Volume 19, Issue 1 (2023)                   ioh 2023, 19(1): 520-533 | Back to browse issues page

Research code: 12085
Ethics code: IR.SSU.RSI.REC.1400.024

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Dehghani K, shadi D. Determination of COVID-19 Nursing Research Priorities in Iran: Delphi Technique. ioh 2023; 19 (1) : 34
URL: http://ioh.iums.ac.ir/article-1-3425-en.html
PhD student in nursing, Department of Nursing, Tabriz University of medical science, Tabriz, Iran , shadidanyal@gmail.com
Abstract:   (1139 Views)
In the coronavirus (SARS-CoV-2) 2019 (COVID-19) pandemic, the global burden on health care systems increased significantly (1), And led to unprecedented changes in the organization and provision of health care at the national, systemic, and organizational levels. Nurses are recognized worldwide as a focal point for health care in a pandemic field (2). Nurses are at the forefront of care and are more vulnerable. Life-threatening situations during the outbreak of Covid-19 make the nurse's physical and mental condition very stressful (3). A developing body of research highlights deep concerns about the impact of work during the Covid-19 pandemic on this group’s health and well-being. Until today, thousands of healthcare professionals around the world have died from Covid-19 (4). There is also evidence of high levels of psychological stress and burnout due to a sudden increase in demand and the resulting workload (2). On the other hand, during the crisis, people are trying to adapt to the new normal conditions; while health care personnel, including nurses, are still struggling under the heavy burden of the pandemic, many of them become ill themselves due to lack of protective equipment and constant exposure to the virus during hours of daily contact with patients (5).
Nurses face major problems in this situation such as lack of nurses, beds and medical equipment including personal protective equipment and psychological changes and fear of critical infection. Further research is needed to explore the experiences of front-line nurses for further development, preparedness and responsive actions for the future (6). Checking the issues that nurses face during the battle with COVID-19 helps to support them and develops protocols and programs to improve their preparedness. The implications of these findings may help provide support and identify the needs of nurses (5). Nurses have a vital role in providing rapid and creative solutions; since their opinions to determine research priorities are mostly not determined, the need for more information in this regard can be beneficial to patients and their families (2). Determining research priorities is critical to the practice of the nursing profession that uses evidence to provide optimal care (5). Determining research priorities is considered as a key point and the beginning of the research management cycle, so that practical issues are determined according to the limitation of budget allocation (7) and it can make more connection between research topics in nursing with the government and investment institutions and provide services and regulate research and prevent uncoordinated and scattered nursing research (which leads to inefficiency and rework) (8). Using these priorities can be useful in organizing the nurses' response to COVID-19. Also, setting research priorities in Corona nursing can be effective in compiling health policies and innovations. On the other hand, the existing COVID-19 nursing cannot be depicted without information (2). ). Based on the Research Committee overall review of COVID-19 in IRAN, the three main areas of clinical management, health measures and socio-economic responses and eight sub-areas of screening and testing, drug treatment, intensive care, prophylaxis, prognosis, management Clinical effects of pandemic on health, infection prevention and personal protection have been identified (9). However, until today, despite the abundance of research activities, there has been no coordinated approach to attract nursing priorities for research during the Covid-19 pandemic (2), so the present study aims to determine the nursing research priorities in the Covid-19 pandemic in Iran- designed with Delphi technique.
This is a descriptive modified classical Delphi study that was conducted to determine Corona nursing research priorities. The Delphi technique is a structured process for predicting and assisting decision-making during survey rounds, gathering information, and ultimately group consensus (10). The purpose of using the Delphi method is to identify one or a limited range of numerical estimates of corona nursing research priorities. The researchers, first by reviewing the related texts extracted a list of research topics and sub-topics (questionnaire design).   Then, a group of 55 experts (considering 25% dropouts)  with at least three years of experience were selected purposefully from people in charge in the field of corona nursing, including members of the nursing board of the Ministry of Health and Medical Education, nursing members in the corona headquarters, heads of all research centers and managers of nursing department, vice chancellors of a number of nursing and midwifery schools in Tehran, Mashhad, Tabriz, Isfahan, Yazd, Sari, Ahvaz, Hamedan, Urmia, hormozgan and Zahedan. The individuals were included in the study with their own consent and agreement after their contact number and postal address were extracted. Subsequently Delphi steps were performed after compiling the initial questionnaire and identifying the group of experts. The questionnaire consisting of three parts: The first part includes personal characteristics including age, gender, educational and clinical background, type of responsibility, education, and place of activity. The second part includes a list of research topics for prioritization with a scale of 1 to 3(low (1) - medium (2) - high (3).The third section includes an open-ended question to prioritize other research topics that, according to participants, were not considered in the suggested list.
 The designed questionnaire was sent to eligible samples to determine the priority of the items in the questionnaire based on the criteria to express their opinions regarding the degree of importance from 1-3. The questionnaires were distributed by e-mail or in person along with a letter in which the objectives of the project, the application of the results and the deadline for submitting the answer were specified. An online questionnaire prepared via WhatsApp was also sent for those who did not respond. The samples were continuously followed up by phone and SMS to answer within the specified time.
After receiving the questionnaires, quantitative data were analyzed by calculating the mean and standard deviation of the response score for each of the topics with SPSS software version 21. Also, after qualitative analysis by content analysis method, new items were set up in different areas and some cases were merged based on participants’ opinions in the open-ended question.  Based on the analysis of the results, the items that were given a score of 2 or higher were identified as a priority and were listed based on a higher mean and less standard deviation. In the second stage, the issues raised in the first stage were submitted to the experts in the form of a questionnaire to determine the degree of their agreement with the priority of each case with a score from 1 to 7. At this stage, the issues were included in the list if they had a degree of agreement higher than 5. At the end of this phase, the final list of COVID-19 nursing research priorities in Iran was extracted.

