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Training Needs Assessment for Nurses in Sennar State, Sudan: Cross Sectional
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DOI: 10.11648/j.sjph.20190704.11

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Science Journal of Public Health
2019; 7(4): 104-114
http://www.sciencepublishinggroup.com/j/sjph
doi: 10.11648/j.sjph.20190704.11
ISSN: 2328-7942 (Print); ISSN: 2328-7950 (Online)

Training Needs Assessment for Nurses in Sennar State,

Sudan: Cross Sectional Study (1)
Nada Mohamed Ali Alnair1, *, Elfatih Mohamed Malik2, Malaz Elbashir Ahmed3,
Ibrahim Ismail Mohamed Abu4, 5
1
Federal Ministry of Health, Continuous Professional Development Directorate, Khartoum, Sudan
2
Community Medicine Department, Faculty of Medicine, University of Khartoum, Khartoum, Sudan
3
Community Medicine, Federal Ministry of Health, Khartoum, Sudan
4
Community Medicine Department, Faculty of Medicine, King Abdul-Aziz University, Al Fashir, Sudan
5
Kingdom of Saudi Arabia &Community Medicine Department, Faculty of Medicine, Al Fashir University, Al Fashir, Sudan

Email Address:

*
Corresponding author

To cite this article:

Nada Mohamed Ali Alnair, Elfatih Mohamed Malik, Malaz Elbashir Ahmed, Ibrahim Ismail Mohamed Abu. Training Needs Assessment for
Nurses in Sennar State, Sudan: Cross Sectional Study (1). Science Journal of Public Health. Vol. 7, No. 4, 2019, pp. 104-114.
doi: 10.11648/j.sjph.20190704.11

Received: February 26, 2019; Accepted: April 12, 2019; Published: July 12, 2019

Abstract: Continuous professional development for all health care providers including nurses is vital to be updated and able
to provide quality services. All types of continuing professional development programs are often described as a cycle. This
cycle is composed of interrelated components that are the steps of a systematic process, usually starting with identifying
learning needs and ending with assessing learning and training evaluation. Training Needs Assessment (TNA) is a method to
determine performance gaps, and what training is required to fill in these gaps. Appropriate use of TNA can prevent
unnecessary spending on improper, inefficient, and/or ill-targeted training programs, and maintain more focus on the real
needs. It also helps save time and resources. The following paper will address the issue of TNA and its accompanying paper
will consider the issue of training evaluation in Sudan. The study overall objective was to assess training needs among nurses
in Sennar and Singa hospital and to compare the results. Specific objectives were: to identify training needs from viewpoint of
nurses, doctors and sisters as well as to develop need-based training module. It was descriptive cross sectional study. A total of
173 nurses, 15 sisters and 13 doctors participated in the need assessment survey. Survey results showed that most of nurses had
not attended any in-service training. There were clear gaps in equipment using, task performance, communication and ethical
issues. The most important training needs were infection control, communication, ethics, and nursing emergency. Infection
control training manual was developed accordingly. There were real and conceptual training needs for nurses identified by
nurses, sisters and doctors. All of these training gaps and needs should be considered in the development of future training
modules for nurses in Sennar State. In the future, continuous professional development should be promoted through sound
evidence-based planning, which means that TNA must be an activity that precedes the preparation and implementation of
training programs. Delivering training with the career path so that each nurse has the training opportunity is also strongly
recommended as well as fair distribution of training opportunities in the state.
Keywords: Training Needs Assessment, Needs Assessment, Training, Training Evaluation, Nurses

pioneering country in the continent. Educational and

1. Introduction management work over years has culminated into a health
Training of human Resources for Health (HRH) and workforce that is composed of more than 100 thousand
practice were deeply rooted in Sudan, which is regarded as a health workers making over 20 different professions [1]. The
105 Nada Mohamed Ali Alnairer al.: Training Needs Assessment for Nurses in Sennar State,
Sudan: Cross Sectional Study, 2016 (1)

