Introduction
The decrease in infant mortality in Saudi Arabia means a growth in the load on neonatal intensive care units (NICUs), as more newborns would have died immediately before going to them. This is among the sources of the countrywide shortage of medical personnel, primarily nurses, to which newcomers frequently are appointed in NICUs without prior training. This threatens the quality of their work and subsequently determines the need for appropriate in-house education.
The training has to allow for both theoretical knowledge and practical skills so that practitioners are able to fulfill their functions without permanent supervision and frequent consultations. Along with this, it should not be excessively long, as the issue of nurse scarcity needs to be solved immediately. Another essential nuance is funding; the program has to be commonly affordable to provide both public and private sectors, whose financial capacities can be dramatically different, with an additional workforce.
After an exploration of the topic, it becomes apparent that the training should involve doctors and nurses who work in neonatal intensive care as supervisors of newcomers. The latter, in turn, have to undergo assessment on a regular basis throughout the program, due to which their progress, hence current competence, is apparent. The proper length of the course is four months, at the end of which period, new staff members need to be able to assist doctors, care about patients, and communicate with their families as appropriate.
Training Development Project
Neonatal mortality rates are among the most important markers of the effectiveness of the healthcare services that a particular country has. In Saudi Arabia, the amount of surviving newborns has substantially increased throughout the recent several decades. Such changes illustrate the growing quality of medicine but, along with this, mean a more serious load on intensive care units (NICUs). Consequently, those need reorganizing and updating, primarily in terms of bed capacity as well as human resources that are dramatically scarce at the current stage.
The paper provides both qualitative and quantitative data on critical cases that occur in the Saudi Arabian newborn care system and characterizes the state of nursing in the country. Analysis of the findings provides sufficient theoretical and practical evidence to underlie a training program that targets increasing the amount of competent medical practitioners. It has to be based on the following points, a sequential investigation that will contribute to the probability of solving the issue.
What are the most frequent reasons why Saudi newborns find themselves in NICUs? What new knowledge and skills do medical professionals subsequently need to address critical cases? What learning strategies and approaches are the most relevant under the given circumstances? How long may it take to train the necessary amount of practitioners? What ethical concerns, if any, can emerge and what permissions, if any, consequently may be needed?
Background
Shortage of Competent Nursing Workforce
In general, neonatal mortality rates in Saudi Arabia have been declining slowly but steadily for at least half a century. In the 1950s, they exceeded 100 deaths per 1000 births; in 2016, there were less than 7, and the amount most probably will continue to decrease from year to year (Salam & Al-Khraif, 2020). The most apparent reasons for this are the substantial increase in living standards and the incomparably higher quality of healthcare services in the country than it was several decades ago. Among those services is neonatal intensive care, due to which more newborns with pathologies receive a chance for survival rather than die immediately or soon after birth. Therefore, an increasing number of them find themselves in NICUs, and the time they spend there frequently is longer than before, which determines the need for further improvements.
One of the critically important updates is adding to the number of nurses, as it has to grow appropriately together with that of patients to eliminate overloading. Meanwhile, the existing scarcity frequently leads to hiring unskilled practitioners to compensate for it as soon as possible. It is worth noting that up to 70% of those are foreign, mostly Malay, Philippine, and Indian (Alsadaan et al., 2021, p. 396). The presence of individuals with diverse migratory backgrounds in healthcare facilities may cause cultural issues in addition to professionalism, hence aggravate the overall incompetence of the caregivers.
The possible origin of the above phenomenon is low prestige. Specifically, the majority of the locals do not regard nursing as a worthy profession (Alsadaan et al., 2021). It would be reasonable, therefore, to invest effort in promoting it to the Saudis by focusing on the non-financial rewards that correspond to their traditional values. Ethnocultural homogeneity allows for more security in workplaces, which is of special importance in medical facilities. However, even native personnel frequently lack the appropriate knowledge and experience due to their appointment in NICUs with little to no prior training.
