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Abstract

Introduction

Qatar's ongoing healthcare transformation, aligned with the Qatar National Vision 2030, underscores the need for a robust nursing and midwifery research agenda to drive systemic improvements. While an earlier Delphi study identified initial research priorities, its stakeholder representation was limited in scope and diversity.

Objective

To validate and refine Qatar's national nursing and midwifery research priorities through an expanded expert consensus.

Methods

This study represents Phase Four of a previously conducted Delphi project. A new panel of 20 experts from public, private, academic, and primary healthcare institutions re-evaluated 30 research priorities using a 5-point Likert scale. The consensus was defined as ≥70% agreement. Quantitative analysis assessed consensus strength, while changes in item rankings were evaluated using inferential statistics.

Results

High consensus was achieved across most items, with median ratings ranging from 4.0 to 5.0. Key validated priorities included transforming nursing education to integrate evidence-based practices (median = 5.0, interquartile range (IQR) = 4.0–5.0, 100% agreement), aligning nursing education with advances in healthcare technology (median = 5.0, IQR = 4.0–5.0, 100% agreement), and enhancing workforce development and retention (median = 5.0, IQR = 4.0–5.0, 100% agreement). Significant changes were observed in areas such as the influence of policy and legislation on nursing roles (p = .004), developing and evaluating nursing curricula and learning strategies (p = .029), and interprofessional collaboration (p = .026), indicating evolving national and institutional perspectives. Conversely, chronic disease management and palliative care showed a decline in priority (p = .009).

Conclusions

The findings reinforce and refine Qatar's national nursing and midwifery research priorities, emphasizing education reform, workforce resilience, and integrating innovation and leadership into nursing practice. The expanded consensus approach enhances the legitimacy and applicability of the research agenda, offering a foundational tool for guiding future research, policy, and academic development in Qatar's nursing and midwifery sector.

Keywords

Delphi method nursing and midwifery research national agenda Qatar healthcare transformation consensus nursing education policy leadership workforce development

Introduction/Background

Qatar's healthcare system has advanced significantly in recent years, demonstrating the nation's dedication to achieving world-class healthcare standards aligned with Qatar National Vision 2030 (Qatar Tribune & QNA, 2024). Over the past two decades, the healthcare sector has evolved remarkably into a modern, integrated system delivering comprehensive medical services meeting high international standards. The Ministry of Public Health (MoPH) is the primary regulatory authority. At the same time, Hamad Medical Corporation (HMC) remains the largest public healthcare provider (Abujaber & Katsioloudes, 2015). Furthermore, Qatar's private healthcare sector has grown significantly over the past decade, establishing numerous hospitals, clinics, and specialty services to meet the population's needs, offering everything from routine check-ups to advanced treatments (Generis Global Legal Services, 2024).

Globally, the development of nursing research agendas has been recognized as a critical strategy for strengthening health systems, advancing professional practice, and achieving universal health coverage. The World Health Organization has emphasized the importance of aligning national nursing research priorities with its Global Strategic Directions for Nursing and Midwifery (2021–2025), which highlight education, workforce development, leadership, service delivery, and research capacity as foundational pillars for nursing advancement (WHO, 2021). Similarly, the International Council of Nurses (ICNs) has consistently underscored the role of nursing-led research agendas in informing policy, guiding professional development, and addressing global workforce and practice challenges through its strategic frameworks and global advocacy initiatives (ICN, 2021).

Within this global context, national nursing research agendas serve as essential mechanisms for translating international priorities into locally relevant, culturally responsive, and system-specific research programs. Recent national health strategies increasingly recognize nursing and midwifery research as central to enhancing healthcare system resilience, quality of care, and workforce sustainability. By prioritizing innovation, these strategies aim to create sustainable, high-quality care models that adapt to evolving healthcare challenges.

Review of Literature

Investment in nursing and midwifery research and development drives the creation of new care strategies, nursing practices, and health technologies, improving patient outcomes and system efficiency (Salmond & Echevarria, 2017). Integrating technologies like Artificial Intelligence (AI), telemedicine, and personalized nursing interventions enhances these models, enabling nurses to provide more individualized and effective care (Nashwan et al., 2025). Collaboration between nurses, healthcare providers, researchers, policymakers, educators, and the private sector is essential to ensure that nursing practices are continuously evolving and that healthcare systems are prepared to meet future challenges in patient care (National Academies of Sciences, Engineering and Medicine, 2021).

Many nurses have limited confidence in appraising research studies and often struggle with understanding research concepts and methodologies (Mannethodi et al., 2023). Amidst the growing prominence of nursing and midwifery research across diverse healthcare environments, strategically implementing evidence-based findings becomes imperative for optimizing care effectiveness and efficiency. However, without precisely identifying and prioritizing the most critical challenges facing these professions, valuable resources and intellectual capital risk being directed toward peripheral concerns rather than addressing the core issues that would significantly advance patient outcomes and healthcare delivery. Developing a national nursing and midwifery research agenda enables the identification and prioritization of key research challenges, which can lead to more successful implementation of research findings (Alomari et al., 2024).