picture of Sudan nursing workforce today shows dominance training processes and in terms of the professional
of females representing more than half but with increasing development of learners. This cycle is composed of
trends. The age structure points to a rather young nurses interrelated components that are the steps of a systematic
probably due to the recent expansion in medical and health process, usually starting with identifying learning needs and
profession education [1]. ending with assessing learning and training evaluation. The
The Ministry of Higher Education is responsible for pre- CPDD is mandated to develop wide - range of in-service
service training and production of nurses through nursing curricula, guidelines and Standard Operational Procedures
schools and health training institutes [1]. As a result of the (SOPs) for health personnel. However, training should follow
Sudan Declaration (2001) for up-grading the paramedics, the all steps of the training cycle from needs assessment to
Ministry of Health established the Academy of Health evaluation which is not the case in Sudan now. TNA is the
Sciences (AHS) in 2005. Accordingly, all the old training approach supposed to be introduced unduly for this purpose.
schools and institutes that were affiliated to the Federal Appropriate use of TNA can prevent unnecessary spending
Ministry of Health (FMOH) are now under the umbrella of on improper, inefficient, and/or ill-targeted training
the AHS, including all the nursing schools, midwifery programs, and maintain more focus on the real needs. It also
schools, paramedics training institutes [2]. Now the AHS has helps save time and resources as well as having good impact
15 main branches, one in each state with some states have on the performance [7]. Therefore, this study is aimed to
some other training sites at main cities. The academies now study CPD for nurses in Sudan. This work will be presented
enrolled about 15,300 students, 80% of them are nurses and in series of papers. This paper considers the TNA and
graduated about 1,727 cadres from different programs, e.g. intended to assess the training needs for nurses in Sennar
nursing (diploma) and upgrading (BSc.) according to AHS state.
statistics in 2010. Consequently, there are 4 different
undergraduate nursing programs in Sudan; three years’ 2. Materials and Methods
diploma (nurse technicians), two years bridging program to
upgrade the three years’ program to BSc, four years BSc 2.1. Study Design
(professional nurses/sisters) and five years’ honor BSc [2].
The National Council for medical and health Professions is In this paper we will address only the first stage which is
entrusted with registration and licensing of nursing descriptive cross sectional study. However, the whole study is
workforces [1]. The Federal Ministry of Health and the State a quasi-experimental one, composed of four stages, namely
Ministries of Health are the major employers responsible for (i) a baseline survey in the two selected hospitals to assess
nurse’s management and in service development. The HRH the training needs of nurses; (ii) pre-assessment of status of
national survey conducted in 2006 had shown that three nurses’ knowledge, attitude and practices (KAP); (iii)
quarters of the country health workforce (74%) did not training of nurses (study intervention); and (iv) post-
receive any form of in-service structured training during the intervention assessment 3-month later.
past 5 years. The few staff that had the chance to attend 2.2. Study Area/Setting
Continuous Professional Development (CPD) programs is
mostly confined to urban areas and predominantly belongs to Sennar State has an area of 37,844km² and approximately
the medical profession. In rural areas, it is common to find 1.1 million populations; the State has 8 localities and its
health workers who have not been refreshed for periods of 15 capital town is Singa, while Sennar is the second town. There
years or more [1]. As a result of that, Continuous are two main Teaching Hospitals in each of Sennar and Singa
Professional Development Centre (CPDC) is established with towns, which are both serving the Faculty of Medicine of
25 main branches established in states and hospitals [3]. Sennar University. The 2015 annual frequency rate was
Now, there are 18 branches in all states due to increase in the 76,998 in Sennar Teaching Hospital with 490 beds. For the
number of states. The Continuous Professional Development same period, the annual frequency rate in Singa Teaching
Directorate (CPDD) has progressed very well in issues Hospital was 79,774 with 169 beds.
related to finalization of the CPD policy, strategy, improving
the quality and expansion of activities, fostering partnership, 2.3. Study Population/ Subjects
and strengthening the state branches and developing the e- The study population composed of three categories of
learning system. Nevertheless, the current practices of CPD health cadres, as follows:
in Sudan are fragmented and lacking coordination, which Nurses:
demand a patent system for need assessment and impact Inclusion criteria: all nurses in Sennar and Singa Hospitals
evaluation [4]. And the idea of CPD is not well understood who have nursing certificate, diploma or bridging courses
among health professionals [5]. The culture and attitude of were included in the study.
continuing learning and self-development amongst health Exclusion criteria: nurses who were under training and those
professionals are considered poor in Sudan [6]. enrolled for National Service were excluded in the study.
All types of continuing professional development Sisters:
programs are often described as a cycle. This cycle refers to Inclusion criteria: all sisters in Sennar and Singa Hospitals
the process of continuous improvement, both in terms of who hold 4-year bachelor degree in nursing studies were
 Science Journal of Public Health 2019; 7(4): 104-114 106

included in the study. identify training needs. Semi-structured in-depth interviews

Exclusion criteria: all sisters with work experience for less tool was used for data collection from the Doctors (medicals
than 3-month period in the specific hospital, and sister and consultants). Interview questions were developed by the
midwives were all excluded in the study. researcher around four main themes (CPD concept, previous
Doctors: training courses conducted for nurses, challenges
Inclusion criteria: all doctors (medicals and consultants) encountered and challenges for the training of nurses in
working in Sennar and Singa hospitals were included in the general, and training needs for nurses. FGDs were used for
study. data collection from the sisters using specific FGD-guide.
Exclusion criteria: doctors with work experience for less The discussion was around four main themes
than 3-month period in the specific hospital, registrars and (communication and leadership skills, basic nursing skills,
house officers were all excluded in the study. nursing ethics and nurses training needs or gaps). All data
collection tools were tested and piloted before actual data
2.4. Sample Size and Sampling Technique collection. Tools were piloted at Ibrahim Malik Hospital in
The sampling technique was total coverage for the nurses Khartoum and were modified accordingly.
in Sennar and Singa Hospitals. The total number of nurses in 2.6. Data Collection Techniques
Sennar hospital was 122 nurses out of which 110 nurses
accepted to participate in the study (90.2% response rate), Interviewing:
while 2 nurses refused to participate and the other 10 were on A structured questionnaire was used to collect data from
annual leave. In Singa Hospital, 63 out of the total number of nurses, the data collection conducted by the researcher and
68 nurses accepted to participate in the study (92.6% one data collector who was trained before conducting the
response rate), while the remaining other 5 candidates were fieldwork.
on annual leave. This made the sample of the total coverage Focus group discussion:
at 173 nurses. Convenient sampling technique was used for The FGD was carried out by the researcher and one
sisters in Sennar and Singa Hospitals. Out of the total number assistant. Two FGDs were conduct, one in Sennar Hospital
of 10 sisters in Sennar Hospital, 7 of them participated in the and the other one was in Singa Hospital. The researcher took
Focus Group Discussion (FGD), while one sister refused to the responsibility of leading the discussion; the assistant took
participate, another one had severely ill patient at the time of the responsibility of documentation of the discussion points
the FGD and the third one was on maternity leave. In Singa and observation of the tape. The researcher carried out the
Hospital, all of the 8 sisters participated in the FGD. This FGD in each hospital in privacy, all the rules for conducting
made a total number to 15 sisters participated in the two FGD were considered, and all points which were discussed
FGDs conducted (one in each Hospital). were well documented.
As for doctors in the two Hospitals, satisfaction sampling In-depth interviews:
technique was used, where 13 doctors in the two hospitals In-depth interviews data, observation check lists and the
out of the total number of 102 doctors were interviewed. intervention data were all collected by the researcher.
2.5. Data Collection Tools 2.7. Data management and Analysis

