The Implications of Nursing Degree Education for Future Workforce Planning in Saudi Arabia: A Case Study Noura Abdulla Almadani A thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Philosophy University of Salford School of Nursing, Midwifery, Social Work & Social Sciences January 2017 Table of Contents Table of Contents ...................................................................................................................... i List of Tables ........................................................................................................................... vi List of Figures ........................................................................................................................ vii List of Appendices ................................................................................................................ viii List of Abbreviations .............................................................................................................. ix List of Terminology ................................................................................................................. x Dedication ................................................................................................................................ xi Acknowledgements ................................................................................................................ xii Abstract ................................................................................................................................. xiii Introduction ............................................................................................................................. 1 Significance of this Research ......................................................................................... 2 Statement of the Research Problem ............................................................................... 3 Research Aim and Objectives ........................................................................................ 4 Research Question .......................................................................................................... 4 Structure of the Thesis.................................................................................................... 5 Chapter 1 The Healthcare System in Saudi Arabia ......................................................... 7 1.1 Introduction ............................................................................................................. 7 1.2 Demographic, Socio-economic and Cultural Context of Saudi Arabia .................. 7 1.3 The Health System in Saudi Arabia ...................................................................... 10 1.3.1 Ministry of Health/ Public Health Care System ............................................ 11 1.3.2 Other Governmental Sectors ......................................................................... 15 1.3.3 Private Sector ................................................................................................. 17 1.3.4 The governmental bodies responsible for the legislation of a national policy for health service and education ................................................................................... 18 1.4 Summary and Conclusion ..................................................................................... 21 Chapter 2 Nursing in Saudi Arabia ................................................................................. 23 2.1 Introduction ........................................................................................................... 23 2.2 History of Nursing in Islam .................................................................................. 23 2.3 Nursing Education in Contemporary Times ......................................................... 25 2.4 An Overview of Policy Perspectives .................................................................... 31 i 2.5 Summary and Conclusion ..................................................................................... 35 Chapter 3 Literature Review ............................................................................................ 37 3.1 Introduction ........................................................................................................... 37 3.2 Section One: An Overview of Global and Local Trends in the Nursing Workforce 38 3.2.1 Global trends in nursing workforce ............................................................... 38 3.2.2 Saudi Nursing Workforce .............................................................................. 40 3.3 Section Two: A Comprehensive Systematic Review .......................................... 47 3.3.1 Search strategy ............................................................................................... 47 3.3.2 Electronic database search ............................................................................. 47 3.3.3 Inclusion and exclusion criteria ..................................................................... 48 3.3.4 Searching strategy result ................................................................................ 49 3.3.5 Critical appraisal process ............................................................................... 50 3.3.6 Key Themes in the Literature ........................................................................ 63 3.3.7 Effectual impact upon patient care through degree education & experience 66 3.4 Summary and Conclusion ..................................................................................... 74 Chapter 4 Methodology .................................................................................................... 76 4.1 Introduction ........................................................................................................... 76 4.2 Philosophical Rationale ........................................................................................ 76 4.3 Methodological Approach .................................................................................... 78 4.3.1 Research Design ............................................................................................ 81 4.4 Case Study Methodology ...................................................................................... 83 4.5 Macro, Meso, and Micro Theory/Framework ...................................................... 87 4.6 Methods ................................................................................................................ 90 4.6.1 Sampling Criteria ........................................................................................... 91 4.6.2 Study Location ............................................................................................... 93 4.7 Data Synthesis ....................................................................................................... 93 4.8 Trustworthiness of the Study ................................................................................ 95 4.8.1 Truth-value/Credibility .................................................................................. 96 4.8.2 Applicability/Transferability ......................................................................... 99 4.8.3 Consistency/Dependability .......................................................................... 100 4.8.4 Neutrality/Confirmability ............................................................................ 101 4.9 Ethical Considerations ........................................................................................ 102 ii 4.10 Summary and Conclusion ................................................................................... 104 Chapter 5 Data Collection Phases .................................................................................... 106 5.1 Introduction ......................................................................................................... 106 5.2 Macro Level (Phase one): Documentary Analysis ............................................. 107 5.2.1 Sampling ...................................................................................................... 107 5.2.2 Data Collection Procedure ........................................................................... 108 5.2.3 Data Analysis ............................................................................................... 110 5.3 Macro Level (Phase Two): Face-to-Face Interview ........................................... 112 5.3.1 Sample and Recruitment .............................................................................. 112 5.3.2 Procedure of Data Collection ...................................................................... 113 5.3.3 Data Analysis ............................................................................................... 114 5.4 Meso Level (Phase Three): Focus group ........................................................... 118 5.4.1 Sampling and Recruitment .......................................................................... 118 5.4.2 Data Collection Procedure ........................................................................... 119 5.4.3 Data Analysis ............................................................................................... 121 5.5 Micro Level (Phase Four): Focus Groups ........................................................... 121 5.5.1 Sampling and Recruitment .........................................................................