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ournal of Infection and Public Health (2013) 6, 63—68

ublic health nursing education in Saudi Arabia

oda Jradi ∗, Amal Zaidan, Ali M. Al Shehri

ing Saud Bin Abdulaziz University for Health Sciences, College of Public Health and Health Informatics, audi Arabia

eceived 8 July 2012 ; received in revised form 7 November 2012; accepted 10 November 2012

KEYWORDS Public health nursing; Saudi Arabia nursing; Nursing education

Abstract Public health nurses are key personnel in promoting and protecting the health of populations using knowledge from the nursing, social, and public health sciences. In Saudi Arabia, the nursing profession requires the integration of public health education and associated competencies in the nursing curriculum. In this paper, we aim to highlight the importance of public health nursing in overcoming the challenges associated with epidemiological transitions and responding to the health needs of rising populations, describe the development of the nursing profession in Saudi Arabia, and recommend public health teaching and training objectives for nursing education. The future Saudi public health nurse should be competent in addressing the determinants of health and illness that are salient to a culturally

distinct group. This newly outlined role for public health nurses will maximize the use of the educated Saudi nursing workforce and will fill the gap in population public health needs in an efficient and effective way. © 2012 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier

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Ltd. All rights reserved

ntroduction

ith the burgeoning heath care system in Saudi rabia and the expansion of the nursing schools,

critical need exists for nurses who are ready to artner in the shared responsibility of the preven-

ion movement and to assume a leadership role. lthough the nursing workforce is central to the

∗ Corresponding author at: College of Public Health & Health nformatics, King Saud bin Abdulaziz University for Health Sci- nces, PO Box 22490, Riyadh 11426, Saudi Arabia. el.: +966 1 252 0088x49857.

E-mail addresses: [email protected], [email protected] (H. Jradi).

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876-0341/$ — see front matter © 2012 King Saud Bin Abdulaziz University for Health

ttp://dx.doi.org/10.1016/j.jiph.2012.11.002

erformance of any health system, in Saudi Ara- ia, very little is known about its size, composition, kills, training needs, current functions and perfor- ance, expectations, or how it can be empowered

o support priority health problems in the coun- ry. There is pressure to recognize nurses as an mportant and visible component of the health care ovement. Modernizing nursing careers to fit the pub-

ic health profession requires emphasizing public ealth education and the associated competencies.

ublic health competencies, particularly those elated to chronic illnesses, will be of great impor- ance to the 21st century global health care force 1]. The Ministry of Health (MoH) in Saudi Arabia has

Sciences. Published by Elsevier Ltd. All rights reserved.

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repeatedly underlined the importance of nursing education and still faces the challenge of deliver- ing public health education and training in nursing curricular development [2—4]. In this paper, we aim to highlight the importance of public health nursing in overcoming the challenges associated with epi- demiological transitions and the health needs of the rising population, describe the development of the nursing profession in Saudi Arabia, and recommend public health teaching and training objectives for the nursing profession. This is a call for educational and training programs in public health nursing to create ‘‘tomorrow’s nurse’’, a professional that is responsible for protecting and promoting the health of individual patients, their dependents, and the public.

The transition from past to future public health needs in Saudi Arabia

Improvement in socioeconomic development over the past 40 years has resulted in startling progress in health, education, housing, and environmental resources in Saudi Arabia [5]. Life expectancy has reached 72.37 years for males and 76.42 years for females, an increase of approximately 11 years since 1970 [6]. The country’s aging population, cou- pled with rapid socioeconomic development, has increased the prevalence of risk factors for chronic disease; for example, obesity affects 64% of men and 70% of women in Saudi Arabia [7]. In particular, cardiovascular diseases and diabetes have remark- ably increased the burden of disease and disability [8,9]. Additionally, deaths and disability from road traffic accidents have been increasing exponen- tially and are now the most frequent cause of death in adult males aged 16 to 36 years in this rapidly growing nation [10,11].

