Nurses play an important role within the healthcare team and therefore, a lack of well-qualified and highly trained staff, may lead to poor healthcare quality and nursing activities cannot be carried out professionally [1]. Nursing as a profession involves multi-tasking and includes persistent care measures that start with simple activities and move gradually towards more complicated care and eventually, lead to inclusive decision-making in providing care [2]. The nurses who work in mental health facilities are considered an essential part of the psychiatric team and take responsibility for many roles, such as preparing patients with mental illnesses to handle their current and different circumstances to regain their former abilities [3]. Clinical competency is a set of knowledge, skills, values, attitudes, and abilities that result in successful professional performance in different aspects of a specialized career area [4]. Competency within the nursing profession contains different learning types, including skills, knowledge and attitudes [5]. Recently clinical nursing competence in the mental health field seemed to be of great importance issues in conceptual and clinical nursing training, with various factors influencing it [5]. Mental health clinical competency evaluation offers a chance to improve and develop the profession of nursing [6]. Furthermore, frequent assessment of the clinical competency of psychiatric nurses leads to the development of a standardized baseline about their clinical competency and also discloses the defect in practical skills and insufficient knowledge in their work [3]. Accordingly, training and educational interventions in different countries worldwide have improved clinical competency and supplied society with better-qualified nurses [7].

Continuing professional development (CPD) among mental health nurses has been crucial to guarantee the competence of their profession. CPD, in general, offers new information that could aid individuals in navigating novel circumstances and maintaining their progress toward objectives. They are also able to stay updated with instructional techniques. Mental health nurses' CPD with well-designed programs that focus on skill improvement provide an opportunity to raise mental health nurses' competence and enhance their ability to meet the clinical demands of the workplace. Thus, it is essential to establish a routine educational and training program within health organizational structures, especially psychiatric hospitals, to improve professional development opportunities [8]. There has been much study on the value of CPD for businesses and employees, but less attention has been paid to the value of CPD for those in the mental health field. Besides, participation in ongoing professional development, is now required for nursing and midwifery registration. However, it is unclear how clinically based mental health nurses feel about CPD and how it relates to their career goals.

Education is essential for professional nursing skills and provides opportunities to acquire a wide range of knowledge, problem-solving abilities, and critical thinking. Once licensed, nurses are responsible for continuing their education to be informed on medical breakthroughs and new research. A well-educated nurse may differentiate between a patient's life and death since knowledge is a strong instrument in healthcare. Enhancing their education also gives nurses more employment options; some switch from hospital work to research. The problems with nursing competency assessments manifest the intricacy and challenges of the field [9]. The field of mental health nursing confronts various difficulties due to several factors, including a lack of clarity regarding the responsibilities of mental health nurses and an absence of guidelines for mental health treatment. The necessity for clinical competence has increased in relevance recently since communities today demand a higher quality of service, leading the healthcare system to improve the efficacy of their personnel [10]. Despite the tremendous importance of the topic, little research has been done in this area, and there is a limited understanding of clinical nurses’ competency and skill level.

Mental health nurses need access to all fundamental competencies throughout their study to be clinically competent. In this regard, mental health nurses' motivation to partake in CPD activities is derived from a desire to provide their patients with high-quality treatment and from their dedication to lifelong learning as members of a self-regulated profession. Since regulatory organizations progressively demand CPD as a certification, there is a growing need to ensure that nurses maintain their performance and expertise in line with industry standards [11].

To be competent, up-to-date, and capable of meeting the demands of their patients as well as their statutory duties through their regulating bodies, mental healthcare professionals must continually update their knowledge, abilities, and attitudes. Therefore, CPD is crucial for retaining the nurses' knowledge and abilities, as it is at the core of lifelong nursing learning. Although the need for nurses' ongoing professional development is widely accepted, little is known about how nurses perceive such growth [12]. Reviewing the evidence on the value of continuous professional development for mental health nurses might lay the groundwork for more well-thought-out future initiatives in this area.

