Advancing Nursing Practice: The Emergence of the Role of Advanced Practice Nurse in Saudi Arabia

Identifying competencies in advanced healthcare practice: an umbrella review

The four pillars of advanced healthcare practice (AHCP) are clinical practice, leadership and management, education, and research. It is unclear, however; how competencies of AHCP as defined by individual health professions relate to these pillars. Addressing this knowledge gap will help to facilitate the operationalization of AHCP as a concept and help inform educational curricula. To identify existing competencies across AHCP literature and examine how they relate to the four pillars of a multi-professional AHCP framework. An umbrella review was conducted in accordance with JBI methodology. The electronic search for published and grey literature was completed using CINAHL, Scopus, Medline (OVID), Embase (OVID), ERIC (OVID) and Google. Secondary reviews and research syntheses of master level AHCP programs published after 1990 in either English or French were considered for inclusion and results were analyzed using a directed content analysis. Seventeen publications detailing 620 individual competencies were included. AHCP competencies were described across four professions and 22 countries, with many publications related to nursing and AHCP in the United Kingdom, Canada, and Australia. Many retrieved competencies were found to map to the four pillars of AHCP, although clinical practice and leadership and management pillars were addressed more often. Competencies of AHCP are generally consistent with the four pillars. However, the distribution of competencies is unequal across pillars, professions, and geographical regions, which may provide direction for further research. Doi: 10.17605/OSF.IO/KV2FD Published on March 07, 2023.

Nurses' readiness to prescribe under supervision in Saudi Arabia: A cross-sectional study

Aim

To explore nurses' readiness to prescribe medications under supervision and identify associations between prescribing practices under supervision and demographic characteristics in Saudi Arabia.

Design

A cross-sectional study.

Methods

Using convenience sampling, this study used a 32-item survey to collect data on nurses prescribing medications under supervision between December 2022 and March 2023.

Results

A total of 379 nurses were recruited from different regions in Saudi Arabia. Approximately 7% (n = 30) of the participants were prescribing medications independently, and 70% (n = 267) expressed their likelihood of becoming prescribers. The highest motivating factors to become prescribers were improvement of patient care (52.2%) and contribution to the multidisciplinary team (52.0%). Most participants (60%-81%) agreed that prescribing medications under supervision would improve potential outcomes at the system, nurse, and patient levels. Availability of appropriate mentors or supervisors (72.9%) was the highest rated facilitating factor, followed by support of nursing colleagues (72%). Based on demographic characteristics, findings revealed significant differences in the: a) likelihood and motivators of becoming prescribers; b) required minimum qualification, years of experience, and continuing professional education hours to become prescribers; and c) type of organizations delivering educational programs for nurse prescribing.

Conclusion

Majority of nurses in Saudi Arabia favored becoming prescribers, and motivating factors were mostly relevant to optimizing patient care outcomes. Having the proper supervision was rated as the most facilitating factor for nurse prescribing. Nurses' views on potential outcomes, facilitating factors, and possible motivators varied based on nurses' demographical characteristics.

Implications for the professional and/or patient care

Nurses favored prescribing under supervision to improve patient care outcomes, which is an opportunity to expand the benefits of health services, including easy access to healthcare.

Impact

Results revealed that nurses support the implementation of prescribing practice under supervision. Thus, the findings may inform practice change in Saudi Arabia to allow prescribing under supervision, which was perceived to have a positive impact on patient care outcomes.

Reporting Method

This study adhered to STROBE guidelines.

Advanced clinical practice in paediatric haematology and oncology: developing a capability document

Specialist roles have been developed to provide holistic care to children and young people with cancer, one of which is the advanced clinical practitioner (ACP) in paediatric oncology and haematology. A survey showed that paediatric oncology and haematology ACPs in the UK work in a wide variety of roles and that their numbers vary greatly between treatment centres. The survey also confirmed the need for a national standardised framework delineating the knowledge, skills and expertise required of ACPs working in paediatric oncology and haematology. This article describes the development of a capability document to support and standardise advanced practice in paediatric oncology and haematology. The document reflects the advanced level of critical thinking, autonomy and decision-making required of ACPs and has been endorsed by the Children's Cancer and Leukaemia Group and by the Royal College of Nursing. It is hoped that it will support ACPs to consistently deliver high-quality, safe care for the benefit of children and young people with cancer and their families.

