Perception of Physicians about Advanced Nurse Practitioners in Saudi Arabia

Running head: Dissertation
LACK OF KNOWLEDGE, UNDERSTANDING AND AWANESS ABOUT THE
ROLE OF ADVANCED NURSE PRACTITIONERS AMONG PHYSICIANS IN SAUDI
ARABIA
Ahlam AL-Harbi
CAPSTONE PROJECT SUBMITTED FOR THE MASTER OF SINCE IN
NURSING: ADVANCED PRACTICE
DR.MARRY
DCU&PNU
18-6-2019

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Table of Contents
Chapter 1:.......................................................................................................................4
Introduction....................................................................................................................4
Background................................................................................................................4
Research aim:.............................................................................................................6
Theory Framework:....................................................................................................7
Educational Need to be certified as ANP:..................................................................8
Perception of physicians about ANPs........................................................................9
Significance..............................................................................................................10
CHAPTER 2:...............................................................................................................11
Literature review:.........................................................................................................11
Introduction..............................................................................................................11
Search strategy.........................................................................................................11
Inclusion and exclusion criteria...............................................................................11
Key words................................................................................................................12
Discussion................................................................................................................12
Chapter 3......................................................................................................................14
Methodology................................................................................................................14
3.1 Introduction........................................................................................................14
3.2 Research design..................................................................................................15
3.3 Research method................................................................................................16
3.4 Data collection...................................................................................................16

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3.5 Data analysis......................................................................................................16
3.6 Evaluation..........................................................................................................17
3.7 Method and materials (instruments)...................................................................17
3.8 Sample................................................................................................................18
3.9 Ethical considerations........................................................................................18
3.10 Preparation.......................................................................................................19
3.11 Protocol design.................................................................................................19
Chapter 4......................................................................................................................20
Result and analysis.......................................................................................................20
Demographic study (data collected prior to the conduction of survey).......................20
Profession of the participants.......................................................................................20
Experience of the participants......................................................................................20
Gender of the participants............................................................................................22
Training received in last one year................................................................................23
Nationality....................................................................................................................23
Highest degree of education.........................................................................................24
Current employment status..........................................................................................25
Demographic findings..................................................................................................26
Pre survey data analysis...............................................................................................26
Findings from the pre survey data................................................................................31
Conduction of post training survey and analysis of the data.......................................31

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Paired t-test for the repeated seven questions (Both in pre and post survey)..............32
Chapter 5......................................................................................................................38
Discussion....................................................................................................................38
Overview......................................................................................................................38
Interpretation and evaluation of the findings...............................................................39
Validating findings.......................................................................................................40
Chapter 6......................................................................................................................42
Conclusion....................................................................................................................42
References....................................................................................................................44
Appendix......................................................................................................................51

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List of Tables
Table 1.........................................................................................................................21
Table 2.........................................................................................................................21
Table 3.........................................................................................................................22
Table 4.........................................................................................................................23
Table 5.........................................................................................................................24
Table 6.........................................................................................................................24
Table 7.........................................................................................................................25
Table 8.........................................................................................................................26
Table 9.........................................................................................................................29
Table 10.......................................................................................................................29
Table 11.......................................................................................................................30
Table 12.......................................................................................................................32
Table 13.......................................................................................................................32
Table 14.......................................................................................................................34
Table 15.......................................................................................................................34
Table 16.......................................................................................................................36
Table 17.......................................................................................................................37
Table 18.......................................................................................................................37
Table 19.......................................................................................................................38
Table 20.......................................................................................................................39
Table 21.......................................................................................................................39
Table 22.......................................................................................................................40
Table 23.......................................................................................................................41