Continuous Nursing Education (CNE), also known as CPD, is a process for professional growth that involves several actions taken by an individual while acting in the ability of a practice nurse in order to uphold and advance that nurse's professionalism under the established competency standards [13]. For healthcare professionals to maintain their skill sets, ongoing professional development (CPD) or continuing education is required [12]. Recognizing that continuing education (CPD) is a method for professionals to improve and broaden their knowledge, skill, and competence, as well as to develop both personally and professionally. Professional nursing development can enhance clinical nurse retention, job satisfaction, and the quality of patient care [14]. Nurses should be supported while their coworkers and the hospital management pursue professional development [15].

Recent research on workplace learning highlights the necessity to simultaneously consider individual and group learning prerequisites if the learning is successful. Encouraging nurses' CPD in a clinical setting is essential given its good effects on patients, professionals, and organizations [16]. Additionally, CPD helps to improve the standard of care and health outcomes. Moreover, previous research, highlights that CPD encourages professionals' enthusiasm, dedication, and happiness, which improves their retention and performance [12]. Since the practice standards rely on the possession and utilization of high-level abilities, which, if neglected, may have negative consequences on the patient, CPD is crucial for trained healthcare professionals [16]. As a result, mental health nurses have an ethical and professional duty to engage in it. The effectiveness of CPD has been defined as, in theory, the practitioner improving practice via knowledge and competence, and this development translates into better patient health outcomes.

Individual nurses, midwives, and other healthcare workers can benefit from participating in CPD; nevertheless, restricting chances might harm job satisfaction and the desire to leave the field. Despite a wealth of studies on CPD in healthcare, little is known about how it affects patient outcomes. Continuous Nursing Education assessment is essential since it has been demonstrated that better clinical practice or patient outcomes do not always follow more excellent knowledge for healthcare professionals [5]. However, CPD must go beyond knowledge acquisition and use employee preferences for learning connected to their jobs to yield benefits for patients and organizations [8]. Finally, there is limited consensus about the best techniques for assessment and analysis, the standard of CPD, and the price and cost-effectiveness of doing so.

A quasi-experimental study pretest and posttest with one group design were used in the current study to evaluate the effectiveness of an educational intervention on mental health nurses' clinical competency. The quasi-experiment purpose was to assess the effect of an intervention on a selected population. The interval between the pretest and posttest was 3 months. The study was conducted in the city of Tabuk which is located in the northwest of Saudi Arabia. The study was conducted in a large government mental health hospital called (ERADH mental health complex) from 1 November 2021 until 1 March 2022. The ERADH mental health complex was established in 1983 with 200-bed capacity and the total number of beneficiaries of hospital services annually is about 40000 referrals. The hospital also, includes different departments such as mental health ward for males and females, an addiction ward, an outpatient department, an emergency room, halfway houses, an occupational and recreational therapy department and home care.

A total of 135 nurses work at ERADH mental health complex. However, only 80 nurses responded and agreed to participate in this study, therefore, the total response rate was around 60% of the nurses that were recruited for the current study according to convenience sampling. Some of the potential reasons for nurses not being able to be included in the study include: the night shift nurses not being able to join, some nurses being on annual leave and others being assigned to assignments external to the hospital at the time of the study. The inclusion criteria were full-time nurses who work in direct contact with patients. The participants who were included in the current quasi-experimental study were informed about the aim and the type of methods that were utilized in this study. In addition, participants were informed that participation in the current study is voluntary and they have the right to refuse or withdraw from the study at any time without any harm or discrimination against them.

The data collection process during the current study was collected through two stages: In the first stage, the researcher distributed the questionnaire through paper forms to the participants before attending the educational intervention. The purpose of this step was to establish pre-assessment for the level of mental health nurses' clinical competency. In the second stage, the researcher distributed the same questionnaire to the same participants to compare both results of the pretest and posttest. Data collection was implemented by using two types of tools to measure the effectiveness of the independent variable (educational intervention) and the dependent variable (mental health clinical competency).

As shown in Table 3 a total of 80 healthcare employees participated in the study including 45(56.3%) males while females were 35(43%), 43(53.8%) aged from 30-40 years old, while 34(42.5%) were less than 30 years old, only 3(3.8%) aged from 41-50 years old. 72(90%) were Saudi, while 8(10%) were non-Saudi.