Reasons for Intensive Care
As said above, the rates of infant admission to intensive care units in Saudi Arabia have increased in recent decades. Thus, the share of newborns that go to NICUs equaled 6.4% on average in 2004 and 7.8% in 2012; in 2021, it may reach 8.6% (Al-Hindi et al., 2021; Alnajim et al., 2017.). An adequate assessment, however, is frequently complicated due to focusing on whether term or preterm infants, between which two groups there may be a considerable difference. Generally, newborns whose gestational age equals or exceeds 37 weeks are approximately twice less likely to need intensive care than those who are born earlier (Al-Hindi et al., 2021; Al-Wassia & Saber, 2017). Prematurity, in other words, physical underdevelopment, is actually among the main causes of infant mortality in Saudi Arabia.
Other sources, which are quite common in term babies as well, include a range of congenital abnormalities. The list of those is, in particular, respiratory complications that are responsible for at least a third of all term-birth admissions, hypoglycemia, and jaundice (Al-Wassia & Saber, 2017, p. 420). These, along with prematurity consequently, are the conditions that personnel of NICUs has to be able to address timely and adequately.
Training Development
Topic
Considering the above, newcomer nurses need in-house training that has to be maximally specific so that the knowledge and skills that they acquire meet the existing demand. Therefore, the program should explain the main symptoms of the disorders with which newborns have predominantly been admitted to intensive care units, as well as the role of nursing in their treatment. It is also essential to teach beginners how to interact with the patient’s relatives and alleviate their pain, as this is another responsibility of nurses. For expatriate practitioners, an additional brief course of Arabian culture would be helpful for integrating into the team and cooperate productively with their coworkers, which is critical for preventing fatal outcomes.
Significance in Nursing Practice
Primarily, the project allows for a systematization of theoretical knowledge on nursing in neonatal intensive care units by collecting, analyzing, and organizing topic-specific information. Second, it involves acquiring relevant practical skills and experience within relatively short timeframes, which, in turn, enables smoothing the apparent shortage of qualified medical personnel. Finally, it provides a clear understanding of a nurse’s role in interactions with doctors, with patients, and with patients’ families, hence contributing to the unity and, subsequently the productivity of a medical team.
Purpose
The purpose of the project lies in compensating for the existing scarcity of a competent nursing workforce. The primary objective, which allows for fulfilling it, is to educate the newcomers in a way that will enable them to assist doctors in NICUs effectively. Another essential step is to allocate the human resources properly so that the amount of beds for which each of the nurses is responsible does not exceed the acceptable maximum.
Program
Problem and Needs Assessment
The issue that the training is expected to solve is the inability of newcomer nurses to fulfill their professional duties, in other words, the big difference between the current and the desired capacity. Therefore, the main learning goal is to ensure that all staff members are aware of the medical procedures to conduct in critical cases whose sources include prematurity, respiratory applications, hypoglycemia, or jaundice. It is also essential to communicate to all of the participants where the responsibility of a nurse begins and ends; awareness of that would minimize hierarchy misunderstandings. In particular, staying in contact with an infant’s family and psychological support are the tasks of a nurse, while treatment-related consulting is not. It is worse noting that, according to Alsaiari et al. (2019), information and assurance are among the most important needs of Saudi parents. Subsequently, another goal is to teach the newcomers the appropriate communicative skills, including approaches to telling tragic news.
Data Collection
The assessment of the needs and, subsequently, the relevance of the training presupposes collecting and analyzing a maximal possible variety of information. The sources should be both external of general theoretical data and internal of specific evidence, which may differ considerably not solely from region to region, but even from one particular medical facility to another. For instance, the social and financial status of the patients can play a substantial role in the frequency of fatal outcomes, considering that they are noticeably less common in the private sector (Ur Rahman et al., 2020). Therefore, each healthcare institution has to make its trainees acquainted with the local specificities so that they demonstrate sufficient dedication and productivity. Among internal sources may be topical documentation, in particular, that on NICU admissions, as well as evidence from coworkers and patient families. Regarding external, those include scientific literature and other types of media, such as video tutorials.
Evaluation
Estimating the efficiency of training from a short-term perspective presupposes the evaluation of the following points: immediate reactions of the participants and the increase in their knowledge. Such a scheme corresponds to the hierarchy of learning by Donald Kirkpatrick (Cahapay, 2021). Within the program proposed, assessing the trainees’ progress comprises questioning them on theoretical data and several practical exercises that imitate assisting in a NICU in various cases as well as communicating with parents.