In Qatar, the healthcare system faces challenges in workforce development, with a growing demand for highly skilled nurses and specialized nursing education to meet evolving healthcare needs (WISH, 2020). Additionally, while evidence-based practice (EBP) and research are essential for improving patient outcomes, fostering a strong research culture within nursing is hindered by limited resources and the need for greater support for nursing and midwifery research initiatives (Al-Lenjawi et al., 2022). These challenges require targeted efforts to strengthen Qatar's nursing and midwifery education, leadership, and research.

Nursing and midwifery research in Qatar has recently concentrated on defined national priorities, utilizing a Delphi survey to achieve expert consensus on key focus areas such as improving patient care outcomes, enhancing workforce development, strengthening nursing leadership, integrating technology into clinical practice, and promoting EBPs (Alomari et al., 2024). While the study effectively identified research priorities aligned with the country's healthcare vision, its reliance on the subjective judgments of a relatively small expert panel comprised primarily of individuals from public institutions posed limitations. Excluding nurses from the private sector restricted the diversity of perspectives and may not adequately reflect the broader spectrum of experiences within the Qatari nursing community.

To address this gap, the subsequent phase of the research initiative expanded stakeholder involvement to include a broader range of high-caliber nursing professionals and institutional leaders from across Qatar's healthcare system. This included representation from the public health institutions, prominent private hospitals and academic institutions. The enriched diversity of contributors enabled the establishment of a more inclusive and representative consensus on research priorities. This comprehensive engagement ensures greater alignment with Qatar's evolving national health strategies and supports formulating a robust, forward-looking research agenda. Ultimately, this approach fosters the advancement of nursing and midwifery scholarships in the country while reinforcing the capacity of the profession to drive improvements in patient care quality, system resilience, and health workforce sustainability.

Beyond its national relevance, this study contributes to the international discourse on nursing research priority setting by demonstrating how global strategic frameworks can be operationalized through inclusive, multi-sectoral expert consensus at the country level. In addition, this study positions nursing and midwifery not only as essential components of the healthcare system but as autonomous professions with a critical role in generating, leading, and applying research to drive healthcare improvement.

Purpose of the Study

The purpose of this study was to validate and refine previously identified national nursing and midwifery research priorities in Qatar by engaging a broader and more diverse panel of experts through Phase Four of a Delphi consensus process.

Methodology

Aim

Study Design

This study employed a Delphi technique, a structured and iterative process to achieve expert consensus on complex topics. The initial 3 phases of this research, published previously, involved identifying and ranking 30 nursing and midwifery research priorities across the domains of practice, education, and management (Alomari et al., 2024). In Phase 1, qualitative input was collected to generate initial research topics. Phase 2 involved rating these topics on a 5-point Likert scale to determine their relative importance. In Phase 3, participants reviewed both individual and group responses from the previous round and were given the opportunity to revise their ratings, further refining consensus. The current manuscript presents Phase 4 of the study, which was undertaken to validate and refine the previously identified priorities by engaging a broader panel of experts to enhance inclusivity and ensure a more representative consensus.

This Delphi study was designed, conducted, and reported in accordance with established methodological guidance for Delphi techniques in health research. The study followed the foundational principles outlined by Hasson, Keeney, and McKenna, including purposive expert sampling, anonymity of responses, structured iteration, controlled feedback, and predefined consensus criteria (Hasson et al., 2000). Reporting was further guided by contemporary Delphi reporting recommendations and quality standards described by Spranger et al., 2022 as well as the ACcurate COnsensus Reporting Document (ACCORD) checklist for consensus methods.

Research Question

What level of consensus exists among a diverse national panel of nursing and midwifery experts regarding previously identified research priorities in Qatar?

Expert Panel Recruitment and Eligibility Criteria

Participants for Phase Four were purposively recruited using predefined expert criteria consistent with Delphi methodology. Experts were identified through professional nursing networks, academic institutions, healthcare organizations, and national nursing leadership structures in Qatar. Eligibility criteria were established a priori and included: (1) Registration as a nurse or midwife in Qatar; (2) a minimum of five years of professional experience; and (3) demonstrated expertise through at least one of the following—senior clinical or managerial role, involvement in nursing governance or policy, academic appointment, or active engagement in research, education, or professional development activities. Only those able to complete the English-language survey in full were included. This approach aligns with established Delphi guidance, which emphasizes expertise, relevance, and informed judgment rather than statistical representativeness when constituting expert panels. Consensus was defined a priori as ≥70% agreement among panel members, a threshold commonly applied in Delphi studies to indicate acceptable convergence of expert opinion while allowing for controlled diversity of views.

Study Procedure

Eligible participants received an information sheet outlining the study's objectives, methodology, and expectations for participation. Invitations were sent via email, including instructions for accessing the electronic survey. The survey mirrored the procedures of the previous Delphi rounds, where participants were asked to review the established 30 previously identified research priorities, rate each priority using a 5-point Likert scale (1 = least important to 5 = most important), and suggest modifications or propose additional research topics, if necessary.