A Mixed-Methods Sequential Explanatory Study of the Factors That Impact Nurses' Perspectives toward Nurse Practitioners' Roles in Saudi Arabia

Nurse practitioners' roles need to be clearly defined in Saudi Arabia. Therefore, we aimed to explore potential factors that impact nurses' perspectives toward nurse practitioners' roles and whether they are interested in becoming nurse practitioners. A mixed-methods study design was employed using a questionnaire and focus groups. The survey was sent to nurses working at a public hospital in the Riyadh region. Participants (N = 77) reported that having more nurse practitioners would improve quality of care and patient safety. Additionally, most participants stated that an increased supply of nurse practitioners would have a positive impact on effectiveness, equity of care, and healthcare costs. In regression analysis, participants with favorable perspectives towards nurse practitioners were significantly more likely to have interest in becoming nurse practitioners (odds ratio [95% confidence interval]:1.04 [1.01-1.07]). In the qualitative domain, three positive factors were identified: effective collaboration with other staff, better contribution to quality care and patient safety, and better contribution to evidence-based practice. Two barriers were also determined: lack of motivation to become a nurse practitioner and unclear scope of practice. Results showed that nurse practitioners can provide quality healthcare services that meet patients' different needs. The growing role of this speciality warrants further research to show its value in daily practice.

Gap Analysis: Quality and Women's Satisfaction Regarding Postnatal Care

Background:

Improving the quality of maternal health is one of the eight major developmental goals of the World Health Organization. Women's satisfaction with maternity healthcare services is a crucial indicator of quality health care.

Objective:

This study aimed to evaluate the gap between the quality of maternity care and women's satisfaction with postnatal care.

Methods:

This study used a descriptive cross-sectional study design. The sample size was 300 postpartum Saudi women. The data were collected from the postnatal care unit at the King Khalid Hospital, Jeddah, Saudi Arabia, The study used the SERVQUAL and Postnatal Satisfaction with Nursing Care Questionnaires to measure the studied variables.

Results:

The mean ± SD (3.73 ± 0.466) of women perceived that the provided care was of high quality and the mean ±SD (3.20±0.511) of women's satisfaction with postnatal care was moderate. The gap between expected and perceived quality of maternity care was reported to be -1.27. There is a significant positive relationship between the quality of maternity care and women's satisfaction.

Conclusion:

The study concluded that the participants were generally satisfied with the postnatal care and overall maternity care provided in the King Khalid Hospital. However, they showed the desire to get more empathetic care. Patients' satisfaction should be evaluated periodically to establish baseline data and provide postnatal care interventions tailored to women's expectations. There is a need to increase training for enhancing healthcare providers' empathetic and communication skills to improve the relationship between the staff and women.

Scope of Nursing Practice as Perceived by Nurses Working in Saudi Arabia

The absence of scope of practice guidelines may lead to role ambiguity and legal consequences in nursing practice. This study measures the scope of practice of nurses in Saudi Arabia. The study utilized a descriptive cross-sectional design using an electronic version of the Arabic Actual Scope of Nursing Practice (A-ASCOP) questionnaire among 928 nurses. Descriptive analysis was followed by a t-test and an analysis of variance (ANOVA). Significance was assured through the Bonferroni test; the effect size was measured through partial η2 when appropriate. The A-ASCOP mean score of each dimension ranged from 4.29 to 4.72 (overall mean = 4.59). Significant overall ASCOP score variations were evident, with higher ASCOP among expatriate nurses, females, Hospital Operation Program (HOP) nurses, and nurses with postgraduate qualifications. Partial η2 showed a small effect of <0.016. Low-complexity nursing tasks showed insignificant differences no matter the nurse’s position, but were less practiced by Bachelor of Science in Nursing (BSN) and advanced-degree nurses than by those with a diploma education. High complexity of ASCOP was practiced significantly more often by postgraduate-prepared nurses than by diploma-educated nurses. The study showed that there is a range of variation in nursing practice, but that the lack of internal regulations (nursing scope of practice) has no effect on nursing duties. In a country such as Saudi Arabia, where massive national improvement initiatives are frequent, clearly defining the scope of practice for nurses is essential and needs to be done through government mandates. Further studies are essential to define what the scope of practice should include.