A structured questionnaire was used for data collection The quantitative data (questionnaire) was checked, vetted
from nurses. The questionnaire was a standardized one and validated after entry and before analysis. The entered
developed by Jayne Fraser a training manager and adapted by data was analyzed Using SPSS version 21 appropriate
the researcher according to the context in Sudan. The statistical test was used.
questionnaire adopted the job-task analysis modality based The qualitative data (FGD with the sisters and in-depth
on job description. In this study, the job description for interview with the doctors) was analyzed using thematic
nurses was obtained from Sudan Council for Allied content analysis.
Professions, containing 12 tasks. Each task had been rated
along 4-point scale according to two criteria: how important 2.8. Ethical Considerations
the task is to the successful performance of the respondent's Ethical approval from SMSB research committee was
job; and how well the respondent is currently performing the obtained. Clearance from Sennar state Ministry of Health,
task, a comparison of the two ratings on any item provides an Sennar teaching hospital and Singa teaching hospital was
assessment of the training need associated with the task. obtained. Verbal consent from the participants (nurses,
When a task ranks as highly important but is not well- doctors &sisters) was also obtained.
performed, this means there is a need for training. Similarly,
when a task that ranks less important or is well-performed,
this means that there is no need for training. The training 3. Results
needs are then prioritized so as to identify the ones in most 3.1. TNA Quantitative Results
need for development. Such importance/performance
comparison is well established as a reliable technique to The results showed that out of 173 nurses, a total
107 Nada Mohamed Ali Alnairer al.: Training Needs Assessment for Nurses in Sennar State,
Sudan: Cross Sectional Study, 2016 (1)

number of 110 nurses (64%) were from Sennar Teaching training attended by 21 of the respondents (12%) (Table
Hospital and 63 nurses (36%) were from Singa Teaching 2). Although the result indicated that only 1% of the study
Hospital. The nurses who participated in the study were participants received training on communication skills,
80% female, while only 20% were males. Most 62% believe they are performing communication skills
participants were young, 78% of whom were between 20 excellent in all the tasks assigned to them and have
and 30 years of age. Regarding education, 64% of the interaction part (table 3). While in average 79% of the
respondents received the diploma, 32% received a respondents believe that communication skills are very
bachelor nursing certificate and only 4% received bridging important to do their job, 93.1% of them perceived ‘oral
certificates. In addition, 70% of the participants have 10 communication’ as the extremely important
years of work experience and less. communication skill and 64.2% of them perceived
Most of the nurses deal well with most of the ‘listening’ as the one extremely important (Table 4). The
equipment; yet, some of them believed that they cannot nurses' perception of their performance indicates that there
deal with rectal catheter, pulse oximeter, tape, and are gaps in the application of all tasks but clearly shown in
tracheotomy set and chest tube (Table 1). The vast quality and infection control procedures, 50% and 60% of
majority of nurses did not attend some of the major them cannot do so and need training respectively (Table
training courses. The results showed that the percentage of 5). And (81.4%) of the nurses appreciated the importance
participants who received training in any of the nine basic of their tasks (Table 6).
training was less than 12%, except for basic life support
Table 1. Perception of nurses towards their skills in using basic equipment, Sennar State 2016 (n=173).

I don’t know how to use it and I need

Equipment I can use it properly and train others I can use it properly to do my job
training
Sphygmomanometer 121(70%) 48(28%) 4(2%)
Stethoscope 106(61%) 51(30%) 16(9%)
Weighing scale 115(67%) 53(31%) 5(3%)
Canula 144(83%) 27(16%) 2(1%)
NG Tube 106(61%) 50(29%) 17(10%)
Urinary catheter 118(68%) 42(24%) 13(8%)
Rectal catheter 81(47%) 37(21%) 55(32%)
Ventilator 116(67%) 49(28%) 8(5%)
Nebulizer 109(63%) 41(24%) 23(13%)
Safety box 113(65%) 44(25%) 16(9%)
Pluseoxmeter 46(27%) 30(17%) 97(56%)
Tape 57(33%) 34(20%) 82(47%)
Tracheotomy 34(20%) 22(13%) 117(67%)
Chest tube 27(16%) 21(12%) 125(72%)

Table 2. Training courses attended by nurses in the last 3years, Sennar State 2016 (n=173).