All these changes in environmental and human resources require an urgent adjustment in the health care system and the health workforce of the country. It has become crucial to empower current health promotion programs and initiate new ones with the aim of reaching the community before they reach the hospital for treatment. Increasing the level of awareness of critical health issues and health education will result in a tremendous improvement in the health of the Saudi population and will enhance the prevention movement. The public health nurse will be able to take the lead

in raising awareness and planning health promo- tion programs to reduce and minimize the burden of disease and disability. This prevention move- ment requires future Saudi nurses to have an

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nderstanding of the changing dimensions of the opulation and changing living conditions and to osses an elite public education.

istory of the nursing profession in audi Arabia

o understand its strength and weaknesses and be ble to make recommendations for public health ducation in the nursing profession in Saudi Ara- ia, it is important to understand the history of his role. In Saudi Arabia, the history of nursing nd public health can be traced back to Rufaida l-Asalmiya, the first Muslim nurse [12]. In addi- ion to being the founder of the first school of ursing in the Islamic world, Rufaida advocated or preventive care and delivered health-related eachings to the community [13]. In the last cen- ury, the first contribution to nursing is credited to rs. Lutfia al Khateeb, who obtained her diploma

rom Cairo in 1941 and has dedicated her life to nhancing the health education of Saudi women 14]. Samira Islam was also a nursing advocate,

pharmacology professor, and, like Lutfia and ufaida, made a remarkable contribution to nurs- ng advancement within the framework of Islamic alues [12,15].

The first formal training for nurses in Saudi Ara- ia was initiated in 1958 as a collaborative effort etween the Ministry of Health (MoH) and the orld Health Organization [2,15]. Shortly after,

he health care system in Saudi Arabia began to evelop rapidly in response to the changing health are needs of a population that arose from the doption of an increasingly affluent lifestyle [3]. n 1996, Saudi nurses comprised 9% of the total ursing work force, and by 1999, 17% of the total ork force was comprised of Saudi nationals [15]. he rise in Saudi nursing graduates increased the ercentage of nurses to 18% in 2003 [15]. The audi healthcare system has long been dependent n expatriate nurses that form a large proportion f the nursing workforce [4]. Saudis today still omprise only 29.1% of the total nursing work- orce [4]. In recent years, Saudi women have been ecruited into nursing preparation courses taught t the degree level [15]. For several years, the MoH ontinued to operate two levels of nursing educa- ion: the ‘‘Post-Intermediate Nursing Institute’’ (3 ear course with a diploma) and the ‘‘Post-High

chool Nursing College’’ (bachelor degree in nurs- ng) [5]. In 2010, the MoH recommended that a accalaureate of nursing is the minimum degree equired for professionalism and the entry level to

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ractice [16]. However, the MoH, which is striving o improve the nursing profession, has developed n upgraded bridging program for diploma students or the purpose of improving the professional qual- ty of Saudi nurses entering the labor market [15]. pproximately 23,000 Saudi nursing graduates were

dentified as candidates for the bridging program 17]. Furthermore, the MoH has upgraded its Health nstitutes to the ‘‘Colleges of Health Sciences’’, nd by 2008, all educational organizations under he MoH were transferred to the Ministry of Health ducation (MoHE) to improve the quality of nursing ducation [4].

Despite these efforts to improve nursing educa- ion in Saudi Arabia and the history that includes he role of pioneers who founded and practiced ursing fourteen hundred years ago [12], nurses n this country still lack a consensus on their role ithin the wider context of social and health care omains.