Relationship between clinical performance and professional self-concept in critical care nurses

Objective

To determine the relationship between clinical performance and professional self-concept in critical care nurses.

Methods

This study was conducted on 308 critical care nurses. Data gathering instruments were nurses’ clinical performance questionnaire (NCPQ) and nursing professional self-concept measure (NPSCM). Independent sample t-test, one-way analysis of variance (ANOVA), and Pearson correlation coefficient were used for data analyses.

Results

The average age of the nurses was 33.74 ± 7.01 years. The clinical performance score of female nurses was significantly higher than male nurses. In the domain of clinical performance, clinical judgment and clinical inquiry had the highest and lowest scores, respectively. In the nurses’ professional self-concept, the highest and lowest scores were awarded to the subscales of self-confidence and staff relations, respectively. In addition, there was a significant positive correlation between self-concept and clinical performance of nurses.

Conclusions

Increasing professional self-concept improves the clinical performance of critical care nurses. Professional self-concept enhancement measures are recommended to improve the clinical performance of nurses in critical care units.

Nurse-run preanaesthesia assessment clinics: an initiative towards improving the quality of perioperative care at the ambulatory care centre

Introduction

Nurse-run preanaesthesia assessment is well established in ambulatory surgery. However, in the Middle East the implementation of such a service is new and needed careful preparation. Aim of this audit is to assess the feasibility and the quality of preoperative assessments by the specially trained nurses, patient and nurse satisfaction and overall perioperative quality of recovery.

Methods

The nurses were selected and trained first in an accredited programme. Then an implementation period of 3 month was used for them to gain experience. Hereafter, we performed a four-step audit on the quality of preassessment, the patient’s satisfaction, the quality of recovery and adverse events if any. Finally, we also monitored the nurse’s satisfaction of their new advanced role.

Results

The quality of preanaesthesia assessment was high as with 95% compliance to the accepted standards. In the patient satisfaction survey, all 152 patients were either highly satisfied or satisfied with the nurse-run service. The nurses were also highly satisfied and felt that they were either highly or moderately valued. All the patients who were operated at the ambulatory care services were followed up postoperatively by telephone calls which revealed that most of them were highly satisfied. No major or minor adverse events occurred.

Conclusion

Our specially trained nurses perform preoperative assessments on high standard without adverse events, while patient and staff satisfaction is very high. Future projects will focus on reducing the rate of cancellation of surgeries, investigating the cost-effectiveness of this approach as well as training the specialised nurses for paediatric preoperative anaesthesia assessments. This model of care could induce further nurse-run models of care in the Middle East.

Linking the Saudi Arabian 2030 vision with nursing transformation in Saudi Arabia: Roadmap for nursing policies and strategies

The Saudi government is currently facing multiple challenges in achieving “The Gold Standard” in nursing practice. This is not limited to educational challenges, staffing shortage, paucity of international and national benchmark evidence, absence of clear and defined scope of nursing practice, and lack of appropriate policies and regulations. This study presented a comprehensive plan for developing a policy based on current challenges, recognition of policy goals, assessment of potential options and alternatives, identification of stakeholders, proposition of recommended solutions, and implementation of the framework to transform nursing standards and link these changes with the Saudi Vision 2030. However, amendments are required in the present strategic plan for the better management of the nursing profession. It is doubtful that the current nursing profession status quo is capable of meeting the golden standards for health care. Thus, the transformation of the nursing profession in Saudi Arabia is necessary.

Nurse Practitioner: Is It Time to Have a Role in Saudi Arabia?

