needs to be paid to factors influencing retention of older nurses in primary and community care. These factors need to be incorporated into local and national policy planning and development.     

Educational needs of nurses when nursing people of a different culture in Ireland

Background:  Over the last 10–15 years, there has been a dramatic change in the population of the Republic of Ireland (ROI). Because of strong economic growth, a buoyant economy and universal population migration, the ROI has moved from a mono to a multicultural society over a relatively short period of time. Therefore, nurses in this state have limited experience of caring for people of a different culture.
Aim:  To discuss registered nurses' experiences in the ROI of nursing people from a different culture.
Methods:  The study design was qualitative and participants were purposively sampled ( n  = 7). Data was collected through semi-structured interviews and thematically analysed.
Findings:  The main themes to emerge from the interviews were: dealing with cultural issues in practice; accessing and using the interpreter service; planning and taking action to improve nursing care for patients from a different culture.
Conclusion:  Support and education is needed by nurses to improve nursing care of people from a different culture.
Practice implications:  Recommendations for practice are to: develop transcultural nursing education; promote an ethos of providing culturally competent and culturally safe nursing to people of another culture; improve resources available to nurses; provide easier access to formal interpreter services with continuity of interpreters for patients and conduct further research into aspects of health care in multicultural Ireland.     

Beyond profession: nursing leadership in contemporary healthcare

Aim(s)  To examine nursing leadership in contemporary health care and its potential contribution to health service organization and management.
Background  As the nursing profession repositions itself as an equal partner in health care beside medicine and management, its enhanced nursing standards and clinical knowledge are not leading to a commensurate extension of nursing's power and authority in the organization.
Method(s)  An ethnographic study of an ICU in Sydney, Australia, comprising: interviews with unit nursing managers (4); focus groups (3) with less experienced, intermediate and experienced nurses (29 in total); and interviews with senior nurse manager (1).
Results  Inter- and intra-professional barriers in the workplace, fragmentation of multidisciplinary clinical systems that collectively deliver care, and clinical and administrative disconnection in resolving organizational problems, prevented nurses articulating a model of intensive and end-of-life care.
Conclusion(s)  Professional advocacy skills are needed to overcome barriers and to articulate and operationalize new nursing knowledge and standards if nurses are to enact and embed a leadership role.
Implications for nursing management  The profession will need to move beyond a reliance on professional clinical models to become skilled multidisciplinary team members and professional advocates for nurses to take their place as equal partners in health care.     

A critical review of the nursing shortage in Malaysia

BARNETT T., NAMASIVAYAM P. & NARUDIN D.A.A. (2010) A critical review of the nursing shortage in Malaysia. International Nursing Review 57 , 32–39
Objective:  This paper describes and critically reviews steps taken to address the nursing workforce shortage in Malaysia.
Background:  To address the shortage and to build health care capacity, Malaysia has more than doubled its nursing workforce over the past decade, primarily through an increase in the domestic supply of new graduates.
Methods:  Government reports, policy documents and ministerial statements were sourced from the Ministry of Health Malaysia website and reviewed and analysed in the context of the scholarly literature published about the health care workforce in Malaysia and more generally about the global nursing shortage.
Results:  An escalation in student numbers and the unprecedented number of new graduates entering the workforce has been associated with other impacts that have been responded to symptomatically rather than through workplace reform. Whilst growing the domestic supply of nurses is a critical key strategy to address workforce shortages, steps should also be taken to address structural and other problems of the workplace to support both new graduates and the retention of more experienced staff.
Conclusion:  Nursing shortages should not be tackled by increasing the supply of new graduates alone. The creation of a safe and supportive work environment is important to the long-term success of current measures taken to grow the workforce and retain nurses within the Malaysian health care system.     

Attitudes of nurse professionals and nursing students towards children with disabilities. Do nurses really overcome children's physical and mental handicaps?

Background:  Many health professionals and nurses, who are involved in the care of disabled children, do not exhibit the essential sensitivity and appropriate attitudes towards them, resulting in a poor quality of nursing care.
Aim:  The objective of this study was to investigate the attitudes of nurse professionals (paediatric nurses) and nursing students towards disabled children.
Patients and methods:  The present study is a comparative study. The sample consisted of 228 first-year nursing students, 90 post-diploma nurses attending MSc degree course and 123 nurse professionals who are employed in paediatric hospitals. After obtaining permission from the hospitals and the educational settings and informing about the subjects of the study, data were collected using the paediatric Attitude Towards Disabled Person Scale (ATDP).
Results:  Overall nurses' attitudes appeared to be poor (mean ATDP score 61.7 ± 14.2). However, the post-diploma nurses had significantly higher ATDP scores than first-year students and paediatric nurses ( P  < 0.001). In addition, first-year students had significantly higher scores than paediatric nurses ( P  = 0.047). Across the sample, females hold significantly more positive attitudes than males ( F  = 9.5, P  = 0.002), while age did not have any significant effect.
Conclusions:  Carefully designed curricula can influence the attitudes of nursing students towards children with disabilities. Special courses for treating disabled children should be integrated to the basic nursing studies. Moreover, continuing hospital education can change paediatric nurses' attitudes towards children with disabilities.     