Attended the course Course location

Title of training course
No Yes Outside the State Inside the State
1 Basic nursing skills 166(96%) 7(4%) 2(20%) 5(80%)
2 Ethics 165(95%) 8(5%) 6(80%) 2(20%)
3 Communication skills 171(99%) 2(1%) 0(0%) 2(100%)
4 Self-development skills 172(99%) 1(1%) 0(0%) 1(100%)
5 Wound care 169(98%) 4(2%) 0(0%) 4(100%)
6 Nursing Emergency 170(98%) 3(2%) 0(0%) 3(100%)
BLS (Basic Life
7 152(88%) 21(12%) 3(14%) 18(86%)
Support)
8 Infection control 170(98%) 3(2%) 0(0%) 3(100%)
9 Drug administration 171(99%) 2(1%) 0(0%) 2(100%)

Table 3. Perception of nurses towards their performance in communications skills, Sennar State 2016 (n=173).

Type of skill Low Acceptable Good Very good Excellent

Oral communication 1.2% 0.6% 2.9% 11% 84.4%
Written reports 1.7% 1.7% 8.7% 22% 65.9%
Listening and skills of asking questions
4.6% 2.9% 5.8% 22% 64.7%
to service recipient
Team management 4.0% 8.1% 11% 22% 54.9%
Managing meetings efficiently 8.1% 5.8% 26% 22.5% 37.6%
Overall average 4% 4% 11% 20% 62%
 Science Journal of Public Health 2019; 7(4): 104-114 108

Table 4. Perception of nurses towards the importance of communications skills, Sennar State 2016 (n=173).

Type of skill 1 2 3 4 5
Oral communication 0.6% 0.6% 2.3% 3.5% 93.1%
Writing reports 1.2% 1.7% 3.5% 9.8% 83.8%
Listening and asking questions skills 5.2% 2.3% 13.9% 14.5% 64.2%
Team management 2.3% 4.0% 7.5% 12.1% 74%
Managing meetings efficiently 3.5% 2.9% 5.2% 10.4% 78.0%
Overall average 3% 2% 6% 10% 79%

1=Not important; 2=Moderately important; 3=Important;4=Very important; 5=Extremely important.

Table 5. Nurses’ perception towards their performance in nursing tasks, Sennar State, 2016 (n=173).

Task Cannot do it Can do it but need training Can do it Can do it & train others
Basic nursing skills 2.9% 39.9% 28.9% 28.3%
Drug administration 2.9% 31.2% 29.5% 36.4%
Wound dressing and minor surgery 4.6% 42.8% 24.3% 28.3%
Reporting of abnormal signs and symptoms 1.7% 32.4% 37.0% 28.9%
Urine and stool sample collection 4.6% 32.9% 28.9% 33.5%
Sterilization of tools and devices 8.1% 40.5% 29.5% 22.0%
Receiving and dealing with accident and emergency cases 6.4% 34.7% 35.8% 23.1%
Documentation of all nursing procedure in the records 2.3% 24.3% 34.1% 39.3%
Patient discharge and giving instructions about how to
2.4% 30.6% 33.5% 33.5%
continue the treatment especially for the chronic diseases
Application of infection control and safety measures 10.4% 39.9% 26.0% 23.7%
Application of quality control measures 16.8% 42.8% 20.8% 19.7%
Assisting in training of junior nurses and students 2.9% 37.6% 24.3% 35.3%
Overall average 5.5% 35.8% 29.4% 29.3%

Table 6. Nurses’ perception towards the importance of nursing tasks, Sennar State, 2016 (n=173).

Task Not important Moderately important Important Very important

Basic nursing skills 0.6% 4.0% 15% 80.3%
Drug administration 0.6% - 13.3% 86.1%
Wound dressing and minor surgery - 1.2% 17.5% 81.3%
Reporting of abnormal signs &symptoms - 1.2% 13.9% 85.0%
Urine and stool sample collection - 1.2% 17.3% 81.5%
Sterilization of tools and devices - - 16.2% 83.8%
Receiving and dealing with accident and emergency cases - 1.7% 18.5% 79.8%
Documentation of all nursing procedure in the records - 2.3% 15.6% 82.1%
Patient discharge and giving instructions about how to continue
- 0.6% 19.1% 80.3%
the treatment especially for the chronic diseases
Application of infection control and safety measures - 1.7% 17.3% 80.9%
Application of quality control measures 1.2% 3.5% 18.5% 76.9%
Assisting in training of junior nurses and students - 0.6% 20.2% 79.2%
Overall average 0.8% 1.8% 16.9% 81.4%