Feedback
Regarding the long-term productivity of learning, its main measure is the quality of job performance, both of each participant and of the facility as a whole. These two points also are integral to Kirkpatrick’s hierarchy of the results of education (Cahapay, 2021). Assessing them requires collecting feedback on a regular basis from employees themselves as well as patients’ families, who are actually secondary customers of NICUs. The former can evaluate the understandability and helpfulness of the materials, simply stated, and decide whether the training has improved their competence; job satisfaction is another essential parameter. The comments from the latter, meanwhile, are the major criterion of whether the healthcare facility is fulfilling its functions properly. All types of feedback should be collected in the closing phase of the training and during a certain period after its end.
Training Development Theory Used
It is doubtlessly not sufficient in the given case to make the trainees change their behavior. In a critical case, an individual needs a clear understanding of what and why he or she is to do, as a lack of it most probably will have tragic consequences. Therefore, all of the newcomer nurses have to develop a view of their duties at the workplace as well as their role in the process of curing, which is one of the two major tasks of the training. Another is gaining the appropriate competencies, whose relevance the practitioners should understand equally well to be able to perform without constant supervision. Such an approach to learning corresponds to the definition of constructivism, which sees education as “a continual process of construction” (Brown, 2020, p. 84). Another reason why this theory underlies the training is the desirable checking and expanding knowledge through communication, which gains additional importance in multicultural teams.
Financial Concerns
A possible obstacle to effective education is that, notwithstanding the great progress in the quality of medicine, a considerable amount of Saudi Arabian healthcare institutions continue to face difficulties, including financial. The most common reasons for this situation are the population growth resulting from that of living standards, the scarcity of resources, and poor management (Rahman & Salam, 2021). Therefore, it would not be quite reasonable to invest much in training; affordability is on the list of the key points to consider, along with practicality and topic-specificity. One of the appropriate variants subsequently is the direct interaction between more experienced practitioners and newcomers, during which the former instruct and supervises the latter for an increment that does not burden the facility.
Eligibility Criteria
To have a right to participate in the program, both trainees and supervisors need to meet several requirements. Those to nurses actually match the core demands on job seekers and primarily involve a diploma from a medical college, desirably Saudi. Being native is a big advantage in accordance with the current policy of Saudization of nursing that results from the above cultural issues (Alsadaan et al., 2021). Immigrant practitioners, however, are welcome as well on the condition of an appropriate degree.
Regarding both doctors and nurses who have the right to teach newcomers, they should have no less than 5-year experience in neonatal intensive care to ensure that their practical skills are sufficient. In addition, it is important to determine how long they have worked for a particular facility because, as said above, parameters such as the frequency of certain cases and the social status of the patients may be different. Considering this, it is reasonable to opt for those who joined the team at least 2 years ago since a short period can hardly allow for a diverse selection of cases, including less typical ones.
Timeline
It is apparently not possible to present all of the necessary information and provide sufficient practice in less than 2 months. As supervisors cannot abandon their work, hence are unable to devote all of their time to trainees, the term doubles. A more detailed timeline is below; it is, however, approximate since neonatal intensive care is a dramatically unpredictable sphere of activity that consequently does not favor strict planning.
Permission Considerations
The official approval of the training needs to be received from King Salman Medical City after its representatives review the program. A big ethical concern is the families’ consent. Specifically, it is essential to receive permission from parents or other relatives, so that newcomer nurses may participate in medical procedures on newborns. Considering that over 80% of respondents mention proper attitude towards their infants among the key priorities, presumably not all of them will agree (Alsaiari, Magarey, & Rasmussen, 2019, p. 1). This may complicate following the above timeline due to a lack of practical cases.
Conclusion
To compensate for the considerable shortage of competent nurses in Saudi Arabian newborn intensive care units, it is critical to train newcomers appropriately. Notably, in-house educational programs, a variant of which the paper introduces, should be informative but quite brief and not excessively expensive, especially for the public sector of health care. A reasonable solution, therefore, is to involve more experienced practitioners as supervisors. The training may take approximately 4 months, although external factors can interfere with the timeline. It has to provide theoretical data on the causes and frequency of NICU admissions as well as the symptoms of the most typical conditions. Practical evidence is also critical since it allows for a clearer understanding of the necessary actions. In addition, young practitioners are to acquire the appropriate communicative skills to contact the patients’ families, which includes telling bad news.
References
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