Nursing and midwifery research activity in Arab countries from 1950 to 2017

The growing role of nurses and midwives in the provision of healthcare services and the growing burden of both communicable and non-communicable diseases have created an urgent need of many trained, knowledgeable, and skilled nurses who rely on scientific evidence in their daily practice [1‐5]. In response to this need of skilled nurses and midwives, many Arab countries started new nursing education programs including graduate and specialized nursing programs. The increased number in nursing programs in Arab countries helped in meeting the increasing demand for nursing profession. However, research output remains an important indicator of the progress in nursing profession and the quality of healthcare services in any country [6, 7].

Bibliometric analysis is a method used for quantitative and qualitative assessment of research activity in any field [8‐11]. Bibliometric analysis is used to generate indicators of the excellence and professional development. Several bibliometric studies have been published on nursing research. For example, a very recent bibliometric study about global research output on nursing was carried out [12]. A second example, a bibliometric study about robotics used to assist or augment nursing care was published [13]. A third example is a bibliometric study carried out to address the characteristics of the research utilization literature in nursing field [14]. A fourth example is a bibliometric analysis to visualize the impact of nursing research in which the authors illustrated the importance of bibliometric methodologies to explore the richness of nursing research [15].Up to the authors’ best knowledge and based on a literature review, no bibliometric analysis of nursing and midwifery research in Arab countries had been published. Therefore, the aim of the current study was to analyze research activity in the nursing and midwifery field in Arab countries. Health policymakers, educators, clinicians, and researchers will benefit from the current bibliometric study in identifying how to direct research funding and how to allocate budgets for future development of nursing profession. Assessment of nursing research activity will motivate researchers and create a nursing research alliance in Arab countries that serves to promote nursing profession, education, research, and healthcare services in Arab countries. The current study is in line with recommendations and future strategic planning of the World Health Organizations (WHO) regarding developing nursing and midwifery research and profession in the Middle Eastern region [16].

In the current study, research activity on nursing and midwifery in Arab countries was assessed and analyzed. The study showed low nursing research activity and research collaboration in Arab countries. In the past two decades, there was an increase in the number of researchers and the number of nursing faculties in Arab countries which participated in the growth of nursing and midwifery publications [57, 58]. For example, in Jordan, at least nine governmental and non-governmental faculties of nursing are running. Similar situation exists in KSA and Egypt. A second potential reason for the upsurge in the number of publications is research collaboration. Several publications resulted from collaboration between researchers in Arab countries with their mentors or colleagues or collaborators in developed countries [59‐61]. The third potential reason is the academic pressure and competition which made researchers struggle to be promoted or get a tenure. In most Arab countries, academic promotion is based on the number and quality of publications. This is a strong driving force for competition among academics in various institutions to publish for tenure and promotion purposes. Finally, governments, health policy makers, international health organizations, and patients’ demand for better healthcare quality [62‐67] are also potential reasons for faculties of nursing to excel and adopt international standards in nursing education, practice and research. Recently, many academic institutions in Arab countries became aware of the importance of research component in regional and international university ranking systems. This was a major driving force for some universities in Arab region to give financial incentives to researchers based on their research activity. Furthermore, more funding became available from universities to encourage researchers to publish. Unfortunately, no data are available concerning the annual volume of financial support for research activity from most active Arab universities. Therefore, correlation between funding and volume of publications from Arab universities remain an intuitive one.

The current study showed that the mean number of citations per article and the h-index of the retrieved documents were low when compared to other fields [68‐70]. This was unsurprising given the fact that research in this field is a relatively recent. Most documents published from Arab countries in the nursing and midwifery field are of local or regional interest. Therefore, it is difficult to attract a high number of citations from international authors [71]. A third potential reason for the low mean number of citations is the lack of a nursing and midwifery journal published from the Arab region. Such a journal will create a comprehensive database for Arab scholars, which will increase the visibility of publications and citations. The low number of citations, h-index, and the low percentage of documents published in Q1 journals indicate modest quality of publications from Arab countries. The current study showed limited number randomized clinical trials (RCTs) in the retrieved literature. Arab countries are still behind in this type of studies because of cultural and legal issues [72, 73]. Not all Arab countries have laws that support the implementation of RCT and other types of experimental studies that involve humans [73‐75]. Patients in Arab countries might not be willing to participate or volunteer in such studies. Patients in Arab countries lack the awareness of such type of studies and might think negatively and suspiciously about such type of studies [72, 74]. One final point is that researchers in Arab countries might lack the expertise or adequate funding to carry out such studies given that RCT require team work with diverse experiences as well as adequate funding to cover all aspects of the trials. A recently published Delphi survey about nursing research priorities in Middle Eastern region concluded that “critical research priorities should focus on population-based health topics” [76].

The current study showed that nursing and midwifery research in some Arab countries has made noticeable progress while research in other Arab countries is still lagging and even “neglected”. The Arab Gulf countries (Oman, Qatar, UAE, Bahrain, KSA, and Kuwait)with high income and research funding are present in the list of active countries. In the past three decades, all Arab Gulf countries established various medical colleges including ones for nursing and allied health sciences [77, 78]. Furthermore, most institutions in Arab Gulf countries had successfully recruited researchers who helped improve nursing research output from these countries [79]. Despite the huge budget available for medical education and research in Arab Gulf countries, both Jordan and Lebanon made an outstanding quantitative and qualitative contribution to nursing and midwifery research that surpassed that of Arab Gulf countries. Medical and nursing education in Lebanon started as early as 1900s while that in Jordan is relatively recent. It seems that conflict in the Middle East created a high demand for medical services in both Jordan and Lebanon, which prompted greater planning for nursing education and research.

Nursing and midwifery research in Arab countries is part of the overall medical research in Arab countries, which has been lagging relative to other countries [80‐89]. However, nursing and midwifery research in Arab countries is on the rise and expected to advance nursing practice and healthcare services in Arab countries. Researchers in active Arab countries such as Jordan, Lebanon, and Gulf countries need to seek high quality publications to contribute positively to the global advancement of nursing profession. Researchers in Arab countries need to launch RCTs to contribute to evidence-based nursing practice. It is also important that researchers in Arab countries start focusing on nursing topics in the field of infectious diseases and potential role of nursing staff in minimizing the burden of such diseases. Authors of the current study recommend stronger research collaboration between active Arab countries and those lagging in nursing research. Nursing conferences in Arab world need to be encouraged to help better communication among all those in the field.