Future of Nursing Education in the Kingdom of Saudi Arabia The primary objective of this book is to provide the reader with evidence-based nursing education and practice principles. The goal of this work is to help nursing educators and nurse practitioners develop evidence-based nursing education standards and curriculum while providing nurses with effective examples of patient-centered care that is both high quality and cost effective. Patients and family members in Saudi Arabia have needs and expectations that nurses should seek to meet and fulfill. To that end, this book aims to support nurses and nurse educators.

The cultural values of the Kingdom of Saudi Arabia are also an important component of this work, as it is the culture of this country that supports and advances the aims of the nursing profession. This is seen in every aspect of the nursing profession -- from the earliest days of the first nursing pioneer to now, as the nation seeks to define itself and forge a path forward in the 21st century.

The secondary objective of this book is to help in developing a culture of professional nursing. It aims to provide a professional nursing model that can be utilized by nursing educators and clinicians, enabling them to strive professionally towards demonstrating the values, ideals, aims, and skills of the nurse practitioner. To that end, this book puts forward suggestions for a rigorous nursing curriculum, promotes research development and utilization, and provides both educators and students with new ideas about how to face the difficulties and issues that are unique to the culture of the Kingdom of Saudi Arabia.

It is my sincere hope that you find this book useful and appropriate as you partake in the advancement of the nursing profession in Saudi Arabia.

Chapter 1: Historical Perspective of Nursing in the Kingdom of Saudi Arabia

Compassionate care served as the basis for the first nurses in the Arab world. From the very first days of Islam to now, this has been the primary driver of nursing in what is now known as the Kingdom of Saudi Arabia. Because of strict rules and observances regarding the roles of men and women in Arab culture, the nursing profession has had to develop almost organically in between cultural directives and modern governmental and educational policies. Historically, the nursing profession has depended upon the community-based care of local healers, with some noteworthy exceptions, who have pioneered the nursing profession.

In 1932, the Kingdom of Saudi Arabia was formed. The unification of the Hejaz and Nejd under Abdul-Aziz bin Saud resulted from a series of battles and wars fought throughout the first part of the 20th century. The region over which Saud exerted control was exceedingly poor -- a desert landscape where civilizations had existed in clusters for thousands of years. What would become the Kingdom's lucrative oil fields had, at the time of its founding, not yet been tapped. As a society, the Kingdom stood at the very beginning stages of development and yet, compared to the Western world, rooted in a very old culture -- Islam -- with a Wahabbi slant. The conditions required for modern, research-based nursing were virtually non-existent. Health care in the early days of the Kingdom was primarily community-based rather than research-based.

6th to 7th Century AD: The Islamic Period

The community-based practices of the Kingdom stemmed from the regional and cultural traditions of the Arab population. This population dated back for centuries -- even to the earliest days of Islam. The first major Muslim nurse was in fact a contemporary of Mohammed: her name was Rufaida Al-Asalmiya (Miller-Rosser, Chapman, Francis, 2006). Rufaida al-Asalmiya demonstrated a number of skills -- those of nurse, surgeon and social worker (Jan, 1996). This combination of medical knowledge, compassion, and full spectrum service corresponds with the concept of community-based practices commonly exercised in the Arab land: empathy and compassion were the heart of community-based care. Compassionate care drove the first nurses, like Rufaida al-Asalmiya, to hone their skill-set and identify best practices to treat the various ailments that patients would present. Considering the often war-torn times of the Middle Ages when Rufaida lived, it should not be surprising that this type of care was provided. Necessity outweighed formal practice and Rufaida's response to the needs of wounded warriors was based on her role both as a woman in Islamic society and as a leader, identified as such by Mohammed himself.

Rufaida was essentially an early Arabic version of the (much later to come) Western Florence Nightingale -- a nurse devoted to caring for the fallen soldiers who fought in the holy wars. Rufaida and her attendant nurses were women who sought to give comfort and emotional assistance to Mohammed's...

Their roles helped to set the stage for future nurses by providing an historical example of care during the initial Islamic Period (Tumulty, 2001).
Combining the Teachings of the Ancients with the Ideas and Nursing Practices of Physicians in the Post-Prophetic Era

This early period of history was not without some degree of research-based understanding of medicine. Islamic physicians often provided nursing care to patients that combined the learning of the Greeks with the compassionate care demonstrated by Rufaida. Rufaida's nursing style was, moreover, an extension of the natural and organic impulse of the nurse practitioner to tend to the needs of others -- which today is called patient-centered care (Karabudak, Arslan, Basbakkal, 2013). Thus, Arab physicians during the post-Prophetic Era in Arabian history, drew both upon the works of Mediterranean scholars and the cultural imperatives passed on to them by Mohammedan society. Caring was very much a spiritual act (Rassool, 2014) that nonetheless drew on the medical knowledge of the ancients (Kyziridis, 2005).

The Arab world had, after all, inherited the vast body of medical works and treatises written by the Greeks. As Lin (2008) notes, "The knowledge of the earlier Greek medical teachings came to Islam through Nestorian Christians driven out of Byzantine and settling in Persia" (p. 41). The Arabs not only preserved the Greek writings and teachings, but translated them, studied them and added to them. The Arabic language became a the language of scholarship in the region -- for as the Golden Era of Greek civilization fell away under the ashes of time and history the Arab civilization gathered and saved that which it deemed worth keeping. From Plato's assessment that if one wished to cure the body he must first start by healing the soul, to Galen's second century AD finding "that mental diseases could be the result of a disorder in the brain or the secondary result of the disorder of another organ" (Kyziridis, 2005, p. 43), the Greeks had made significant penetrations into the world of medical science and nursing from both a spiritual and a biological perspective. The Arab world was much indebted to the work of Galen in Rome, who extended and deepened the work begun on the Greek island of Kos, where Hippocrates laid the foremost teachings for physicians under Pericles (Holmes, 1997). The Arab world also drew on its own deep spirituality to provide guidance in terms of how it approached the practice of nursing. As Rassool (2014) points out, "the history of nursing in Islam grounds the nursing identity in the religious values shared between nurses and patients" (p. 36). Thus it was that Rufaida found such favor with Mohammed: she represented to him and his followers exactly the type of compassionate community-based care that a devout Muslim should show towards others who were suffering and in need. Al-Osimy (2005) states as much when he quotes the Quran as teaching that "whoever works righteousness, whether male or female, while he (or she) is a true believer (of Islamic Monotheism) verily, to him We will give a good life" (p. 1). In other words, if Rufaida set the stage for nurses in Saudi Arabia, Mohammed provided the spiritual guidance and support for their commission.

Yet, there was much intellectual activity among physicians and nurses during this time as well. By the 800s AD, even as Charlemagne was uniting the European tribes under the banner of Rome, an Arab physician named Ibn Rabban at-Tabari was busily describing in his own book the various maladies and diseases known to affect the working of the brain (Kyziridis, 2005). Thus, to assume that no research was being conducted in the Arab world prior to the modern era is to miss out on a number of substantial facts. The Arab peoples of the past were thoroughly interested in deepening the vast body of knowledge on medicine, pharmacy, therapy, chemistry, and nursing techniques that could be used to help patients experiencing a wide variety of symptoms (Saad, Said, 2011). And though direct study of the human body (via dissection) was forbidden in the Arabic culture, Arab researchers certainly put forward working theories on the relationship of the parts of the body: everything from pores to veins to arteries and lungs was seen as having an integral, relational role to play in the life of the body. These theories were based on Arabic…