Saudi Arabia & Thailand: Comparative Nursing Paper
The two nations that will be utilized for comparison in regards to nursing education are Saudi Arabia and Thailand. These nations are interesting to examine because they are both long histories, especially from the standpoint of such a young nation such as the United States. In addition, both nations have differing cultural influences, as well as, differing governmental approaches that are both quite interesting with regards to how they influence the nursing education, as well as, the nursing profession itself. Thailand and Saudi Arabia are two nations that have many differences, but share many similarities, nursing being one of those similarities.
Political History and Development of Nursing Education
In the early Islamic times, women were known to join men near the battlefield so that they could help tend to the wounded. “These women were known as ‘Al Asiyat’ or ‘Al Awasi’, and each one of them was called ‘Asiyah’” (Almalki, FitGerald, & Clark, 2011). The first recognized female nurse was Kuaibah Bint Sa’ad Al-Aslamiyah. She lived at the same time as the Prophet Muhammad. She set up a tent near the mosque in Madinah and worked there with other women to treat the sick and injured. Following the death of Prophet Muhammad, there was nothing written about nurses until the 1950’s. There could be many reasons for this, including a cultural/religious aversion to sharing private information about one’s body. Nurses were likely viewed as healers, had no regulations directing their reporting methods or findings to any specific organization, and no doubt did not keep records because they knew their patients.
The first nursing school in Thailand was opened in 1896 by Queen Sripatchariantra. “The tragedy of losing her infant child to cholera and the high maternal death rate motivated her to introduce modern nursing to Thailand” (Anders & Kunaviktihul, 1999). Her son Prince Mahidol attended medical school at Harvard University. He invited the Rockefeller Foundation to Thailand in order to offer their assistance to the Ministry of Public Health in order for Thailand’s medical facilities and care to become top notch.
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The first nurses were the daughters of the noble class. These specific women are the only ones who had the required educational background to be accepted into the nursing schools. In the beginning, nursing schools had the female students focus solely on midwifery. At this point in time, it was culturally taboo in Thailand for females to care for male patients; therefore, a male nursing school was then opened in order to train men to be nurses so that men could receive nursing care without breaking the cultural taboo.
Government and Nursing Organizations Influencing Nursing Education
“Health education in present-day Saudi Arabia started in Riyadh in 1958, when the Ministry of Health (MOH), in cooperation with the World Health Organization (WHO), initiated the first health institute for boys” (Almalki, FitGerald, & Clark, 2011). The government of Saudi Arabia is one that can be best described as authoritative; therefore nothing is done without the approval of the King. A few years after the male nursing school opened, a female school opened. This was something that was necessary. From an Islamic perspective, a male cannot care for a female, and a female cannot care for a male. The only way this is permissible are strict familial rules, for example a woman can physically care for her husband or son, but not her father. A man can care for his wife, but not his daughters.
“In 1967, the Department of Health Education and Training (DHET) was established by the MOH” (Almalki, FitGerald, & Clark, 2011). This means the Ministry of Health, which is a governmental organization has complete oversight of nursing education. The Ministry of Health answers to the King, which means the King himself, had direct oversight over nursing education from the early days of nursing education in Saudi Arabia. Of course, he would not directly run the oversight, but any abnormalities, concerns, or changes would have to go before the King.
The royal family of Thailand is the ones who introduced nursing to Thailand, in the modern sense of nursing. The first nursing school was named after the Queen’s son who had passed away, which resulted in her desire for highly educated nurses to care for women and children. Her other son, who became a western-educated doctor, had an American foundation work with the government of Thailand in order to establish medical education and faculties, just like in the United States.
In 1975, the nursing practice act was passed and the Thai Nursing Council was formed. The Thai Nursing Council has 32 members, half of which are elected to their positions by their fellow nurses. “The other 16 members are appointed to the board by other agencies such as the Ministry of University Affairs and the Ministry of Public Health” (Anders & Kunaviktihul, 1999). This means that the government of Thailand not only has a great deal of oversight in regards to nursing and nursing education, they also have a great deal of sway with regards to the running of the council and the decisions they make. The council itself is not governmental, but the fact ministries appoint half the members, one can argue that the governments interests are amply represented.
Current System of Nursing Education
Currently the nursing education programs and organizations were transferred from the MOH (Ministry of Health) to the Ministry of Higher Education (MOHE) (Almalki, FitGerald, & Clark, 2011). This has split all of nursing between two governmental agencies. While training and learning future nurses (as well as their programs and training) are looked after by the Ministry of Higher Education. Once they graduate, receive their licensing, and obtain work they are now under the watchful eye of the Ministry of Health. Either way, both Ministries answer to the King.