A reminder email was sent two weeks after the initial invitation to encourage participation. Data collection began in November 2024, and the study lasted for two months.

Data Analysis

Data were analyzed using descriptive and inferential techniques appropriate for Delphi consensus studies. Descriptive statistics included median, interquartile range (IQR), mean, standard deviation (SD), and percentage agreement to summarize expert ratings and assess the level of consensus for each research priority. To evaluate changes in priorities across Delphi phases, exploratory inferential analyses were conducted using repeated-measures ANOVA to compare mean scores between Phases Two, Three, and Four. Statistical significance was set at p < .05. All analyses were conducted to support transparent reporting of consensus development and priority stability, in line with methodological guidance for Delphi studies and the ACCORD checklist (Gattrell et al., 2024).

Ethical Approval

Ethical approval for this study was obtained from the Medical Research Centre, HMC under approval number [MRC-01-22-689]. The study was conducted in full accordance with the Declaration of Helsinki, Good Clinical Practice (GCP) guidelines, and national regulations of the MoPH. Participation was entirely voluntary, and informed consent was implied through the completion and submission of the online survey. Data were stored securely on password-protected systems accessible only to the research team.

Results

The study included 20 participants, representing a 67% response rate from the 30 professionals invited to complete the survey, with an equal gender distribution of 10 females (50%) and 10 males (50%). The Delphi process was completed in one validation round, as consensus was achieved for the majority of items. Most participants were aged 35–44 years (45%), followed by 45–54 years (40%), while only 10% were in the 25–34 years category, and 5% were in the 55–64 years category. The participants represented a diverse range of job titles, with each designation having one or two representatives, including Registered Nurses (15%), Nurse Managers (5%), and Directors of Nursing (5%), among others. Institutional affiliation was similarly varied, with Aspetar (20%), Sidra Medicine (10%), PHCC (5%), and Qatar University (10%) among the reported workplaces. In terms of educational qualifications, the majority held a master's degree (55%), followed by a bachelor's degree (30%), and a Ph.D. or equivalent (15%). Research interests were primarily in Nursing Practice (35%), followed by Nursing Education (20%) and Nursing Administration (15%), with some participants involved in multiple domains. Regarding research involvement, 50% were part of a research team, and 10% had either published research studies or served as research advisors or journal reviewers.

Consensus was achieved for the majority of nursing and midwifery research priorities, with median scores ranging from 4.0 to 5.0 and generally narrow IQRs, indicating strong agreement among experts. Several priorities reached unanimous consensus (100% agreement) with median ratings of 5.0 (IQR = 4.0–5.0), including transforming nursing education to integrate advances in healthcare technology and EBP, enhancing workforce development, well-being, and retention, and developing care initiatives to improve patient safety and overall patient experience. Research priorities related to nursing leadership, administration, and professional development consistently demonstrated high consensus, with agreement levels ranging from 94.7% to 100% and median ratings between 4.0 and 5.0. In contrast, chronic disease management and palliative care showed comparatively lower consensus (median = 4.0; IQR = 3.5–4.0; 73.7% agreement), suggesting greater variability in perceived priority. Moderate consensus was also observed for embracing cultural diversity in healthcare and holistic approaches to care delivery. Overall, the findings demonstrate a high level of agreement (≥94.7%) on most nursing research priorities, emphasizing the urgent need for leadership development, workforce retention strategies, and technology integration in education and practice. The detailed consensus ratings of nursing and midwifery research priorities based on expert panel responses are given in Table 1.

Table 1.

Consensus Ratings of Nursing and Midwifery Research Priorities Based on Expert Panel Responses.