In Saudi Arabia, the profession of nursing has rogressed in the usual practices and branches of linical and specialized nursing but has omitted the ublic health facet. A developmental model of nurs- ng in Saudi Arabia was presented earlier; in that odel, public health nurses must form the majority

f the nursing workforce and be the foundation that ill maintain the power and play a major role in the ursing profession [18]. It is important to consider he education of nurses for this job. In this paper, he interest in public health is emphasized, and eforms of the nurse’s role are suggested. We sug- est that public health nursing should be integrated nd sustained in the Saudi Arabian health care sys- em in addition to other nursing roles, such as the ospital nurse and the specialized nurse. Recom- endations are made concerning the public health

ompetencies for the Saudi public health nurse, as ell as the integration of public health in nursing ducation and training.

he projected role of the Saudi public ealth nurse

ccording to the American Public Health Asso- iation (APHA), public health nursing (PHN) is ‘the practice of promoting and protecting the ealth of populations using knowledge from nurs- ng, social, and public health sciences’’ [19]. y setting new priorities and goals, this evolv-

ng practice of nursing originates from discussions bout what is most needed in Saudi Arabia in term f health care services, who the vulnerable popu- ations are, and how they can be reached. The

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ublic health nurse is expected to play an extended ole that encompasses community care, support, urveillance, education, and research [20,21]. The evelopment of this role is occurring in response o the rising challenges of chronic illnesses, the ging population, the increase in disabilities, the hreat of emerging infectious diseases, and the fforts to address the socioeconomic and cul- ural determinants of health in order to have the reatest impact on health [20]. Additionally, the eed for public health interventions that change ndividuals’ behavior so they make healthy deci- ions, clinical interventions that require limited ontact but provide long-term protection and a lethora of evidence-based practice guidelines, ngoing surveillance for monitoring and evaluation, nd counseling skills may contribute to the educa- ion and development of the Saudi public health urse.

The Saudi public health nurse may become com- etent in addressing the determinants of health and llness that are salient to a culturally distinct group. s a public health professional, the nurse may plan cological interventions to change the context to romote better health, such as sanitation and safe chools, and may have the capacity to implement rotective interventions, such as immunizations nd screening [20—22]. The Saudi public health urse may advocate, build coalitions, collaborate, nd organize communities of stakeholders to sup- ort health programs [20]. It is expected that this ulturally competent nurse will act as a consult- nt and will counsel, investigate diseases, teach, evelop policies, screen, conduct social marketing ampaigns, and evaluate situations through ongo- ng surveillance [20,21]. These actions will have the reatest population impact and will require a high evel of education and training.

It is anticipated that implementation of the role f the public health nurse as described above will aximize the use of the educated Saudi nursing orkforce and may provide expertise in meeting

he current and future needs of populations, com- unities, families, and individuals. Hence, public

ealth nurses may fill the gap in the public health eeds of the population in an efficient and effective ay.

ecommendations for integrating public ealth in nursing education

elivering public health-specific undergraduate ursing education in Saudi Arabia requires a robust urricular structure that will prepare the nurse to

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meet public health competencies as they relate to the management of chronic illnesses and the importance of the global health care workforce in the 21st century. The health and safety of the Saudi Arabian population and surrounding countries are projected to be an important part of the cur- riculum, and practical learning opportunities must allow the students to perform the following: (1) conduct a needs assessment in relation to the available services; (2) identify the genetic, envi- ronmental, and social determinants of diseases and prevention; and (3) be competent in promoting health and preventing diseases, including screening and evaluation. The public health syllabus in nursing education must cover the sciences and disciplines that underpin public health for this par- ticular population (Box 1) and provide benefits to clinical nursing practice and the Saudi population.