Leadership style and organisational commitment among nursing staff in Saudi Arabia

Aims

To examine how nurse managers’ leadership styles, and nurses’ organisational commitment in Saudi Arabia relate.

Background

Effective leadership is influential in staff retention; however, recruiting and maintaining nurses is an increasing problem in Saudi Arabia.

Methods

Using a survey design, the Multifactor Leadership Questionnaire and the Organisational Commitment Questionnaire were distributed to a sample of 219 nurses and nurse managers from two hospitals in Saudi Arabia.

Results

Transformational leadership was the most dominant leadership style. After controlling for the influence of manager/staff status, nationality and hospitals, transformational leadership was the strongest contributor to organisational commitment. Perceptions of both transformational and transactional leadership styles, increased with age for nurse managers and nursing staff.

Conclusion

Introducing the Full Range of Leadership model to the Saudi nursing workforce could help to prepare Saudi nurses for positions as nurse managers and leaders.

Implications for Nursing Management

The study provides insight into the type of leadership that is best suited to the dynamic and changing health care system in Saudi Arabia. It is possible that transformational leaders could influence and induce positive changes in nursing.     

Conflict and professionalism: perceptions among nurses in Saudi Arabia

ZAKARI N.M., AL KHAMIS N.I. & HAMADI H.Y. (2010) Conflict and professionalism: perceptions among nurses in Saudi Arabia. International Nursing Review 57 , 297–304 Aim: To examine the relationship between nurses' perceptions of conflict and professionalism. Background: In Saudi Arabia, health‐care sectors are constantly undergoing major changes because of social, consumer‐related, governmental, technological and economic pressures. These changes will influence the nature of health‐care organizations, such as hospitals' work environment. The ability of nurses to practise in a professional manner may be influenced by their work environment and conflict level. Methods: A cross‐sectional design was conducted in this study. A simple random selection of three health‐care sectors in Saudi Arabia was performed and 346 nurse managers, as well as bedside nurses participated to provide information about conflict levels and professionalism. The Perceived Conflict Scale was used to assess the level of conflict, and the Valiga Concept of Nursing Scale was used to assess the professionalism perception among nurses. Results: The intragroup/other department type of conflict had a statistically significant correlation with the perception of professionalism. In addition, the findings point to a low perception among the participating nurses regarding their professionalism. Conclusion: A number of factors might explain the low level of perception of professionalism. These relate to the workplace itself, as well as to the personal background of the nurses, which includes the personal interest in the nursing profession, as well as the family's, society's and the consumers' views of the profession. Given the findings of this study, nurse managers are encouraged to create a work environment that supports professionalism and minimizes conflict.     

Lessons from eleven primary health care nursing innovations in New Zealand

Introduction:  In New Zealand in 2003, 11 primary health care (PHC) nursing innovation projects and an evaluation of the initiative were funded by the Ministry of Health to develop and explore the ways new models of nursing practice could help address health inequalities and contribute to PHC.
Design and Methods:  A research-and-development approach was used in the evaluation. Data were gathered from interviews with national stakeholders, workshops with personnel from all projects, visits to each project site and case studies of four projects. Analysis involved assessing each project individually as well as the projects as a whole.
Context:  The initiative was one of many international and local PHC developments in this period designed to reduce health inequalities and improve patient care and health outcomes.
Findings:  Each project was developed from a different starting point; was located in different parts of the health system; and had different levels of funding. Some were principally focused on leading nursing development; others focused on developing nursing practice. Each involved influencing or providing nursing services, nurse education, leadership and service integration. Most projects progressed well, but some had limited success.
Lessons:  Lessons are on many levels, and include those related to: developing successful innovation; the importance of nursing leadership; developing the nursing workforce; and advancing nursing practice.
Conclusion:  The funding of the innovative projects enabled nurses to pioneer developments. Such funding is important, as it paves the way for change and provides an opportunity for reflection and new learnings.     