Variables	Mean ± SD	Median (IQR)	Mean Percent Agreement
Nursing administration, leadership and workforce
The enhancement of the nursing workforce's development, well-being, and retention	4.6 ± 0.5	5.0 (4.0, 5.0)	100.0 (0.0)
Leadership styles and management Practices for a healthy work environment	4.6 ± 0.6	5.0 (4.0, 5.0)	94.7 (22.9)
Create care initiatives to enhance patient safety and optimize the overall patient experience	4.6 ± 0.5	5.0 (4.0, 5.0)	100.0 (0.0)
The role of nursing administration in staff safety and job satisfaction	4.4 ± 0.5	4.0 (4.0, 5.0)	100.0 (0.0)
Developing nursing education and training programs to improve nurses’ leadership	4.6 ± 0.5	5.0 (4.0, 5.0)	100.0 (0.0)
Exploring the influence of organizational culture on the leadership practices of the below	4.5 ± 0.5	4.5 (4.0, 5.0)	100.0 (0.0)
Integration of technology and innovation in nursing administration	4.5 ± 0.5	4.5 (4.0, 5.0)	100.0 (0.0)
The importance of interprofessional collaboration in nursing administration	4.5 ± 0.5	4.5 (4.0, 5.0)	100.0 (0.0)
Balancing financial considerations and economic value, and patient care	4.2 ± 0.6	4.0 (4.0, 5.0)	89.5 (31.5)
The effects of policy and legislation on the role and responsibilities of nursing	4.4 ± 0.5	4.0 (4.0, 5.0)	100.0 (0.0)
Nursing practice
Transforming nursing education to meet advances in healthcare technology and evidence	4.7 ± 0.5	5.0 (4.0, 5.0)	100.0 (0.0)
The integration of patient-centered nursing practices	4.6 ± 0.5	5.0 (4.0, 5.0)	100.0 (0.0)
Empowering nurses to practice to the full extent of their capabilities	4.6 ± 0.5	5.0 (4.0, 5.0)	100.0 (0.0)
Advancing nursing education and professional development	4.4 ± 0.5	4.0 (4.0, 5.0)	100.0 (0.0)
Fostering teamwork and cooperation between nurses and other healthcare profession	4.4 ± 0.5	4.0 (4.0, 5.0)	100.0 (0.0)
Expanding the role and responsibilities of nurses to optimize healthcare outcome	4.4 ± 0.77	5.0(4.0,5.0)	100.0(0.0)
Adopting a holistic approach to healthcare delivery and problem-solving.	4.3 ± 0.7	4.0 (4.0, 5.0)	89.5 (31.5)
Chronic disease management and palliative care	3.9 ± 0.8	4.0 (3.5, 4.0)	73.7 (45.2)
Embracing diversity and cultural differences in healthcare	4.2 ± 0.8	4.0 (4.0, 5.0)	84.2 (37.5)
Taking responsibility for improving healthcare on a global scale	4.2 ± 0.6	4.0 (4.0, 4.5)	89.5 (31.5)
Nursing education
Promoting Evidence-based outcomes and research in nursing education	4.6 ± 0.5	5.0 (4.0, 5.0)	100.0 (0.0)
Integrate clinical-based learning into nursing education programs	4.5 ± 0.6	5.0 (4.0, 5.0)	94.7 (22.9)
Utilizing technology-based methods in nursing education	4.4 ± 0.5	4.0 (4.0, 5.0)	100.0 (0.0)
The value of nursing education programs on patient outcomes	4.4 ± 0.5	4.0 (4.0, 5.0)	100.0 (0.0)
The importance of family education for front-line nurses	4.3 ± 0.7	4.0 (4.0, 5.0)	84.2 (37.5)
Strategies to enhance professional development and continuous learning among nursing	4.5 ± 0.6	5.0 (4.0, 5.0)	94.7 (22.9)
Cultural competence and diversity	4.2 ± 0.7	4.0 (4.0, 4.5)	94.7 (22.9)
Developing leadership skills and empowering nurse educators	4.4 ± 0.5	4.0 (4.0, 5.0)	100.0 (0.0)
Developing and evaluating nursing curricula and learning strategies	4.3 ± 0.6	4.0 (4.0, 5.0)	94.7 (22.9)
Examining the advantages and difficulties of interprofessional collaborations in nursing education	4.3 ± 0.6	4.0 (4.0, 5.0)	94.7 (22.9)

IQR = interquartile range; SD = standard deviation.

Phases 2, 3, and 4 results indicate strong consensus on nursing and midwifery research priorities, with most mean scores above 4.0. However, several areas showed statistically significant changes over time. The most significant increase was observed in the effects of policy and legislation on nursing roles (p = .004), rising from 3.9 ± 0.9 in Phase 2 to 4.4 ± 0.5 in Phase 4, highlighting a growing concern about regulatory impacts. Similarly, chronic disease management and palliative care significantly declined (p = .009) from 4.2 ± 1.0 in Phase 2 to 3.9 ± 0.8 in Phase 4, suggesting a reduced perceived priority. Taking responsibility for improving healthcare globally also showed marginal significance (p = .050), indicating increased recognition of global healthcare challenges. In nursing administration, interprofessional collaboration (p = .037) and strategies to enhance professional development (p = .030) significantly increased in priority. Additionally, developing and evaluating curricula (p = .029) and examining interprofessional collaboration challenges (p = .026) showed significant increases in nursing education, reflecting an evolving focus on education reform. These priority shifts across phases are presented in detail in Table 2.

Table 2.

Changes in Nursing and Midwifery Research Priorities Across Delphi Rounds.