Low recruitment of Saudi nationals into the nursing profession, coupled with a growing population, has led to a severe nursing shortage in Saudi Arabia, particularly of nurses with advanced qualifications in clinical nursing. While the role of nurse practitioner has been successfully integrated into the healthcare systems of the U.S., Canada, the UK and Australia for decades, the advanced practice registered nurse (APRN), which includes nurse practitioners and clinical nursing specialists, is still not being implemented effectively in Saudi Arabia due to a variety of regulatory, institutional and cultural barriers. The author looks at some of those barriers and offers recommendations of how they might be overcome. Given that in many parts of the world, nurse practitioners are considered an essential component to meeting healthcare demands, the author considers the question of whether APRNs can find a role in Saudi Arabia’s healthcare system.

A snapshot of clinical educational experiences for advanced practice nurses worldwide

Using a convenience sampling, nurse educators representing 10 countries were surveyed to describe required clinical education for advanced practice beyond basic traditional nursing education. This article explores the many factors currently influencing the structure and diversity of these clinical experiences worldwide.

Development of nurse education in Saudi Arabia, Jordan and Ghana: From undergraduate to doctoral programmes

Doctoral programmes in nursing have a long history in the US where traditional research based PhDs and more clinically based doctoral programmes are common. In the rest of the world PhDs are better accepted though professional doctorates with a thesis component are common in the UK. In countries with newly established or planned doctoral programmes in nursing the research PhD seems the degree of choice. Here we discuss developments in Jordan, Saudi Arabia and Ghana. This study used official documents, strategic plans, curriculum developments and other documentary evidence from Saudi Arabia, Jordan and Ghana. We compared doctoral programmes and development with other countries by reference to the literature. We offer the example of public health and non-communicable diseases in particular as one area where doctorally trained nurses applying international standards in collaboration internationally may be of benefit.

Nursing Education in Saudi Arabia: History and Development

Nursing education in Saudi Arabia commenced in 1948 with the introduction of a nursing diploma program for males. Numerous bodies have worked as nursing education providers since then, leading to an unsteady growth of the field due to the lack of a unified curriculum coupled with an absence of regulating bodies. The absence of nursing leaders and the lack of reliable nursing workforce data during the past few decades have contributed to a lack of maturity and growth of the Saudi nursing landscape compared to the international nursing trends. This review explores the history of nursing education and its development within the context of Saudi Arabia.

Variation in job titles within the nursing workforce

AIMS AND OBJECTIVES/BACKGROUND

The work of specialist nursing has been under scrutiny for many years in the UK due to a perception that it is not cost-effective. A common issue is the lack of consistency of job titles, which causes confusion to the public, employing organisations, colleagues and commissioners of services. Lack of consistency has implications for the wider perception of advanced specialist practice in the worldwide community and the workforce more generally. This study aims to understand the variation in job titles in the UK population.

METHODS

A pre-existing data set of accrued studies into the work of nurses working in specialisms was mined for insight (N = 17,960). This study used knowledge discovery through data and descriptive statistics to perform secondary analysis.

RESULTS

Mining these data revealed 595 job titles in use in 17,960 specialist posts once the specialism had been removed. The most commonly used titles were Clinical Nurse Specialist, Nurse Specialist/Specialist Nurse, Advanced Nurse Practitioner and Nurse Practitioner. There were three other primary groupings. These were variants with a specialist or technical prefix of suffix, for example Nurse Endoscopist, variants of seniority such as trainee, senior nurse for [specialism] or variants of function such as Nurse Prescriber. The clustering was driven primarily by pay band. A total of 323 posts were recorded as holding titles such as Advanced Nurse Practitioner or Specialist Nurse who were not registered with the Nursing & Midwifery Council.

RELEVANCE TO CLINICAL PRACTICE

In this data set, there is a large array of titles, which appear to have little relationship with other factors like education. This is confusing to the public, employers and those commissioning services. It also demonstrates that the previous assumptions by Council for Healthcare Regulatory Excellence that advanced practice labels are associated with career progression are unsound and should be addressed by the regulator.