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“In 2004, the Department of Nursing was once again upgraded to College status (in Saudi Arabia, colleges are the principal divisions of the university, and each college contains a number of departments)” (Almalki, FitGerald, & Clark, 2011). The disticinction of college status helps organize the gender specific schools, the curriculum, and the training. For example, one can train to be a specialized nurse, this specialization would require certain educational standards, the College status allows this specificity to occur for the students, as well as, the faculty, and members of the Ministry that oversees them.
Private nursing colleges must be accredited and licensed, which is overseen by the Saudi Committee for Health Specialists. Every nurse who completes their education is given a diploma or a certificate for completing training courses. Some are provided both, the certificates being minor achievements and the diploma being the major achievement. Recently, the Saudi Arabian government has been focusing on bettering the nursing education due to the shortage of nurses it is and has been facing.
“The Thai Nursing Council regulates the accreditation and licensing of nursing schools” (Anders & Kunaviktihul, 1999). Students can attend a nursing school for a 2-year nursing degree. They also have the option of attending an additional 2-years in order to be determined a ‘professional’ nurse. A single 2-year degree results in a certificate, and the additional 2-year degree results in a diploma. Each degree is differentiated by the status one obtains upon completion of the educational coursework. In addition, in order to obtain the degree for the 4-year degree, one must has to pass a major test.
Much like the rest of the world, Thailand is experiencing a nursing shortage. It has incentivized students to attend nursing schools by offering very low tuition in combination with stipends for those students. While this has worked, and there is an average of seven students applying for every one open nursing school spot, not enough students have graduated yet to fill the needed nursing roles in the nation (Anders & Kunaviktihul, 1999). This will take time, but Thailand’s approach is working as applications to nursing schools have skyrocketed.
Post-Graduate (Masters/Doctoral) Education
“The latest figures for the Saudi nursing workforce show 67% Diploma holders from health institutes; 30% Associate Degree holders from junior colleges; and 3% Bachelor’s Degree graduates from colleges and universities. In addition, there are 28 graduates with a Master’s Degree, and only seven graduates with a Doctoral Degree” (Almalki, FitGerald, & Clark, 2011)T Saudi government permits and is now encouraging nurses from Saudi Arabia to go abroad to further their education in nursing. There are current efforts underway in the Kingdom of Saudi Arabia to fortify the nursing education sector. They express desire to expand from nursing assistant to the PhD level.
Saudi Arabia is currently over dependent on expatriate nurses. There is a nursing shortage in Saudi Arabia, and expatriate nurses are presently the only way to fill the shortage. Bolstering the entire educational field of nursing and breaking down the cultural stigma of women working, women being educated, or women caring for people who are not their families must be addressed. Once the Saudi Arabian government addresses these issues they will be on the road to successfully addressing the nations nursing issues.
Nurses in Thailand are expected to complete a four year degree. “The nursing curriculum is similar to those in the USA with the major courses being nursing fundamentals, adult health, geriatrics, psychiatric mental health, pediatrics, obstetrics and gynecology, and public health” (Anders & Kunaviktihul, 1999). There are programs for Master’s and Doctoral level nursing program, the issue in Thailand is there are not enough teachers for those roles. For example, there are only 101 professors for Doctoral level nursing education (Anders & Kunaviktihul, 1999).
Thailand is working to bolster their higher education level nursing programs. However, until it is ready to start educating people and getting them out into the workforce, other routes must be examined. Another route that is being examined and utilized is partnering with schools in the United States of America. Students from Thailand go abroad for one year, attend nursing school, and then return to Thailand to complete 2 more years of education. Doing this allows their students to obtain their education but return to Thailand to utilize their education for the betterment of Thailand and its people.
Conclusion: Reflections on Nursing Education
There were many similarities between Saudi Arabia and Thailand in regards to nursing. For example, both nursing programs were encouraged by the respective monarchies. One this that was very surprising is that they are still struggling with implementing higher education such as Master’s degrees and Doctoral degrees. The nursing shortages that both nations are combating are an issue many nations are fighting. The older generation is becoming older and sicker and the newer generation does not have enough people in it to care for all of them unless efforts are made to sway more people to join the nursing/medical profession.
Saudi Arabia allows children to begin studying to be nurses; the article stated that they allow the education to begin in Middle School. This was quite shocking, but sensible. In the United States many schools partner with a vocational training center in order to prepare students for their adult lives. This may be an answer to filling the nursing shortage from a global perspective, encourage schools to allow training to begin for certain professions. The offering of that choice could hold a massive influence over the future of the medical field.
- Almalki, M., FitGerald, G., & Clark, M. (2011). The Nursing Profession in Saudi Arabia: An Overview. International Nursing Review, 58, 304-311.
- Anders, R. L., & Kunaviktihul, W. (1999). Nursing in Thailand. Nursing and Health Sciences, 1, 235-239.
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