The results also revealed that only 5% of the participants The discussions were conducted in Arabic by the principal
had no idea about nursing ethics. With regard to the training investigator and research assistant and were all of them noted
needs identified by the respondents, 61 nurses thought that and some of them tape recorded. The discussions lasted
they need training in the infection control, followed by 59 between 45 and 60 minutes. Themes that discussed were;
and 57 nurses who identified basic life support and ICU as tasks performance, performance gaps and training needs. The
their training needsrespectively. discussion started with an ice-breaking question on the
reasons behind their choice of the nursing profession. Most
3.2. TNA Results of FGDs and in-Depth Interviews of the participants justified their choice because they perceive
3.2.1. Qualitative Results of the FGDs with Sister Nurses nursing as a humane profession. Some of the participants see
On account of the exploratory nature of the research nursing as a way to help their communities, while others see
objective, the study utilized qualitative research methods. it as self-satisfactory job. Participants also listed other
Two (FGDs); one group from Sennar and other group from reasons such as the influence of some nurses they see them as
Singa Hospitals; were conducted in November and December models, a desire of their families, or an educational
2016. A total of 16 female nurse sisters participated in FGDs opportunity they got through formal enrolment to nursing
each comprising of 8 participants. The participants were colleagues.
purposively selected from the targeted hospitals under the Sisters’ evaluation of skills of nurses in communication:
study. The discussions were held in halls within the hospitals. Nurses need abilities to effectively use communication
skills with their patients, colleagues and doctors. One
109 Nada Mohamed Ali Alnairer al.: Training Needs Assessment for Nurses in Sennar State,
Sudan: Cross Sectional Study, 2016 (1)

sisterclaimed that "communication skills help the nurse to doses, non-registration of drug, and lack of close mentoring
manage her work inside the ward”. However, participants of patients in the ward so as to meet their needs. Participants
highlighted that the majority of nurses had gaps in admitted that "some nurses delay the doses; some others
communication skills, especially young nurses who had don’t register what they did; and so, patients’ files sometimes
limited exposure to communicate with others. As well, the are not filled in with information in regards to what happened
discussion described some of the nurses to have negative inside the ward”. This is further complicated with the nurse
attitudes towards dealing with patients, colleagues and workload as a result of the small number of nurses compared
doctors. One of the participants argued that “some of the to the large number of admitted patients. Another nursing
nurses have bad attitude in dealing with patients, and some skill gap is that nurses don’t follow the management plan
nurses usually refuse to attend to advises by other properly, before patients are send to the operation room.
colleagues”. This is further associated to the respondents’ Nurses don’t give patients the regulations and advises
observation that elderly patients are relatively demanding, correctly. Likewise, they also don’t report to the medical
and so they need special caring and communication style. director when medical devises are stopped at workplace.
However, some of the nurses have poor skills in dealing with According to participants, these gaps exist due to absence of
elderly patients. One of the nurses argued that “elderly regular supportive supervision.
patients need nurses with special skills". Another Participants said that nurses in general have skill gaps in
communication problem identified was that nurses don’t ask handling wounds and minor surgery but certified nurses are
others for information that they don’t know. This is situation relatively better. This gap further complicated by absence of
because some of nurses hold the view that such a query for a system of infection control measures. This requires an
information may mean that they are less experienced and less application of standard precautions in nursing work, which is
knowledgeable; for example, urgent calling and consultation lacking, so as to reduce risk of transmission of blood-borne
with other health staff (doctors) in the case when a patient and other pathogens to nurses. Hospitals covered by the study
has a new complain or develops serious signs. Instead, lack prevention measures for HIV transmission.
participants mentioned that such a query is a task performed Unavailability of soaps also was found to limit hand-washing
by co-patients who directly talk to doctors – “co-patients among nurses. Participants stressed on raising the staff
inform the duty-doctor of their patients complain or develop awareness and avail the resources for applying the quality
convulsions as an example; this is the nurse job" – one assurance program. The study found that most of nurses
participant said. Communication gap on non-querying for working in wards don’t wear gloves, masks and lab-coats, as
information also exists because some nurses have problems well as they don’t use safety boxes, which are lacking inside
in sharing information with others. the wards in most cases. Participants admitted that “after
Sisters’ evaluation of nurses’ basic nursing skills: giving patients intravenous or intramuscular treatment, some
Nursing requires several skills, depending on roles and of the staff just dispose the syringes on the ward floor
responsibilities identified in job descriptions. This study without caring for the protection of others”. However, nurses
examined some specific basic nursing skills, namely: (i) drug revealed diverse level of awareness with regard to infection
administration; (ii) wounds dressing and minor surgery; (iii) control measures. A number of nurses were found to be
registration and file keeping of nursing activities; (iv) subconscious of hygiene procedures (e.g. hand-washing) and
reporting of abnormal signs and symptoms during duty; and infection control measures. Moreover, they are faced with
(v) patient discharge and post-discharge instructions and shortage in availability of personal protection measures.
advises. In analyzing the discussions by participants, it is Participants went further to mention that "inside the ward, it
found there is a necessary association between the is usually difficult to differentiate between working nurses
performance of the above-mentioned basic nursing skills and and co-patients, because nurses don’t wear lab-coats, for
other issues, such as safety and infection control measures. example”.
Findings generally indicate that professional nurses (sisters) Training of the nursing students:
who hold bachelor degrees are more competent than nurse One of the nurses’ tasks in their job description is the
technicians who have hold diplomas or departmental training of the nursing students inside the wards so that
certificates. Competency gaps were found most among nurse students are able to practice the acquired skills. Participants
technicians who normally did not do self-improvement or mentioned that nurses are good tutors in general. However,
request support to acquire skills or apply them properly. One some of the nurses do not train students but they rather assign
sister said that “nurse technicians have fewer experiences the students and junior nurses to do their tasks so as to reduce
than the other nursing staff; for example, when a nurse the workload. One of the sisters said that "nursing students
technician receives a patient, and his/her intravenous are faced with problems during the practical training stage;
treatment may lead to vein rupture and blockage of canola. some tutors leave nursing students work without close
They don’t care to improve their skills”. One the basic supervision while requesting them to do work that is assigned
responsibility of nurses is to ensure appropriate drug to nurses”.
administration, including pharmacology, anatomy and Evaluation of commitment to nursing job ethics:
physiology, and legal issues. The main skill gaps identified in Nursing ethics are a set of moral principles that nurses
drug administration were: delays in giving the subscribed should follow and commit to when delivering their tasks. The
 Science Journal of Public Health 2019; 7(4): 104-114 110

