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?
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
|1 week||All of the newcomers are familiar with the frequency and causes of NUCI appointments at the facility where they work. Each of them is aware of the key symptoms of the most common diseases and able to both describe them verbally and identify them in a patient.|
|1 month||The trainees have both a theoretical and practical understanding of what they are to do in each of the above cases. Specifically, the nurses realize what procedures doctors normally perform on patients, why they do that, and what assistance they need in the process. Each has observed several instances and can explain the actions of his or her colleagues in those. |
Immigrant practitioners have received the answers to all of the questions regarding how and why Saudi culture is different from their native if they had such. The locals have developed a view of the reasons why nursing is a quite honorable activity, such as the participation in rescuing lives. Each can motivate in his or her own words why dedication, mutual respect, and teamwork are not less important than competence.
|2 months||The trainees can assist doctors in the most typical cases without consulting their supervisors. Each of them has made several successful attempts under control and been able to give clear reasons for the relevance of his or her behavior post factum. In addition, the new nurses can notice the possible mistakes of their fellows and control each other in case this is necessary. The load on their more experienced colleagues has partly decreased.|
|10 weeks||The trainees have learned and observed how to interact with parents and other relatives of newborns who are in NICUs, including non-survivors, if there have been any. Each realizes that the primary needs of the patient’s families are information as well as reassurance and knows, at least theoretically, how to satisfy those. In addition, all of the practitioners understand what approaches to communication are unacceptable and why they should avoid such behavior.|
|3 months||The new nurses can manage most frequent cases without constant supervision. Their awareness enables them to decide timely what they have to do in the given case, and everybody has made several successful attempts. The speed of their reaction is appropriate for eliminating any unwanted interferences with the procedures. In less typical cases, they do not participate in reanimation but can guess what they will have to do in the future. |
The trainees have no personal conflicts with colleagues or are able to cooperate productively, notwithstanding those. They communicate quite confidently at least with the families of survivors.
|4 months||Theoretical and practical knowledge is sufficient to conduct the necessary procedures and stay in contact with patients’ families on condition of bearable load. Nevertheless, they are free to consult their colleagues in case they have questions or doubts to prevent unwanted consequences.|
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.
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.
Al-Hindi, M. Ya., Alshamrani, Z. M., Alkhotani, W. A., Albassam, A. B., Tashkandi, A. M. A., AlQurashi, M. A. (2021). Utilization of health-care resources of preterm infants during their first 2 years of life after discharge from the neonatal intensive care unit. Journal of Clinical Neonatology, 10(1), 37-44.
Alnajim, S. A. S., Modhish, M. M., Alzahrani, R. H. J., Almulhim, A. I., Alkathiry, A. H. M., Alqahtani, M. N., Alobaisy, A. S. S., Al Mulhim, A. M. A., Al Ateeq, A. A., Alshuaibi, S. O. A., Alghamdi, A. S. E., Alqurashi, W. K. M., Bahkely, T. N. A., & Alrubayyi, A. F. W. (2017). Effect of NICU admission on development and nutrition in early childhood years. The Egyptian Journal of Hospital Medicine, 69(5), 2459-2462. Web.
Alsadaan, N., Jones, L. K., Kimpton, A., & DaCosta, C. (2021). Challenges facing the nursing profession in Saudi Arabia: An integrative review. Nursing Reports, 11(2), 395-403.
Alsaiari, E. M., Magarey, J., & Rasmussen, P. (2019). An investigation of the needs of Saudi parents of preterm infants in the neonatal intensive care unit. Cureus, 11(1), e3887.
Al-Wassia, H. & Saber, M. (2017). Admission of term infants to the neonatal intensive care unit in a Saudi tertiary teaching hospital: cumulative incidence and risk factors. Annals of Saudi Medicine, 37(6), 420-424.
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Rahman, R. & Salam, M. A. (2021). Policy discourses: Shifting the burden of healthcare from the state to the market in the Kingdom of Saudi Arabia. The Journal of Healthcare Organization, Provision, and Financing, 58, 1-9.
Rahman, S. U., Abdulghani, M. H., Al Faleh, Kh., Khalil, M., Mustafa, M. M., Anabrees, J., Mansour, M. Ya., Mirza, A., Mousafeiris, K., Mubarak, M., Kamal, M. (2020). Perinatal mortality in Saudi Arabia: Profile from a private setup. Journal of Clinical Neonatology, 9, 8-12.