Out of 55 invited people, 30 people participated in the first round and 20 people accompanied the study until the end of the second round. 55% of participants were female and 45% were male. The mean age of the samples was 52.2(+_8.37) years. 100% of the participants had a doctorate degree in nursing. In terms of professional work experience, the samples had an average of 8.8(+_ 9.84) years of clinical work experience and 23.1(+_7.78) years of educational work experience.
The initial draft of the research priorities list extracted from documents in six areas included 87 priorities as follows: Emotional psychology (16 items), educational research (16 items), nursing management (18 items), nursing care (13 items), prevention and epidemiology (18 items) and health technology (6 items).
In the first round of the study, 30 out of 55 invited individuals (54% response rate) answered the first round questionnaire .In this way, 19 items were removed, 8 items were merged and 13 items were added and finally 77 research priorities were extracted and formed the basis of the second round structured questionnaire. In the second round of the study, with repeated follow-ups, 20 individuals (67% response rate) completed the questionnaire of this stage of the study .all subjects had a degree of agreement higher than 5 in all items. The results of the Delphi study in response to the first and second round questionnaires led to the completion of priorities from 87 priorities to 77 final priorities. They were finally listed in order of priority in each of the six areas of emotional psychology (8 items), educational research area (16 items), nursing management area (16 items), nursing care area (11 cases), prevention and epidemiology area (21 items), and the field of managerial health technology (6 items) (Table 1-7).

Based on the results of this study, nursing research priorities were determined in six areas .These priorities can be a framework for research in the field of corona nursing in the country. As nurses play a specific and broad role in health care planning and service delivery in response to the level of health service demand and changing patterns, the nursing profession is increasingly at the forefront of research, clinical and Health services policy (11).
This study in line with previous studies (4) showed that mental health is an important area for the sustainability of health and nursing services during the pandemic. Nurses and health visitors are in an ideal position to develop and provide focused psychological interventions to patients and the public. Also, a growing body of evidence of the negative impacts of this pandemic on the mental health of the nursing workforce is emerging, necessitating research to improve long-term resilience and well-being in the context of more optimal staff conditions (12,13,14). On the other hand, the unprecedented psychological problems and social health challenges associated with this terrible pandemic are important issues that require further scientific research and evaluation and scientific solutions to mental health (15). Findings of the study showed that due to the high prevalence of patients' mental problems, even after recovery from COVID-19, a comprehensive study of mental health is needed to improve their quality of life (16).
The development of remote practical plans of nursing care during the pandemic and presenting information technology solutions in nursing education during the Covid-19 pandemic had a high priority in this study. The need for research on technology in nursing has started since 20 years ago and it has been used to support daily care, help patients interact and also educate them (5). Therefore, distance nursing has become an essential component of nursing care. Nursing care has been provided directly or virtually during the Covid-19 pandemic. Today the majority of people use virtual nursing care in the community if possible. Therefore, the concept of virtual care and the model of nursing care with non-verbal communication should be developed and examined. (17).