With adequate education, the Saudi public health nurse can practice nursing more effec- tively by applying critical appraisal skills in decision making, even in clinical settings where uncertain- ties are encountered. Epidemiological sciences will merge with clinical skills to form what is called ‘‘clinical epidemiology’’ and eventually produce a

better understanding of the history of disease and disease progression, resulting in improved preven- tion and allocation of resources [20]. Nurses with

Box 1: Recommended sciences and disci- plines for public health nursing education in Saudi Arabia

• Epidemiology • Disease prevention and control • Health behavior • Health promotion • Health from an Islamic perspective • Health disparities (with a focus on gender

inequality) • Critical appraisal skills and research method-

ology • Literature searching skills for evidence-

based practice both globally and regionally • Communicable and non-communicable dis-

ease control • Medical statistics • Health economics • Medical sociology • Occupational health • Environmental health • Global public health • Sociology • Psychology

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good educational emphasis and understanding f their role in the health and social context of he Saudi population may have an impact on plan- ing future healthcare services. The well-educated ublic health nurse will ensure that all delivered nterventions benefit all patients with no gaps in elivery and will make a difference for the entire opulation [20,23].

The public health curriculum in nursing schools n Saudi Arabia will aim to include all the sciences nd disciplines presented in Box 1, in addition to eing mindful of the human rights aspect, reli- ious restrictions, and ethical issues. Equality and

united view of ‘‘health for all’’ are core val- es in public health [24]. There is no single list of ducational objectives that may apply to all nurs- ng colleges in the country, as educational contexts nd environments differ. However, a proposed basic et of public health educational goals (Box 2) for he nurse may be applied flexibly and contribute o what is expected from the Saudi public health urse. The nursing student with a public health ducation should be able to understand the disci- lines that underpin public health education (Box ) in order to benefit the population and improve ts health. Awareness of the determinants of health n Saudi Arabia, the history associated with the ountry and its religious and social structures, and he changing current environment will all enable he public health nurse to manage and overcome bstacles during their working careers. There are essons to be learned from the past and inevitable

hanges to be faced in the future. The delivery of ublic health education for nursing may become

challenge for the nursing and public health

Box 2: Recommended public health nursing educational goals

• The public health nurse should be able to: • Discuss the population determinants of

health and disease • Apply principles and practices of health pro-

motion • Use epidemiology and data handling for the

practice of evidence-based public health nursing

• Apply communicable and non-communicable disease prevention and control strategies

• Implement needs assessment, health care planning, and evaluation

• Describe the Saudi health care system and scope of available services

• Help and cope with research activities

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cademic departments as the ‘what’, ‘how’, and why’ of such education must become a priority on he national public health agenda.

Education and practice guidelines require esources. Ensuring that public health educa- ion and training for nurses is well funded and ailored to local needs is an obligation of the cademic educator and the decision-makers in ursing institutions. This task is a difficult one hat should take into consideration the different odels for public health education for nurses

hroughout the world, as benefits can be gained rom learning from the experience of others. It s beneficial to know the costs and benefits of uch models and to understand how are they valuated.

Recommendations for introducing public health o the nursing profession are a powerful reminder f the need for such a discipline in Saudi Arabia. he Saudi Ministry of Health has repeatedly under-

ined the importance of nursing education and the eed to adopt a public health educational cur- iculum to better meet the heath needs of the opulation. For the nurse, merging individual and opulation care is a way of highlighting the impor- ance of public health in clinical practice and in haping society’s view about public health. The oals proposed for public health nursing in this anuscript are broad principles that should be used

o guide curriculum development and provide the urse with the professionalism that will earn the rust of the public. These goals can be perceived ifferently by different people depending on their areer intention but necessarily pose the question f what ‘skills’ are needed to be able to perform the ole, and whether a good public health education s associated with a good professional public health urse.

We recommend public health education for nurs- ng students in order to prepare the Saudi nurse o take a lead in social responsibility and to ful- ll the need to understand the causes of the health eterminants of the population of Saudi Arabia. The ublic health nurse will have an indispensible role n preventive population health. Education, patient ervices, research, health advocacy, and redesign- ng services for better delivery are all areas that lace individual needs in the context of the wider eeds of the population.

onflict of interest

here are no competing interests to declare.

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unding

o funding sources competing interests.

ontributorship

ll authors have contributed to this publication and old themselves jointly and individually responsible or its content, and there is no conflict of interest.

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