nature of the nursing profession is highly dependent on a small number of the doctors interviewed could not
ethical care much more than the routine care. To do so, recognize “what CPD is about” although they mentioned that
nurses need to know these ethics that guide their job they have heard about. Some doctors know/see the CPD just
performance, as well respecting them. The discussion with as an office inside the State Ministry of Health, rather than a
sisters had revealed various forms of violations of nursing widely-known concept. Furthermore, the interviewed doctors
ethics. These violations included carelessness in delivering have perceived that:(i) a limited number of staff has the
daily clinical work, escaping during working hours, bad interest in receiving in-service training; (ii) some nurses are
attitude, bad treatment and exploitation of patients by not interested in self-development in a professional way like
charging extra fees, and selling of emergency drugs that that of the CPD; and (iii) some nurses think that they are not
should be provided to patients for free. One of the in need of additional skills in the post-graduation era.
participants supported some these arguments by saying that Doctors perceive CPD as an important milestone for career
“the problem of nurses is that they are careless”. Another growth, especially after some years of work. Nevertheless,
participant said “some nurses take money from patients for they believe that most of the health cadres in the two
serving them”. hospitals were subconscious of the importance of in-service
Identification of training needs for nurses: training and upgrading their skills; CPD in-service training is
Nursing is a dynamic profession that is subject to rapid neglected and had limited activities. The limitation of
changes in health care provision. And so, there are needs for resources played a main role of its negligence.
refresher in-service training program for nurses to cope with Doctors’ perspectives of training courses delivered to their
such changes. As mandated institution, it becomes inevitable nursing staff:
for the CPD in Sennar State to conduct in-service training for Interviewed doctors had good capturing of the in-service
nurses. The fact is that nurses in Sennar State have been training courses delivered to their nursing staff. They counted
experiencing limited opportunities for in-service training at least 7 packages of training on: (1) Basic Life Support; (2)
program. One participant mentioned that "some of the Renal Dialysis Devices; (3) Nursing Emergency; (4)
nursing staff members are good when they are doing their Advanced Life Support; (5) Neonatal Resuscitation; (6)
jobs. But some of them have apparent gaps as still perform Quarantine, Management and Prevention of Diarrheal
their tasks in an ‘old way’ and so are in need of urgent Diseases; and (7) Malaria Protocol. However, a small number
refresher training". While part of the old nurses need to of doctors could not identify any event of training during the
update and upgrade their knowledge, newly registered nurses time they have joined the hospital. Impact of these training
require in-service training in order to be skilled in nursing packages were judged by the doctors as useful in many ways;
practice. Another nurse said “there is huge gap between what improvement of the competency and hence the performance
you learn and what the practice in real life; and so newly of nursing staff in delivering quality services for both cold
nurses are in need of training in practical nursing skills”. As and emergency cases; better and quick handling of serious
part of the FGD, the study had a focus on identifying the cases; nurses are better in detecting serious cases and
needs of nurses in relation to in-service training programs, as delivering the appropriate primary aids, which further
well as drawing broad guidelines for the development for contributes to reducing mortalities; nurses had major role in
effective in-service training programs. Based on the focus controlling the latest outbreak of the diarrheal diseases in the
discussion, participants identified a list of the priority areas State.
that are important to nurses as in-service training programs of Doctors’ perspectives of challenges to training courses
Infection control, Communication skills, Ethics of the delivered:
profession, Basic nursing skills, Training on use of medical Interviewed doctors had counted a series of challenges that
equipments especially in the dialysis unit equipment, Basic they perceived to have encountered the training
Life Support BLS. ICU&CCU, Sterilization of equipment, packages/courses delivered to their nursing staff. All doctors
Discharge instructions/advises, Administration and unanimously agreed that the major challenges were: (1)
registration of drugs. problems associated with releasing the nurses so as to enable
them to participate in training courses, which mainly due to
3.2.2. Qualitative Results of Doctors’ in-Depth Interviews the shortage of the nursing staff; and (2) the difficulties
This study also utilized in-depth interviews with 13 associated with financing training courses. Other challenges
doctors from the targeted hospitals and majority of them were identified by some of the doctors are; lack of trainers,
females. The themes discussed were; Knowledge of the fairness of the selection process, language problem and
concept of Continuous Professional Development; In-service enabling educational environment.
training courses to nursing staff – types, benefits, challenges; Doctors’ perspectives of challenges to training courses in
proposals for improving the training of nursing staff and their institute:
Perspectives on training needs of the nursing staff. The challenges identified by some of the doctors are;
Doctors’ knowledge of the CPD concept: difficulties in obtaining financial support for training courses;
Findings of the interviews revealed that doctors in both of lack of well-equipped training halls/ venues; non-releasing of
the surveyed hospitals (Sennar and Singa) are generally nurses of duties to participate in training courses because of
aware of the idea/concept and importance of CPD. However, the already small number of staffing; difficulties in
111 Nada Mohamed Ali Alnairer al.: Training Needs Assessment for Nurses in Sennar State,
Sudan: Cross Sectional Study, 2016 (1)