This study highlighted the priority for focused research on occupational hazards and safety (environment, nurse, and patients) in the field of prevention and epidemiology. The World Health Organization agrees that alternative approaches to reducing the shortage of personal protective equipment should be based on scientific evidence and the principles of safe care (18). This approach is vitally important because concerns about personal protective equipment may arise not only from nurses' personal safety issues, but also from other patients and the transmission of the virus to other people outside the workplace (4). In a study, in order to determine a model for research priorities in the Corona pandemic, the need for research on social psychology to plan preventive measures has been emphasized (19) ,and in this regard, the image of nurses in society and the media can affect the fulfillment of their role(5).
Research related to human resource management and equipment and crisis management had a high priority in this research. Undoubtedly, we must plan for a future with a sufficient number of nurses from now on, and the entire nursing staff must be paid better (20). There is also a generation gap to replace retired nurses. Designing staff models and innovative human resource strategies are essential to replace the new forces. In addition, organizational commitment among nurses needs further consideration due to high workload, low pay, high patient / nurse ratio, and other factors (21). Lack of manpower and medical equipment and resources such as personal protective equipment is the second most important category that nurses stated in the evidence, facing covid-19, which has led to the spread of infection among physicians and nurses and their death (22).
During the Covid-19 pandemic, the training section was one of the most vulnerable (23). To deal with the consequences of the closure of educational centers and the cessation of educational processes, learners and professors in all stages had no choice but to use e-learning in various forms (24). E-learning in nursing education may affect patients' health. There is little consistency between the content, the educational method and the goals of the university (26). Another problem in this section is related to the practical nature of some courses that cannot be presented online (27). Therefore, innovative teaching-learning strategies, utilizing the experience of students and faculty from distance education, educating the patient and their families, and developing an educational guideline are among the priority items that should be considered.
In this study, research in the field of nursing services for patients with COVID-19 at the time of hospitalization and after discharge at home as well as dying patients was given high priority. Families felt a deep sadness for the death of their loved ones who died alone. It is necessary to check and follow up these families and the impact of palliative care (4).
 One of the strengths of this study was the presence of experts and the use of the Delphi method to reach a consensus to determine priorities. The Delphi method was used with the spread of samples in Iran, which strengthens the validity and generalizability of research priorities.This study confirms the pivotal role of nurses in the continuous development of health care services by identifying priority fields that can be the basis for care measures and nursing practices at the national level. It is suggested that the identified research priorities in each of the areas be examined separately and that clinical nurses be used to review future research priorities. Conducting research in the areas identified in this study could guide future nursing research and the allocation of research grants and subsequently lead to the development of nursing knowledge; it could also improve patient outcomes and the quality of nursing care and ultimately lead to maintaining and promoting the health of the individual, family and community. It is recommended that nursing research in the post-corona period be continued due to the effects of this pandemic in the psychological and social fields on nurses and patients.

In this study, the research-nursing priorities of COVID-19 were determined in Iran, via Delphi method, based on nursing experts' opinion in various fields. Developed research priorities could guide the study audience in selecting topics and focusing on future research activities even in the post-corona period. Also purposefully target the allocation of research resources and budgets. Priority evaluation was done virtually via e-mail, which was difficult and time consuming due to the busy schedule of experts Research priorities with an average score equal to and above 2.5 were listed (table 1).
This study was suggested by the Nursing Research Network, "Corona Research Working Group", Mr. Dr Nejatian,Mr. Dr. Mazloum, especially Mrs. Dr. Leila Valizadeh, who are appreciated. We would also like to thank the Research Vice Chancellor of the University of Medical Sciences and the Midwifery Nursing Research Center of the Shahid Sadoughi School of Nursing and Midwifery in Yazd, and all the valuable experts and professors who helped us in this research.
Ethical considerations:
This study is the result of a research project No. 12085 approved by the Ethics Committee of Shahid Sadoughi University of Medical Sciences of Yazd with the code IR.SSU.RSI.REC.1400.024
Conflict of interest: This study has no conflict of interest.
Funding source: This research did not receive any grant from funding agencies.
Author contributions: khadijeh dehghani: design of the work, methodology, analysis, drafting, editing, revision and Supervision of the work.  danial shadi  : methodology , research review , drafting and editing.
Article number: 34
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Type of Study: Full Text | Subject: Qualitative and quantitative studies
Received: 2022/07/11 | Accepted: 2022/12/1 | Published: 2023/04/9

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