Analysis of the interview data resulted in 230 primary codes based on which 15 subcategories, 6 categories, and 3 themes were identified (Table 3).Training to improve knowledge and attitude
The categories associated with this theme were training to improve boththe clinical knowledge and professional attitude of nurses. Training to improveclinical knowledge was strongly recommended as a prerequisite for effective nursing care and was directly associated with faster recovery of patients. The participants indicated that improving clinical knowledge and the competence to recognizeminor medicalproblemsshould be the key items in such training. Furthermore, they stated that themain requirements for effective nursing care are gaining up-to-date knowledge, application of evidence-based nursing practice according toprofessional standards, and anticipation of unforeseen situations that require immediate resolution. Two participants stated:
“Patients expectto receive care according to professional standards of nursing practice and requirecare to be conducted correctly and appropriately.” [P1]
“Anticipating a patient’s reaction to minor medical issues is inherent to nursing care, which requires knowledge and skill. For instance, I immediately suspect low levels of blood glucose as soon as a diabetic patient becomes aggressive.” [P2]
Training to improve the professional attitude of nurses was related to the observance of the Patients' Rights Charter, ahumane attitude toward patients, the importance of time management in providing quality nursing care, and prevention of harm to patients. The underlying philosophy of such training should be based on the spiritual narrative“Whoever saves a life,it is considered as if he saved an entire world”.A participant stated:
“It is important to continuouslytrainnurses, particularly novice nurses,in respecting the dignity of patients and implementing the Patients' Rights Charter. Essentialin nursing practice is to treat patients with respect, respect their rights and preferences, request their permission before conducting medical procedures, and respect their privacy and confidentiality.” [P4]
1- Training to improve professional skills
The categories associated with this theme were training in clinical and communication skills. According to the participants, optimal care can be achieved through effective nurse-patient communication. It is therefore essential that nursing care is based on mutual trust and the use of verbal and nonverbal communication techniques. In order to cover various facets of patient needs, holistic and person‐centred care includes aspects such as physical and mental health needs, spiritual care needs, facilitating the needs of dying patients, follow-up care, and guidance of patients toward recovery. A participant stated:
“Patients suffering from chronic diseases experience physical, mental, spiritual, and financial issues on top of having to deal with discouraging news about their illness and family frustration. They are constantly anxious about the course of their illness and face the fear of death. Mere fulfilment of their physical needs without addressing mental care needs may negatively affect their recovery process and lead to severe depression. These patients should receive comprehensive care.” [P5]
2- Need for effective training programs
Categories associated with this theme were the incorporation of training fundamentals for the effective transfer of knowledge as well as recognition of common challenges and barriers to effective training. An effective training course requires a well-thought-out plan to create a high-quality program, proper implementation, and effective evaluation of the teaching/learning process. The first step in formulating a training program is to identify the specific needs of the target population. A participant stated:
“There is a huge difference between developing a training program for adults or for children. The attention of adults is attracted when the program addresses their questions and covers their immediate needs. In fact, current training evaluation forms are simply standard surveys and do not assess the need fulfilment of the participants.” [P7]
The participants emphasized the importance of proper implementation of a training program. Learners have a higher motivation to engage in and complete the course if the instructor presents up-to-date information, uses interactive learning techniques, and initiatesgroup discussions. A participant stated:
“I only have good memories ofthose training courses that were lively, interactive, and included Q&A sessions ordiscussion groups. I always remember theseinstructors and what they taught me.” [P1]
The participants indicated the importance of evaluating a training course to assess its effectiveness. Feedback from learners is essential to determine the effectiveness of the course, the competence of the instructor, and the extent of knowledge or skill acquisition by the participants. Two participants stated:
“Post-training evaluation is an essential part of any training course. It is important not only for the organizers to evaluate the program, but also for us to gauge how much we have learned.” [P6]
“What helps me to remember what I have learned from a training program are Q&A sessions, group discussions, and most importantly the feedback evaluation form.” [P5]
Timing was a typical obstacle to effective training, especially when training sessions coincided with participants’ professional/personal duties. The effect was amplified by instructors teaching outside their area of expertise, presenting outdated topics through traditional teaching methods, and poor facilities. These in turn led to a decrease in motivation to actively participate and learn. In the worst-case scenario, a course was attended for the sole purpose of obtaining the required certificate or fulfil compulsory attendance. A participant stated:
“Nothing is worse than attending an evening training course after a long day at work. It is really tiresome to have to attend long lectures in a setting that lacks ventilation and proper facilities.” [P8]