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Chapter 1:
Introduction
Background
Advanced Nurse Practitioners are specialized nursing professionals who possess years
of experience in the process of providing care services to the patient (Elliott et al. 2016). ANP
or Advanced Nurse Professionals possess the ability to assess, investigate, diagnose and
prescribe patient care independently (Aldossary 2013). However, research studies suggest
that the role of Advanced Nurse Practitioners in the field of health care system is not clearly
understood by the physicians and the allied health care professionals. Also, the concept of
ANP has not yet been absorbed within the healthcare system of Saudi Arabia (Begley et al.
2013). This paper therefore, intends to evaluate the perception of the physicians in relation to
the role of ANP within the healthcare system of Saudi Arabia.
An ANP (Advanced Nurse Practitioner) is classified as a mid-level practitioner. An
ANP is sufficiently trained to assess the needs of the patient, refer and interpret diagnostic lab
results, diagnose the disorder and accordingly prescribe medication or treatment routine
(Poghosyanet al. 2014). According to Begley et al. (2013), the ANP training critically covers
the aspects of prevention of health related risks, coordinated care planning and health
expertise. These training areas are substantially covered in the training process of Nurse
practitioners but in case of NPs, the training lacks expertise to identify complex cases that
indicate the prevalence of serious disease conditions with multiple symptoms (King, Tod and
Sanders 2017). As stated by the American Association of Nurse Practitioners, a nurse
practitioner who has acquired a master’s or doctoral degree is substantially equipped to
impart primary, acute, chronic as well as speciality care to the patients (Kleinpell, Cook and

6DISSERTATION
Padden 2018). Further, it should be noted that the scope of practice for the Nurse
Practitioners is regulated by territorial jurisdiction. On the basis of the Jurisdiction, it can be
mentioned that the ANP or Advanced Nurse Practitioners might be entitled to practice under
the supervision of a physician (King, Tod and Sanders 2017).
Research studies indicate that the role of ANP (Advanced Nurse Practitioners) came
into being during the mid-twentieth century in the United States of America (Lowe et al.
2013; Dalton 2013).In the year 1940 the individual role of the Nurse Anaesthetists and Nurse
Midwives were recognized. On the other hand, the year 1954 marks the recognition of
psychiatric nursing (Lowe et al. 2013). The recent concept of Advanced Nurse Practitioners
was developed recently in the 1960s when the world experienced a national shortage of
medical doctors. It should further be noted that the first certificate program for nurse
practitioners was developed by Henry Silver who was a physician in collaboration with
Loretta Ford who was a Nurse Practitioner (Hain and Fleck 2014). A formal recommendation
was made by the United States Secretary of Health, Education and Welfare who critically
explained the need to expand the scope of nursing practice so as to grant an equal status to the
Nurse Practitioners as that of Primary Care Providers (Sanders et al. 2016). The year between
1970s to early 1980s made it mandatory for Nurse Practitioners to complete a master’s degree
in order to be awarded with a practice certification (Begley et al. 2013). In the year 2012,
several discussions were held by different accreditation agencies and national certification
bodies as well as state boards that debated about the likelihood of making The Doctor of
Nursing Practice (DNP) as the minimum standard of education criteria for Nursing
Practitioner certification and licensure by the end of 2015 (King, Tod and Sanders 2017).
The quality of care provided by the Nurse Practitioners has often been questioned. It
should be mentioned in this context, that research studies have highlighted a number of issues
consistent with the lack of substantial training among the Nurse practitioners to impart

7DISSERTATION
quality in terms of care delivery (Harris et al. 2016). Issues such as wrong prescription of
antibiotics when not in need have been highlighted by the research studies (Donelan et al.
2013; Lowe et al. 2013). Also, it has been pointed out that there is a need to improve the skill
set of nursing abilities in order to ensure quality in terms of care delivery. Studies also
suggest that nurses are more likely to make unnecessary referrals when there is no need for
the same (Lucas et al. 2019). In addition to this, it has also been argued by researchers that
nurses are likely to order a set of unnecessary tests and procedures such as imaging studies or
skin biopsies for the detection of disease.
Advanced Nurse Practice is majorly dependent upon the contemporary as well as the
social health care needs of the people and identification of influencing factors such as public
health behaviours, population growth trend, life expectancies and community health
programs (Verma and Acharya 2018). The ANP make use of the advanced technology and
knowledge expertise to devise care according to the patient needs (AlYami and Watson
2014). While the healthcare systems of developed nations such as the United States and
Australia have absorbed the ANP care model to render care services to the patient, the same
seems a far-fetched reality for Saudi Arabia (Anderson 2017).
The Nursing profession in Saudi Arabia is laden with a number of challenges which
impedes the development and evolution of the profession. As stated by Lamadah and Sayed
(2014), the primary barriers in the form of lack of adequate staffing, confusion about job role
and lack of advanced education opportunities in Saudi Arabia has led to the decreased
acceptance of the ANP care model in Saudi Arabia (AlYami et al. 2014).
Research aim:
 This research aim of the study intends to assess the perception of Physicians in
relation to the role of Advanced Nurse Practitioners within Saudi Arabia.