Engaging with nature to promote health: new directions for nursing research

Title.  Engaging with nature to promote health: new directions for nursing research.
Aim.  The aim of this paper is to offer a conceptual framework for nature-based health promotion in nursing and provide related recommendations for future nursing research.
Background.  Empirical data suggest that interaction with nature has direct health benefits. When people attend to outdoor habitats, gardens and other forms of nature, they are more likely to engage in physical activity and other behaviours that improve health. Engaging with nature can even cultivate ecological sensibilities that motivate us to protect the health of our planet.
Data sources.  Multidisciplinary theoretical and research publications from 1985 to 2008 were examined in the development of the framework.
Discussion.  As the health of our planet continues to deteriorate, there is a pressing need for theoretically informed, ethical, sustainable ways of engaging with nature to promote human and environmental health. We adapt principles and socio-ecological thinking from the fields of nursing, health promotion and ecological restoration to delineate the essential elements of the proposed framework.
Implications for nursing.  Although evidence-based knowledge about nature-based health promotion is not readily used in nursing and health care, its development and application are critical to designing effective strategies to strengthen both human and environmental health.
Conclusion.  Nurses can use nature-based health promotion concepts to work with citizens, health practitioners and policymakers to explore and optimize reciprocal, health promoting relationships among humans and the natural environment. To the extent that nurses integrate nature-based health promotion into their research efforts, we can expect to contribute meaningfully to both environmental and human health in communities across the globe.     

The praxis of clinical knowledge: learning to care for paediatric patients with a congenital heart anomaly

In Saudi Arabia, the major tertiary care unit for the treatment of cardiovascular disease is the King Faisal Heart Institute (KFHI). Its state of the art technology and patient profile facilitates nurses to become highly knowledgeable in the diversity of treatment modalities and nursing care of a range of paediatric pathology. Like many global nursing organizations, the KFHI is experiencing nursing shortages and nurses coming to work in this highly specialized area are lacking some of the basic understanding and skills development necessary to work efficiently and effectively in the area. This paper describes the work of the cardiovascular education team in developing a praxis-based curriculum that equips nurses to not only function at a high level in the cardiovascular area but also facilitate success in their future careers when they leave Saudi Arabia.     

Job satisfaction of nurses in a Saudi Arabian university teaching hospital: a cross-sectional study

AL‐DOSSARY R., VAIL J. & MACFARLANE F. (2012) Job satisfaction of nurses in a Saudi Arabian university teaching hospital: a cross‐sectional study. International Nursing Review 59 , 424–430 Background: Saudi Arabia is developing very fast in all disciplines, especially in nursing and health. Only about five studies between 1990 and 2010 have been undertaken in Saudi Arabia concerning factors influencing job satisfaction of nurses, although a body of knowledge exists globally. Aim: The purpose of this research was to measure nurses' job satisfaction in Saudi Arabia in a university teaching hospital and to determine the influencing factors. Methods: A quantitative, cross sectional method, self‐administered questionnaire was used for this study. A systematic sample of N = 189 nurses was used to collect data. The SPSS version 16.0. was used to analyze the data. An independent t‐test and one‐way analysis of variance were used to test hypotheses concerning different groups, and correlation tests (the Pearson's and Spearman's rank tests) were used to examine relationships between variables. Results: Overall, nurses were neither satisfied nor dissatisfied with their jobs. However, nurses indicated satisfaction with supervision, co‐workers and nature of work. The sources of dissatisfaction were with subscales such as pay, fringe benefits, contingent rewards and operating conditions. Conclusion: These findings indicate that there is a need to increase nurses' salaries and bonuses for extra duties. More training programmes and further education also should be encouraged for all nurses. Therefore, it is imperative that nursing managers and policy makers in Saudi Arabia consider these findings to improve nurses' job satisfaction.     

Implementation of the abilities-focused approach to morning care of people with dementia by nursing staff

Background.  The efficacy of the abilities-focused approach to morning care has been demonstrated in two studies. However, the extent to which nurses are aware of and actually implement abilities-focused interventions in day-to-day practice is not known.
Aim.  The study aimed to determine the type and number of abilities-focused interventions delivered by nursing staff to residents with dementia during morning care.
Methods.  A one-group repeated measure design was used. Seventy-nine nursing staff attended an educational session to instruct them in the application of abilities-focused interventions. Data on the type and number of interventions used by nurses were obtained before, after and 3-months following attendance at the session. Data were collected through participants' self-report and observation.
Results.  Most nursing staff used abilities-focused interventions when providing morning care. Introduction to resident, orientation to resident and conversation with resident were three types of interventions most often applied over time. The number of interventions implemented increased after attendance at the education session and returned to baseline level at 3-month follow-up.
Conclusions.  Future research is recommended to examine the long-term effects of alternative designs of educational sessions.