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|Author(s), title||Problem||Purpose||Data collection method(s)||Theory/ |
|Al-Hindi, M. A., et al. (2021). Utilization of health-care resources of preterm infants during their first 2 years of life after discharge from neonatal intensive care unit||The burden of infant prematurity on both family and healthcare resources||To determine the frequency of using healthcare services during 2 years after discharge from NICU||Reviewing topic-specific medical records||No||A retrospective cohort study||Preterm infants need considerably closer medical supervision after discharge from hospital than healthy term babies. The difference may equal from 12% to 400%, depending on a service|
|Alnajim, S. A. S., et al. (2017). Effect of NICU admission on development and nutrition in early childhood years||Long-term impact of neonatal intensive care on health is not sufficiently discussed||To identify the influence of NICU admission on developmental and nutritional outcomes in a long-term perspective||Searching medical databases for previous studies on the topic||No||A quantitative study||NICU admissions do not influence health as independent factors, but their etiology can do this|
|Alsadaan, N., et al. (2021). Challenges facing the nursing profession in Saudi Arabia: |
An integrative review
|The lack of qualified nurses in Saudi medical facilities||To investigate on the issues that Saudi nursing is facing and to suggest solutions||Reviewing topic-specific articles and documents.||No||An integrative review||There are a general scarcity of nurses and a lack of native Saudi practitioners. One of the most appropriate solutions is improving the public image of nurses|
|Alsaiari, E. M., Magarey, J., & Rasmussen, Ph. (2019). An investigation of the needs of Saudi parents of preterm infants in the neonatal intensive care unit||Possibly inadequate perception of the needs of those whose children are in NICUs||To identify the actual priorities of the patients’ families||Surveying||No||Synthetic qualitative-quantitative research||The biggest needs of Saudi parents are information and assurance, while comfort and support and in the end of the list|
|Al-Wassia, H., & Saber, M. (2017). Admission of term infants to the neonatal intensive care unit in a Saudi tertiary teaching hospital: cumulative incidence and risk factors||An increase in the number of term infants in NICUs in Saudi Arabia||To assess the frequency of NICU admissions as well as the risk factors to identify the necessary improvements to the healthcare system||Observing an equal amount of cases and controls||No||A cross-sectional analytical study||The most frequent reasons why term Saudi infants go to NICUs are respiratory complications (36.6%), hypoglycemia (16.2%) and jaundice (7.7%)|
|Brown, J. (2020). Using learning theory to shape learning experiences in health care education: Not scary at all!||Education in healthcare is frequently regarded as a separate sphere rather than a type of learning, which may result in non-scientific approaches||To connect the basic learning theories to medical science||Reviewing literature on the topic||The most popular theories of learning||A descriptive analytical study||All tutors, including those who teach medical practitioners, have to understand and apply learning theories, as most reputable training practices are based on them|
|Cahapay, M. B. (2021). Kirkpatrick model: Its limitations as used in higher education evaluation.||Insufficient applicability of the hierarchy of learning by Donald Kirkpatrick to higher education||To analyze the possible limitations of the given model||Reviewing primary sources on the topic||The hierarchy of learning by Donald Kirk-patrick||An analytical qualitative study||The model demonstrates a certain degree of rigidity and a lack of cause-and-effect relations between the levels, hence is not commonly applicable|
|Rahman, R., & Salam, M. A. (2021). Policy discourses: Shifting the burden of healthcare from the state to the market in the Kingdom of Saudi Arabia||A range of social factors may prevent Saudi medicine from further progress||To regard the enhancement of private sector healthcare in various contexts||Reviewing topic-specific literature, primarily articles and documents||No||A synthetic qualitative-quantitative study||The Saudi government has taken considerable effort to develop private healthcare. This, however, resulted in new problems, such as growing inequality and patient dissatisfaction, which determines the need for further reforms|
|Rahman, S. U., et al. (2021). Perinatal mortality in Saudi Arabia: Profile from a private setup||Disparities in perinatal mortality between private and public sectors of healthcare||To analyze the rates and most frequent causes of perinatal death||Exploring medical records||No||A retrospective, comparative, and analytical study||Infant mortality rates in private sector are lower as compared to public, which may result from the unequal financial status of patients as well as the differences in the quality of care|
|Salam, A. A., & Al-Kharif, R. M. (2020). Child mortality transition in the Arabian Gulf: wealth, health system reforms, and development goals||Child deaths in the region remain relatively frequent, although there has been a substantial decline||To trace the change in child, including neonatal, mortality in Arab countries since the 1950s||Reviewing the statistics that the United Nations provides||No||A review||Between 1956 and 2016, newborn mortality in Saudi Arabia decreased by approximately 1400%|