	Phase 2	Phase 3	Phase 4
Variables	Mean ± SD	Mean ± SD	Mean ± SD	p-value
N	32	32	20
Nursing administration, leadership and workforce
The enhancement of the nursing workforce's development, well-being, and retention	4.9 ± 0.3	4.9 ± 0.3	4.6 ± 0.5	0.127
Leadership styles and management practices for a healthy work environment	4.7 ± 0.5	4.7 ± 0.3	4.6 ± 0.6	0.116
Create care initiatives to enhance patient safety and optimize the overall patient experience	4.6 ± 0.6	4.5 ± 0.4	4.6 ± 0.5	0.698
The role of nursing administration in staff safety and job satisfaction	4.5 ± 0.9	4.4 ± 0.4	4.4 ± 0.5	0.409
Developing nursing education and training programs to improve nurses’ leadership	4.5 ± 0.6	4.2 ± 0.8	4.6 ± 0.5	0.091
Exploring the influence of organizational culture on the leadership practices of	4.3 ± 0.6	4.2 ± 0.5	4.5 ± 0.5	0.419
Integration of technology and innovation in nursing administration	4.4 ± 0.8	4.2 ± 0.4	4.5 ± 0.5	0.176
The importance of interprofessional collaboration in nursing administration	4.4 ± 0.6	4.1 ± 0.7	4.5 ± 0.5	0.037
Balancing financial considerations and economic value, and patient care	3.9 ± 0.9	3.8 ± 0.5	4.2 ± 0.6	0.355
The effects of policy and legislation on the role and responsibilities of nursing	3.9 ± 0.9	3.7 ± 0.6	4.4 ± 0.5	0.004
Nursing practice
Transforming nursing education to meet advances in healthcare technology and Evidence-based practice	4.5 ± 0.8	4.5 ± 0.1	4.7 ± 0.5	0.764
The integration of patient-centered care in nursing practices	4.4 ± 0.8	4.4 ± 0.4	4.6 ± 0.5	0.425
Empowering nurses to practice to the full extent of their capabilities.	4.4 ± 0.7	4.4 ± 0.3	4.6 ± 0.5	0.926
Advancing nursing education and professional development.	4.4 ± 0.8	4.2 ± 0.5	4.4 ± 0.5	0.146
Fostering teamwork and cooperation between nurses and other healthcare professionals	4.2 ± 0.8	4.2 ± 0.2	4.4 ± 0.5	0.234
Expanding the role and responsibilities of nurses to optimize healthcare outcome	4.2 ± 0.8	4.1 ± 0.6	4.3 ± 0.7	1.000
Adopting a holistic approach to healthcare delivery and problem-solving.	4.3 ± 0.7	4.1 ± 0.6	4.3 ± 0.8	0.096
Chronic disease management and palliative care.	4.2 ± 1.0	4.1 ± 0.5	3.9 ± 0.8	0.009
Embracing diversity and cultural differences in healthcare.	4.1 ± 0.8	4.1 ± 0.2	4.2 ± 0.8	0.186
Taking responsibility for improving healthcare on a global scale	4.0 ± 0.9	3.9 ± 0.6	4.2 ± 0.6	0.050
Nursing education
Promoting evidence-based outcomes and research in nursing education	4.5 ± 0.8	4.5 ± 0.3	4.6 ± 0.5	0.868
Integrate clinical-based learning into nursing education programs	4.5 ± 0.7	4.5 ± 0.2	4.5 ± 0.6	0.711
Utilizing technology-based methods in nursing education	4.3 ± 0.9	4.3 ± 0.3	4.4 ± 0.5	0.478
The value of nursing education programs on patient outcomes	4.3 ± 0.9	4.3 ± 0.3	4.4 ± 0.5	0.886
The importance of family education for front-line nurses	4.3 ± 1.0	4.2 ± 0.6	4.3 ± 0.7	0.113
Strategies to enhance professional development and continuous learning among nursing	4.4 ± 0.7	4.2 ± 0.5	4.5 ± 0.6	0.030
Cultural competence and diversity	4.2 ± 0.9	4.2 ± 0.2	4.2 ± 0.7	0.837
Developing leadership skills and empowering nurse educators	4.3 ± 0.8	4.1 ± 0.6	4.4 ± 0.5	0.058
Developing and evaluating nursing curricula and learning strategies	4.0 ± 0.9	3.9 ± 0.5	4.3 ± 0.6	0.029
Examining the advantages and difficulties of interprofessional collaborations in nursing education	4.0 ± 1.0	3.9 ± 0.3	4.3 ± 0.6	0.026

Discussion

This study offers a meaningful contribution to advancing a comprehensive set of nursing and midwifery research priorities tailored to Qatar's evolving healthcare system. By strategically expanding stakeholder representation across diverse healthcare settings, including public hospitals, private healthcare facilities, academic institutions, and primary healthcare institutions, we have achieved a more inclusive and robust validation of research priorities compared to previous efforts. This study findings reveal distinct priority patterns across three core domains that collectively shape nursing's contribution to healthcare: nursing administration, leadership, and workforce management, nursing practice, and nursing education. The consensus-driven priorities identified within these interconnected domains provide a structured framework for directing future research investments and initiatives. The following sections provide a detailed analysis of each domain's priorities, exploring their relevance to Qatar's evolving healthcare landscape system and their alignment with both national healthcare challenges and global trends in nursing advancement.

