Nurse-identified patient care and health services research priorities in the United Arab Emirates: a Delphi study

The Delphi method was first developed to examine the impact of technology on warfare in 1950s, and has been defined as a type of consensus method (often using non-face-to-face techniques) for structuring a group communication process and allowing a group of individuals to deal with a complex problem [32]. It has been proven to be a feasible method when developing culturally-adapted interventions in mental health for minority and diverse groups [33]. The Delphi technique involves distribution of online questionnaires to a group of experts, with responses being anonymous. This method involves a number of iterations before consensus is reached. Feedback from the expert group as a whole is obtained to assist panelists to assess their ratings against the group feedback. This process involves eight steps: 1) framing a research question, 2) formation of the panel, 3) determining the expert panel size, 4) constructing the questionnaire, 5) providing information to panel members to aid their judgments, 6) administering the questionnaire, 7) analyzing response rounds and providing feedback to the panel, and 8) reporting results.

This study was conducted across private- and public-sector hospitals in the UAE.

Sample size calculations for the present study indicated that at least 1000 nurses were needed to achieve the desired power level. The calculations were based on an estimated population size of 33,429 nurses working across the UAE, a 95% confidence level, and a confidence interval of 3 [34]. The inclusion criterion was staff nurses who had worked in clinical settings in the UAE healthcare system for more than 1 year. Nurses with less than 1 year of experience were excluded as they might not have had sufficient exposure to the healthcare system to identify relevant research priorities.

A multistage clustered sampling procedure was initially considered appropriate to achieve the goals of the study. However, given difficulties in obtaining information about all UAE hospitals and resistance from many hospitals to recruitment of participants, the sampling procedure was changed to non-probability sampling. Therefore, nurses who met the inclusion criterion in all known hospitals that were accessible (i.e., gave permission to conduct the study) to the research team were invited to participate in the study. This included private and government-run hospitals, and hospitals managed by independent governing bodies (e.g., the DHA and DOH- Abu Dhabi) from across the UAE.

Two questionnaires were used to capture data for the two rounds of this study. The round one questionnaire included an open-ended question that invited participants to identify five research priorities that they considered most important to enhance the general delivery of nursing care in their hospital. Participants’ demographic data were also gathered, including age, clinical setting, clinical grade, emirate in which they worked, qualification level, and years of experience.

The questionnaire for round two was developed from responses received in round one. Identified research priorities were placed randomly in the questionnaire, and round two participants were asked to rate the importance of each research priority on a 7-point Likert scale (1 = low importance to 7 = high importance). Demographic data were not collected in round two to decrease repetition and survey burden on participants, and improve the response rate. However, clinical setting and emirate were extracted from returned questionnaires. Typically, round two participants would be a subset of those from round one, but the variable length of hospital administrative procedures necessary to gain permission for data collection meant that more hospitals were able to participate at the time round two started. The addition of these hospitals meant that demographic information was not available for some round two participants. However, it was anticipated that demographic data collected in round one would provide adequate general information about the study population.

Hospitals that approved participation in the study were consulted about the survey medium (electronic or paper-based) that best suited their organization and staff. Those that selected electronic surveys were asked to provide a list of email addresses for their nursing staff. An invitation letter containing information about the study and a link to an online questionnaire was then emailed to participants. Hospitals that selected paper-based surveys were asked to provide information about their departments and number of staff in each department. Those hospitals were provided with hard copies of the invitation letter and questionnaire, which were distributed and collected centrally through their education or research offices. The same data collection process was followed in both rounds of the study.

Responses to the open-ended question in round one were analyzed qualitatively, assisted by qualitative data analysis software (Atlas.ti V7®). Participants’ statements about research priorities were read and key clinical research areas reported were highlighted as codes. Similar codes were grouped together and categorized into broad issues, which were considered initial research priorities (i.e., patient safety and awareness of international patient safety goals, including nursing staffing issues and shift length). Initial research priorities were then used to construct the second questionnaire (round two), with each priority represented as an item in the constructed questionnaire. Analysis of round two results entailed examination of the rating scores for each initial research priority as ranked on a 7-point Likert scale.

Because healthcare research activity in the UAE, especially among nurses, is still in its infancy [35], the study team agreed to select the highest-ranked research priorities to focus on as a starting point. Therefore, in regard to the consensus cut-off points, the group agreed that the criterion used to determine consensus that a research priority was of high importance was that the identified priority was rated as important/very important by at least 90% of participants. Priorities that were rated as important/very important by at least 75% of participants were considered of medium importance. The remaining priorities were considered of low importance.

In total, 1032 participants completed and returned the round one questionnaire, representing a 56% response rate (1830 questionnaires distributed). Participants were from across the emirates including Sharjah, Ajman, Fujairah, Dubai, and Abu Dhabi. The majority of participants were staff nurses, female, had a diploma-level qualification, and 5–10 years of experience. There were 1339 participants in round two, representing a response rate of 66% (2000 questionnaires distributed); these participants were from various clinical settings. Participants’ demographic details are presented in Table 1.

Round one identified 31 general nursing research priorities, which were rated in terms of importance by round two participants. Based on the established criteria, five research priorities were identified as highly important and 26 were considered of medium importance. No priorities were considered of low importance. The most important research priority was patient safety and healthcare professionals’ awareness of international patient safety goals. This included nursing staffing issues such as shift length and the flexibility of the work schedule and the potential effects on patient safety, and was rated as important by 91.5% of participants. The second most important research priority was infection control practices in different hospital departments, which was rated as important by 91.2% of participants. The third most important research priority was the interpersonal skills of nursing staff, including critical thinking, communication skills, problem solving, time management, and planning skills and the effect of such skills on care outcomes. This was rated as important by 90.4% of participating nurses. The fourth research priority was medication management in clinical settings, which was rated as important by 90.1% of participants. Finally, 90% of participants considered pain assessment and management policies and practices in the UAE to be important. Table 2 presents research priorities of high and medium importance for the nursing profession in the UAE, as ranked by participating nurses.