application. Because sometimes courses were on equipment State, following the establishment of the Faculty of Medicine
not available in the workplace; lack of trainers/ facilitators. University of Sennar. Out of 173 nurses who participated in
carelessness of the health cadre about training; improper/ this study, 80% were females. This result goes with the
injustice and inequality in selection process of trainees, general pattern of increasing female to male ratio in the
which implied biasness. health workforce, which is more visible in the case of nurses
Suggestions to improve the nurses training: in Sudan [5]. This gender imbalance in the health workforce
Doctors suggested many opinions about how to improve requires special planning and policy measures. In terms of
training in their institutes such as; financial support to the age and experience, a total of 78% of the nurses aged
nurses training; provision of skill labs; provision of well- between 20 to 30 years, and 70% of them had work
equipped training halls/venues; increase number of experience of 10 years and less. Because they are young with
facilitators according to the specialty; linking of the training limited experience, these nurses represent a good opportunity
with the career path way/ career progression; creating for investment.
training opportunities at the universities; provision of In terms of the level of education, the majority of the
curricula; allocation of part of the hospital income for the participant nurses (64%) had diploma certificate, 32% had
training; raise the awareness of the managers about the nursing certificate, and only 4% had bridging course
importance of the training. certificate. The reason behind this result was related to
Areas for the training of nurses suggested by doctors’: expansion in the coverage of the Academy of Health
Infection control; nursing emergency; nursing Ethics; Sciences (AHS), which has opened up branches in all states,
communication skills; drug administrations; basic nursing enrolling estimated number of 15,300 students in the years
skills; ICU; training on use of medical equipment especially 2010 out of which 80% were nursing student [2]. The result
in the dialysis unit equipment and accountability. could be attributed to the fact that AHS diploma has
substituted the old nursing certificate. The ‘bridging-course’
4. Discussion was another program introduced by the AHS to upgrade the
diploma into bachelor degree but the program faced
4.1. Respondents’ General Characteristics résistance from the Ministry of Higher Education, and had
worked for only few years. That was the main reason behind
TNA is not very common concept /approach until recently the few nurses with bridging-course certificates.
even in the developed countries. The available literature The largest human resources component in healthcare
reveals that there has been a significant growth in the number institutions is apparently nurses, who have the greatest
of TNA researches during the period 1990 to 2010 in impact on the quality of both outcomes and patient care. As
comparison to the period 1970 to 1989 [8]. For example, such, training becomes essential so as to achieve successful,
TNA for nurses was never conducted before 2014 [7]. tangible and measurable benefits to healthcare institutions.
However, Sudan is not an exception where TNA research is Another importance of training and investment in human
very rare and requires special attention now and in future. resources in general, is retention of the qualified health
The current study is an attempt to draw attention to the workers [7].
importance of TNA in Sudan for better utilization of the Based on the study findings, it is apparently that the great
available resources using parametrically valid instruments. majority (95-98%) of the participant nurses had not attended
To identify the training needs of nurses in Sennar State, this any of the essential training packages during the last three
study adopted different methods, using both quantitative and years preceding the study, although the study’s list of training
qualitative tools for data collection. Such a technique, known courses are the most essential ones that are mandatory for
as triangulation, was used to ensure the validity and any nurse. This finding is similar to the results arrived at by
reliability of results by means of providing different Ghada Abd El-Salam Belal who found that about 91% the
viewpoints to analyze the specific issues from different participants did not attend any type of training [15], and it is
perspectives [9]. The study started by a ‘survey’ which was also similar to the result reached by Debbie Robson’s study
the most common used type for collecting TNA data [8, 10- that only 20% of the participants had received training during
14]. The common problem identified with such type of the last 5 years preceding the study [12]. But, S. Procter’s
survey studies was the low level response since these surveys study found that 95% of the study participants had received
primarily collect data through e-mails, which might affect the training during the last 3years preceding the study [14].
results. But this study was not faced with such a problem According to doctors who were interviewed in this study,
because it directly collected data from respondents with high the only self-funded training course (BLS course) that
level of response, which was more than 90%. organized in Sennar State, had faced many challenges,
According to the study findings, the number of nurses in including non-release of nurses to attend the course due to
Sennar Teaching Hospital was by far more than those in staff shortage, unsuitable training environment, limited
Singa Hospital Teaching Hospital, respectively 64% and announcement / advertising of the training courses to the
36%. This is due to the expansion in Sennar Hospital in terms wider nursing staff, and langue barriers since the BLS’s
of addition of new sub-specialty and more number of modules were in English. These constraints were more or less
consultants to become the main Teaching Hospital in the similar to what was mentioned in Tessa Pascoe’s study [11].
 Science Journal of Public Health 2019; 7(4): 104-114 112

