Final Thesis
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Perceptions of the Community toward the Nursing Profession and its Impact on the Local Nursing Workforce Shortage in Riyadh A thesis submitted for the degree of Doctor of Philosophy By Hammad Meshher Alroqi Faculty of Medical Sciences Anglia Ruskin University February 2017 I Acknowledgements I would like to acknowledge the many individuals and groups who contributed to the development of my thesis. My deep gratitude and thankfulness goes out to my supervisors: Dr Sarah Burch, Dr Mansour Mansour and Professor Sharon Andrew for their continuous support and guidance throughout the course of my PhD study. Their advice and feedback were extremely valuable. My sincere appreciation and thankfulness goes to my family; my beloved wife, daughters and my mother and father for their support, patience and encouragement during my study and stay in the UK. Also, I would like to thank all the students, families and nurses for their participation in this study. I am also thankful to my sponsor, Prince Sultan Military Medical City, for their valuable support during my study. Author’s Declaration I declare that this thesis is a presentation of my original research work for the PhD program at Anglia Ruskin University and has not been previously submitted, in whole or in part, for any other degree or qualification to any other academic institution. Wherever the contributions of others are involved, this is clearly acknowledged and referenced. Some of the material contained here has been presented in the form of the following: 1- Presented as a well-received poster at the Royal College of Nursing Annual International Nursing Research Conference and Exhibition in Nottingham, April 2014. 2-The Ninth Students Conference at Anglia Ruskin University...Presentation June 2015. 3- Nursing Education Today Conference-NET-2015 at Cambridge University...Presentation September 2015. Name: Hammad Meshher Alroqi Date: 13 February 2017 Signature: III List of Abbreviations BSN–Bachelor of Science in Nursing CEO–Chief Executive Officer MoCS–Ministry of Civil Services MoEP–Ministry of Economy and Planning MoH–Ministry of Health MoHE–Ministry of Higher Education MoL–Ministry of Labour MoP–Ministry of Planning KSA–Kingdom of Saudi Arabia RN–Registered Nurse SA–Saudi Arabia KSA–Kingdom of Saudi Arabia SCFHS–The Saudi Council for Health Specialities α–Statistical Significance Alpha ANOVA–Analysis of Variance SD–Standard Deviation SPSS–Statistical Package for the Social Sciences WHO–World Health Organization List of Appendices Appendix 1: An Ethical Approval Issued by Anglia Ruskin University Appendix 2: Written Approval From the Author to Use the Original Questionnaire Appendix 3: Participants’ Information Sheet Appendix 4: Copy of the Consent Form Appendix 5: The questionnaire’s English Version Appendix 6: The questionnaire’s Arabic Version Appendix 7: Written Permission to Access the Selected Schools Appendix 8: Written Permission to Access the Selected Hospitals V ABSTRACT Riyadh City in the Kingdom of Saudi Arabia (KSA) has a chronic and severe shortage of Saudi-trained nurses and a high nurse turnover rate. Expatriate nurses comprise most of the nursing workforce in Riyadh. This presents a challenge to safe healthcare delivery. To formulate strategies to promote and encourage secondary school Saudi students to choose nursing as their career path, it is imperative to understand community attitudes and perceptions toward the nursing profession. The aim of this study is to explore the perception of the Riyadh community toward nursing as a future career choice. In this study, the Riyadh community refers to final year high school students, parents of high school students and Saudi nationals working as nurses in Riyadh. A sequential exploratory mixed-method study was utilised to accomplish the aim and objectives of the study. The first phase uses qualitative focus groups and was conducted with the general community and nursing groups; it explored the issues and their perceptions of nursing in general. A questionnaire was adopted from Elham Al Naqshbandi. The validity and reliability of the questionnaire was tested, and the items of the questionnaire were assessed for their appropriateness. Finally, the questionnaire was distributed to the target sample in groups in Riyadh City. The qualitative findings were presented using explanatory themes in two sections. The three themes in section one are as follows: What is nursing? The contradictions; Social challenges; and Influence on the students’ decision to choose nursing as a career choice. The two themes in section two are the following: Experiences in career choice and a view of nursing in the Riyadh community. In the quantitative stage, 554 (86.6%) high school students completed the questionnaire in October 2014. The findings indicate that although school students respect the nursing profession, they demonstrated a lack of awareness in the community about nursing. Students’ concerns about nursing were around perceived future marital status and the lower financial remuneration compared to other professions. Riyadh community high school students are potential recruits for local nursing programmes and are a source of understanding about nursing as a career choice. The findings of this study support previous studies that reveal that choosing nursing as a career in Riyadh, KSA is strongly influenced by the societal image of the nursing profession and family attitude toward nursing. One’s perception of nursing as a career in Riyadh is influenced by institutional factors in the Saudi context (cultural-cognitive and normative factors). The reasons for not being interested in nursing as a future career include, but are not restricted to, normative factors; social status, financial status and sociocultural factors, such as influence of parents and religion; the issue of mixing with other genders; and long working hours and doing night shifts. Encouraging Saudi high school students to consider nursing as a future career option in Riyadh city requires fundamental reform and improvement to the societal image and understanding of the nursing profession. Strategies to do require plans to engage family members, particularly parents, as well as the leaders from high schools, nursing, the community, media and religious leaders to help reshape the image of nursing. Key Words: Nursing, Saudi Arabia, Workforce, Recruiting, Shortage, Perception VII Table of Contents Chapter 1: .............................................................................................................................. - 1 - 1.1 Introduction ............................................................................................................ - 1 - 1.2 Personal Interest in the Research ........................................................................... - 5 - 1.3 Significance of the Project ..................................................................................... - 6 - 1.4 Methodology .......................................................................................................... - 6 - 1.5 Aim and Objectives of the Study ........................................................................... - 7 - 1.5.1 Aim ................................................................................................................. - 7 - 1.5.2 Research questions .......................................................................................... - 7 - 1.5.3 Objectives ....................................................................................................... - 7 - 1.6 Overview of the Thesis .......................................................................................... - 8 - 1.7 Summary of the Chapter ........................................................................................ - 9 - Chapter 2: ................................................................................................................................. 10 2.1 Introduction ............................................................................................................... 10 2.2 Saudi Demographics ................................................................................................. 10 2.3 Saudi Culture ............................................................................................................. 12 2.4 Health and Healthcare in Saudi Arabia ..................................................................... 14 2.5 Cultural Background of Healthcare in Saudi Arabia ................................................ 15 2.6 A Historical Background ........................................................................................... 16 2.7 Nursing Education ..................................................................................................... 17 2.8 Nursing Workforce in the KSA ................................................................................. 20 2.9 Human Resources in the Saudi Healthcare System .................................................. 21 2.10 Government Plan: Saudizations ............................................................................. 22 2.11 Summary of the Chapter ........................................................................................ 23 Chapter 3: ................................................................................................................................. 24 3.1 Introduction ............................................................................................................... 24