Nursing administrators must prioritize staff well-being and wellness as essential components of workforce sustainability and quality care delivery, particularly during the coronavirus disease 2019 pandemic (Joy & Nashwan, 2024). The unanimous consensus reflected in a Delphi mean score of 4.6 underscores the sector's heightened awareness of critical issues such as burnout, staff shortages, and turnover intentions. International research consistently advocates for developing supportive work environments, accessible mental health programs, and structured professional development to enhance nurse retention and job satisfaction (Aiken et al., 2012; Cummings et al., 2010). Creating psychologically safe, inclusive, and growth-oriented workplaces addresses immediate workforce challenges and strengthens organizational resilience and continuity of care (De-María et al., 2024; Edmondson, 1999). Therefore, investing in staff wellness is not simply a reactive measure but a strategic imperative ensuring long-term healthcare system viability and the well-being of providers and patients (West et al., 2020).

The study observed high consensus around developing leadership styles and management practices conducive to a healthy work environment (mean = 4.6, 94.7% agreement). This indicates a widespread acknowledgment of the pivotal role that organizational culture and leadership play in ensuring effective care delivery and sustaining team morale and job satisfaction (Cummings et al., 2010). Previous research in Qatar has highlighted similar themes, noting the need to investigate culturally tailored leadership models that reflect Qatar's healthcare system's unique demographic and systemic features (Al-Yami et al., 2018).

In tandem with leadership development, addressing nursing workforce sustainability emerged as a critical concern. The Delphi panel strongly emphasized the need for research into effective strategies for recruitment, retention, and reducing turnover. Qatar's healthcare system, like many others globally, faces challenges related to workforce aging, high attrition rates, and increasing demand for specialized nursing roles (Abujaber & Katsioloudes, 2015). Future research should explore tailored interventions such as career progression pathways, flexible scheduling models, and policies that promote nurse well-being and job satisfaction. Workforce development is not merely an operational necessity, it is a strategic pillar that underpins healthcare system resilience, quality of care, and patient safety.

Transforming nursing practice to reflect advances in healthcare technology and EBP has emerged as a foundational priority within the profession. As the healthcare landscape increasingly adopts digital innovations from electronic health records and telemedicine to AI and predictive analytics nurses must be equipped to navigate, apply, and optimize these tools in real-time clinical settings (Institute of Medicine, 2011). Integrating EBP into daily nursing routines ensures that care is technologically informed and scientifically validated, fostering consistency, safety, and improved patient outcomes. To support this transformation, healthcare organizations must facilitate ongoing clinical education, provide access to digital health infrastructure, and cultivate a practice environment encouraging innovation, inquiry, and continuous quality improvement (Nashwan et al., 2025; National Health Strategy 2018–2022).

Integrating Person-Centered Care (PCC) into nursing practice is another critical priority that reflects a shift toward holistic, respectful, equitable, and individualized healthcare delivery. Incorporating patients’ preferences, values, and cultural contexts into care planning and decision-making helps to foster trust, improve communication, and strengthen the therapeutic alliance between patients and healthcare providers (Barry & Edgman-Levitan, 2012; Luxford et al., 2011; ). In Qatar's diverse healthcare system, implementing PCC accreditation reinforces this commitment at a national level. However, to effectively operationalize PCC in practice, nurses must be supported in developing advanced communication skills, cultural competence, and collaborative care strategies. These capabilities enable nurses to deliver truly personalized care that aligns with contemporary expectations for quality and equity in health services (Nashwan et al., 2025; Salmond & Echevarria, 2017).

Although consensus levels remained high, certain research areas within nursing practice demonstrated relatively lower agreement. These included embracing cultural diversity in care delivery (84.2%) and adopting holistic care models (89.5%). While both surpassed the consensus threshold, the comparatively moderate support suggests a need for targeted research to understand how these concepts are currently operationalized in Qatar's diverse clinical settings. In particular, studies exploring the perceptions, barriers, and facilitators of culturally competent and holistic care among nurses can inform more inclusive and effective care models. Addressing these areas is essential for improving patient experience and outcomes in Qatar's multicultural healthcare environment (De-María et al., 2024; Edmondson, 1999).

Empowering nurses to practice to the full extent of their Scope of practice capabilities is equally vital in realizing the potential of a responsive and resilient health system. This involves removing regulatory and institutional barriers that limit professional autonomy and expanding roles that allow nurses to exercise diagnostic reasoning, decision-making, and leadership (Pearce & Breen, 2018). Empowerment in practice includes the development of nurse-led clinics, the introduction of specialized roles in areas such as chronic disease management and palliative care, and broader participation in organizational decision-making (Gordon et al., 2019). Aligned with the objectives of Qatar's National Health Strategy 2030, such empowerment not only enhances service delivery and accessibility but also contributes to professional satisfaction, retention, and leadership development within the nursing workforce (National Academies of Sciences, Engineering and Medicine, 2021).

Although chronic disease management and palliative care showed a statistically significant decline in prioritization (p = .009), these areas remain essential components of comprehensive healthcare, particularly in aging populations and increasing chronic disease burden. Practice environments should focus on evidence-based approaches to chronic disease management while exploring innovative care delivery models that leverage nursing expertise in coordination, education, and symptom management (Kelley & Morrison, 2015; You et al., 2018).