Training in Sennar State in general is facing many used these tasks to assess nurses’ perceptions. Based on the
constrains that need to be addressed. One of the key constrain results, it was apparent that nurses’ perception was more or
was the reality that most of the nurses were not aware of the less the same as the sisters’ opinion with obvious training
importance of self-development, which could be due to the needs in two tasks areas, namely ‘infection control and
fact that the idea of CPD and in-service trainings is not well safety’ and ‘application of quality measures’.
understood by health professionals [5, 16]. In complementary to nurses’ perceptions about the
essential nursing tasks, the nurses were further asked if they
4.2. Discussion of Nurses’ Skills, Tasks and Performance had any idea about ‘nursing ethics’ and whether they apply
Nurses take the responsibility of dealing with most of the these ethics in their work or not. Findings indicate that 95%
hospital equipment and as such require some basic skills that of the nurses claimed that they know and applied ‘nursing
are critical for dealing with this basic equipment. Findings ethics’ while only 5% perceived that of them did not know or
indicated that the majority of nurses perceived that they are apply them in their work. This finding was contrary to sisters’
able to use most of the equipment in a proper way, and some argument about nurses’ application of the ‘nursing ethics’.
believed that they can even train others. However, the Generally, when the respondents were asked about moral and
deficiency was found to be in using the chest-tube in 72% of ethical issues, their response might tend to the famous
the nurses, 67% could not deal with tracheotomy, 56% could respondents’ bias of ‘consistency motif’. There is a
not deal with the pulsoxmeter, 32 % could not deal with the substantial amount of theories and researches suggesting that
rectal catheter, 10% could not deal with the safety box, and people try to maintain consistency between their cognitions
surprisingly that 47% of the nurses cannot deal with tape. and attitudes. This tendency of respondents to try to maintain
Having asked some of the nurses of the reasons behind consistency in their responses to similar questions or to
inability to use tape, the response was the misunderstanding organize information in consistent ways is called the
that such a task is sole responsibility of the nutritionists. All ‘consistency motif’ or the ‘consistency effect’. It especially
the above identified deficiencies in skills of dealing with appears in situations when respondents are asked to provide
basic equipment are critical to be addressed through proper retrospective accounts of their behaviors [18].
in-service training. 4.3. Nurses’ Identified Priority Areas of Training Needs
An essential element of nursing care is communication
with patients. Nurses’ major communication tasks are not As was discussed above, the study findings on nurses’
only to inform the patient about his / her disease and perceptions and performance of essential nursing tasks reveal
treatment, but also to generate effective relationship by that the top priority areas centered around the tasks of
assessing patients’ concerns, showing understanding, ‘infection control and application of safety measure’ and
empathy, and offering comfort and support to patients [17]. ‘quality application’. Having directly asked the nurses of
According to findings of this study, participant nurses their priority training needs, 61% of them identified
perceived themselves to have good communication skills in ‘infection control and application of safety measures’ as their
general; 84.4% of them perceived that they are excellent in first priority, followed by BLS (59%) and the ICU training
oral communication; 65.9% of them excellent in report (57%). The sisters’ opinion about the priority areas of nurses’
writing; a total of 64.7% of them excellent in listening and training was in favor of the nursing tasks of ‘infection control
asking questions; a total of 54.9% have excellent team and application of safety measures’ as the first priority,
management skills; and 37.6% thought that they are excellent followed by ‘communication skills’ and then ‘nursing ethics’.
in managing meetings in an efficient way. In terms of the The doctors identified ‘infection control and application of
importance of these communication skills, all nurses safety measures’ as the first priority and an urgent training
perceived these skills as extremely important for performing need, followed by ‘nursing emergency, then ‘nursing ethics’
their job vis-à-vis the essential nursing tasks. It seemed from and finally ‘communication skills’. Based the above
the nurses’ viewpoint that there was no huge gap in relation prioritization by the three groups of participants, this study
to their communication skills. However, the sisters had had selected the consistently agreed area of ‘infection control
different assessment of the nurses’ communication skills. and application of safety measures’ as the training
Sisters claimed that nurses have gaps in communication ‘intervention’. However, it should be noted that training
skills, especially the newly recruited nurses who have limited needs are context-specific and are hardly common. For
exposure. Sisters described nurses to have harsh example, Tessa Pascoe’s study identified ‘communication
communication with patients and co-patients, colleagues and skills’ as priority for 94.1% of the respondents, ‘infection
doctors. Another communication problem identified was that control’ was equally a priority for 93.7% of the same group
nurses in general do not ask others for information that they respondents, and BLS and CPR was third priority for
don’t know. All the above-mentioned communication gaps 91.4%of them [11]. The study by KL University found that
can be addressed through training that should involve sisters ‘communication skills’ was the least identified training gap
and doctors for smooth communication and constructive [19]. In the study by S Procter, ‘infection control’ was the
feedback between colleagues. second priority need for 44%, ‘equipment training’ and
The nurses’ job descriptions identified by the Sudan ‘customer services’ were the least priority areas for 24% and
Council for Allied Professions include 12 tasks. The study 19% of the respondents, respectively [14].
113 Nada Mohamed Ali Alnairer al.: Training Needs Assessment for Nurses in Sennar State,
Sudan: Cross Sectional Study, 2016 (1)

5. Conclusions and Recommendation

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