Furthermore, 48(60%) were married, 25(31.3%) were single, and only 7(8.8%) were divorced. 38(47.5%) held diploma, 40(50%) had a bachelor degree, and only 2(2.5%) had a higher education degree. Moreover, 39(48.8%) had experience working at the Ministry of health for 5-10 years and 25(31.3%) had experience less than 5 years, 14(17.5%) had experience from 11-15 years each, and only 2(2.5%) had an experience of more than 15 years.

In addition, the majority of the sample (76.5%) had a work experience within the current ward for less than 5 years, and 14(17.5%) had work experience from 5-10 years, while only 3(15%) had a work experience from 5-10 years. Finally, half of the participants worked in the male admission ward, 17 (21.3%) served in the female admission ward, 12 (15%) worked in the outpatient department and 11(13.8%) in other departments.

As shown in Table 4 the scale was measured using 45 items, and the 5-point Likert scale measured the clinical competency among mental health nurses from Always (4) to Never (0). The total score for the pre-test was (74.83±14.25/Average), and then the score increased dramatically for the post-test (96.18±26.53/Good).

As shown in Table 5 the relatively small sample was not normally distributed (p<0.05) therefore a non-parametric test was conducted, thus the Wilcoxon signed rank test indicated that the post-test (Mean rank=102) was significantly higher than the pre-test (Mean rank=59) (U=1480, p<0.001). As a result of the current study, the program showed great effectiveness (p<0.001) with an advantage for the post-test.

This study evaluates the effectiveness of an educational intervention in improving the clinical competency of mental health nurses working in a large mental health hospital in Saudi Arabia. The findings indicated that mean clinical competency of mental health nurses was average in the pre-test score. This result may be due to the fact that nurses at the hospital did not attend any educational interventions before due to a lack of specialized and trained nurses in mental health nursing. Moreover, due to the lack of support and guidance from senior staff most of the nurses have a deficiency in specific knowledge and confidence needed to deal with patients with mental illnesses. This result is consistent with the study of [18]. and another study done by [19] found that nurses are lacking on specific knowledge and confidence needed to deal with suicidal patients which in turn reflects on their ability to effectively provide care to patients with mental illnesses.

The current study shows that the mean score had increased dramatically for the post-test from an average to a good score. This result may be linked to the interventional program about mental health nurses that lead to improving the nurse's knowledge and attitude about mental health nursing. In this respect, this finding is supported by [20, 21] who also found an increase in posttest scores about educational interventions of mental health nursing.

This study found that the educational intervention had a statistically significant positive effect on mental health nurses' clinical competency. One possible explanation for this result may be related to applying an extensive and well-designed mental health program to create an opportunity for nurses' continuous education inside the hospital. Furthermore, provide a chance to discuss and explain any updates about mental health nursing which in turn may enhance nursing practice when dealing with patients with mental illnesses. These results were consistent with previous studies conducted by [22, 23] who reported a positive impact on participants’ competence and attitude scores regarding a similar educational program about suicide prevention and mental health nursing.

This study is not without limitations. The first is with regards to the chosen study design, in which randomization was not used therefore limiting the study's ability to conclude a causal association between the intervention and outcome. The sample size of the current study is relatively small and from a single site, therefore, limiting the generalizability of the study findings. Furthermore, the current study utilized a single cohort pre and post-design without a comparison or control group and did not include a follow-up. Thus, it would be beneficial if future studies replicate the current study, however, making use of a control group, randomization, and including a follow-up.

This study aimed to evaluate the effectiveness of an educational intervention on the clinical competency of mental health nurses. A total of 80 nurses participated in this study. The results of the current study showed that post-test scores were significantly higher than at the pre-test. Hence, the results of the current study, suggest that the program shows great potential and is likely to be very effective.

The current study has developed important recommendations, which include:

• The hospital and nursing administration besides the training and educational department should consider establishing more educational programs about mental health nursing that involve qualified and well-trained mental health nurses.
• It is important to initiate a follow-up assessment to examine the effectiveness of any educational program about mental health nursing.
• The nursing administration and training and educational department within the hospital should consider providing frequent training and orientation programs for new nursing staff who are assigned to work in the hospital.
• This study would benefit from being replicated using two groups of participants rather than one.