The findings reveal continued strong consensus on critical nursing research priorities, particularly in nursing education. The highest-rated priority “transforming nursing education to align with advances in healthcare technology and evidence-based practice” reflects the urgent need to revise academic curricula in line with the digital transformation sweeping global healthcare systems. This aligns with recent national research identifying educational reform as a cornerstone of Qatar's nursing agenda, particularly through integrating digital health tools, simulation, and informatics training (Alomari et al., 2024). Global literature likewise highlights the importance of embedding emerging technologies, such as AI and telehealth, into foundational nursing training to improve professional competencies and patient outcomes (Nashwan et al., 2025). Competency-based education (CBE) ensures that nurses are equipped with the practical skills and clinical judgment required for effective nursing practice in today's complex healthcare settings. By focusing on demonstrated competencies over time-based training, rather than time spent in training, CBE ensures that Nursing education is aligned with real-world demands. This approach supports the integration of integrating digital tools, simulation -based learning, and EBP ultimately preparing nurses to deliver safe, high-quality, and patient-centered care. In Qatar, adopting CBE can strengthen workforce readiness and support national goals for high-quality, technologically advanced nursing care. The unanimous agreement on this priority (mean = 4.7, 100% consensus) reflects Qatar's nursing leaders’ recognition that educational transformation is essential to building long-term workforce sustainability and healthcare resilience (Alomari et al., 2024). Beyond technical proficiency, contemporary nursing education must foster critical thinking, clinical reasoning, and ethical decision-making in technology-mediated care environments (Rugen et al., 2018).

A second priority emphasizes expanding simulation-based learning and cultivating lifelong digital competence across all stages of nursing career. Simulation modalities like high-fidelity mannequins, virtual reality, and augmented reality enable experiential learning in controlled, risk-free environments, allowing nurses to refine their clinical judgment and response capabilities (Nashwan et al., 2025). Moreover, ongoing digital literacy training ensures that novice and experienced nurses can confidently adapt to evolving technologies and deliver safe, high-quality care (Bandeali & Maita, 2023).

Finally, interprofessional education (IPE) emerged as a key area of focus, prioritizing interprofessional collaboration research (p = .026), reflecting the growing complexity of modern healthcare environments. Embedding IPE into nursing curricula through structured collaboration with other healthcare disciplines can foster mutual respect, enhance team communication, and improve patient outcomes (Institute of Medicine, 2011). These three research priorities, when pursued collectively, provide a robust framework for cultivating a future-ready, collaborative, and technologically empowered nursing workforce.

Strengths and Limitations

This study offers several strengths that enhance its contribution to national nursing and midwifery research planning in Qatar. Phase Four expanded the expert panel beyond previous rounds by including participants from public, private, academic, and primary healthcare sectors, thereby improving representativeness and ensuring a broader national perspective. The study also built on an established Delphi framework from earlier published phases, enabling structured refinement of priorities using a transparent, iterative, and consensus-driven approach.

Despite these strengths, several limitations must be acknowledged. First, the panel size of 20 experts was smaller than the original pool of 32; however, the number was not based on statistical power calculations. Instead, it followed accepted Delphi methodology, wherein expert panels commonly range between 10 and 30 participants. The decision intentionally prioritized diversity of expertise over numerical size, ensuring inclusion from multiple sectors rather than only from the largest healthcare institution.

Although efforts were made to broaden representation by including participants from public, private, academic, and primary healthcare sectors, the distribution of responses resulted in fewer frontline nurses, early-career practitioners, and specialized midwifery staff than anticipated. This imbalance was not due to design oversight; invitations were intentionally extended widely in accordance with the study protocol, which identified nursing executives, directors, academic leaders, and professional association representatives as key experts. However, response rates varied across groups, a common challenge in Delphi studies. While the final panel remained consistent with Delphi guidance on expertise-driven sampling, the underrepresentation of some subgroups may have limited the extent to which practice-level concerns were reflected in the final rankings.

Additionally, the structured survey format—an intentional component of the Delphi method—limited the depth of qualitative explanation participants could provide. This was a deliberate design choice to maintain comparability and facilitate quantification of consensus, though it may have constrained exploration of nuanced reasoning behind certain ratings.

As Delphi studies do not aim for statistical generalization, the findings should instead be interpreted as representing the collective judgment of the assembled expert panel. Finally, because the study was conducted in late 2024, the priorities reflect the healthcare context of that period and may require reassessment as Qatar's health system, workforce, and digital infrastructure continue to evolve.

Implications for Practice

The validated national nursing and midwifery research priorities identified in this study have important implications for the nursing profession in Qatar and beyond. By articulating a consensus-driven, profession-led research agenda, this study reinforces nursing's role as a knowledge-generating discipline with a distinct contribution to healthcare transformation, rather than solely as an operational component of the health system.

For nurses and midwives, the findings affirm the profession's collective voice in shaping research priorities that reflect real-world practice challenges, professional development needs, and evolving roles within increasingly complex healthcare environments. The strong emphasis on education reform, leadership development, workforce well-being, and digital competence underscores the need for nurses to engage actively in scholarly inquiry, evidence generation, and innovation to advance practice standards and patient outcomes.

For nurse leaders and managers, the agenda provides a strategic framework to guide research-informed leadership, workforce planning, and professional empowerment. Priorities related to leadership styles, organizational culture, and workforce sustainability highlight the responsibility of nursing leadership to foster supportive practice environments, promote professional autonomy, and champion research as a core component of nursing governance and decision-making.

For nurse educators and academic institutions, the findings emphasize the urgency of aligning curricula, pedagogical approaches, and research training with contemporary professional demands. The consensus around integrating EBP, digital health technologies, and interprofessional collaboration into nursing education signals a shift toward competency-based, future-ready professional preparation. Embedding these priorities into undergraduate and postgraduate nursing programs can strengthen research literacy, critical thinking, and leadership capacity across the nursing workforce.

For nursing researchers and professional bodies, this study offers a validated roadmap for coordinating research efforts, reducing duplication, and strengthening national and international research capacity. The agenda supports the development of collaborative, multisectoral research programs that elevate nursing-led inquiry, enhance professional credibility, and position nurses as influential contributors to health policy, innovation, and system improvement.

Collectively, these implications highlight that advancing nursing and midwifery research priorities is not only a system-level endeavor but a professional imperative. By grounding research agendas in expert consensus and aligning them with global nursing frameworks, the profession is better positioned to lead change, strengthen its scientific foundations, and shape the future of healthcare delivery.

Conclusion

This study provides an updated and validated set of national nursing and midwifery research priorities for Qatar by incorporating perspectives from a broader and more diverse panel of experts. The findings confirm the importance of previously identified priorities while refining them to reflect emerging needs related to education reform, workforce resilience, digital transformation, interprofessional collaboration, and leadership development. These validated priorities offer a coherent and actionable national research agenda that aligns closely with Qatar's evolving healthcare strategies and workforce modernization goals.

By expanding participation beyond earlier phases, this study enhances the applicability of the final priorities across healthcare sectors and strengthens their relevance to real-world system challenges. The work contributes meaningfully to regional efforts to structure national nursing research agendas and provides a model for iterative, stakeholder-driven priority setting. Future efforts should focus on operationalizing these priorities through targeted research programs, policy initiatives, and curriculum reforms, as well as establishing a recurring review process to ensure the agenda remains responsive to ongoing healthcare advancements.

Declaration of Generative AI and AI-Assisted Technologies

The authors used Microsoft Copilot, an AI-assisted writing tool, solely to support language editing and improve grammar, clarity, and readability of the manuscript. The AI tool was not used to generate scientific content, analyze data, interpret results, or influence the study's methodology or conclusions. All content was critically reviewed and verified by the authors, who take full responsibility for the integrity, accuracy, and originality of the work.

Footnotes

Acknowledgment

The article was funded by Medical Research Center, Hamad Medical Corporation, Doha, Qatar.

ORCID iDs

Abdulqadir J. Nashwan

Kamaruddeen Mannethodi

George V. Joy

Jibin Kunjavara

Kalpana Singh

Ederlie E. Martinez

Albara Alomari

Ibrahim Al Hussein

Sandra L. Holmes

Majeda M. El-Banna

Asma A. Taha

Ethical Approval

Ethical approval for this study was obtained from the Medical Research Center, Qatar (MRC-01-22-689). The study was conducted in full accordance with the Declaration of Helsinki, GCPguidelines, and national regulations of the MoPH. Participation was entirely voluntary, and informed consent was implied through the completion and submission of the online survey. Data were stored securely on password-protected systems accessible only to the research team.

Author Contributions

AN and KM contributed to the study concept, manuscript writing, and data collection. MN contributed to the study concept and manuscript writing. GJ, AT, EM, and AO contributed to manuscript writing. JK contributed to data curation and manuscript writing. KS contributed to data analysis and manuscript writing. IH, KA, SH, FY, EA, and MB contributed to data collection and manuscript writing.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This article was supported by the Medical Research Center at Hamad Medical Corporation, Qatar.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Availability of Data and Materials

The data supporting this study's findings are available from the corresponding author upon reasonable request.

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Towards a National Nursing and Midwifery Research Agenda: Validating Priorities Through Expert Consensus in Qatar

Abstract

Introduction

Objective

Methods

Results

Conclusions

Keywords

Introduction/Background

Review of Literature

Purpose of the Study

Methodology

Aim

Study Design

Research Question

Expert Panel Recruitment and Eligibility Criteria

Study Procedure

Data Analysis

Ethical Approval

Results

Discussion

Strengths and Limitations

Implications for Practice

Conclusion

Declaration of Generative AI and AI-Assisted Technologies

Footnotes

Acknowledgment

ORCID iDs

Ethical Approval

Author Contributions

Funding

Declaration of Conflicting Interests

Availability of Data and Materials

References