Research priorities in nursing – a Delphi study among Swedish nurses

RESEARCH ISSUES

Research priorities in nursing – a Delphi study among Swedish nurses

Siv Back-Pettersson PhD, RN

Director of Research, Fyrbodal Research Institute, Uddevalla, Sweden

Evelyn Hermansson PhD, RNMT

Senior Lecturer, Institute for Health and Care Science, The Sahlgrenska Academy at Goteborg University, Goteborg, Sweden

Ninni Sernert PhD, RPT

Director of Research, Fyrbodal Research Institute, Uddevalla, Sweden

Cecilia Bjorkelund PhD, MD

Professor, Institute of Medicine, Department of Public Health and Community Medicine/Primary Health Care,

The Sahlgrenska Academy at Goteborg University, Goteborg, Sweden

Submitted for publication: 14 January 2007

Accepted for publication: 4 May 2007

Correspondence:

Siv Back-Pettersson

Citronfjarilvagen 1

S-444 46 Stenungsund

Sweden

Telephone: þ46 303 82370

E-mail: [email protected]

BACK-PETTERSSON S, HERMANSSON E, SERNERT N & BJORKELUND CBACK-PETTERSSON S, HERMANSSON E, SERNERT N & BJORKELUND C

(2008)(2008) Journal of Clinical Nursing 17, 2221–2231

Research priorities in nursing – a Delphi study among Swedish nurses

Aims and objectives. The main aim was to illuminate essential areas for future

patient-related nursing research. The secondary aim was to stimulate nurses to

explore important research areas based on clinical practice.

Background. Priority-setting is regarded as one of the main strategies to ensure

excellence in nursing science, to direct nursing research and develop healthcare

practice accordingly as well as strengthening the nursing profession’s research

commitment.

Design and method. A three-round Delphi survey was conducted. A panel of 118

clinicians, in various nursing, teaching and administrative positions participated.

Ninety-five panel members completed all three rounds (81%). The majority were

female, aged 25–67 (mean 49) years, with an average of 23 (range 1–40) years in

nursing, working in hospitals (42%), primary healthcare centres, community care

(44%) and administration/education (14%). Sixty-six per cent had graduate diplomas

and 34% had an academic education, ranging from bachelors’ to doctoral degrees.

Results. Three hundred and eighty nursing research areas were identified, evaluated

and ranked using content analysis and descriptive statistics. The participants’ priori-

tised research aimed at preserving humanistic values and developing cross-organisa-

tional collaboration in the healthcare system. Nursing research aimed at preserving

human dignity in geriatric care, respectful transfers, continuity of care and exploring

the characteristics of a caring encounter were ranked high relative to the patient

welfare, to the healthcare organisation and to the nursing profession.

Conclusions. Nurses prioritise research that will improve clinical practice, assure

patients’ wellbeing and a caring environment. Nurses can reach consensus on the

� 2008 The Authors. Journal compilation � 2008 Blackwell Publishing Ltd 2221

doi: 10.1111/j.1365-2702.2007.02083.x

objectives of patient-related nursing research despite differences in age, workplace,

educational period and level of academic degree.

Relevance to clinical practice. When prioritising important areas for patient-related

nursing research, informed nursing practitioners’ commitment initiates knowledge

development within clinical practice from a nursing science perspective as well as

expanding cross-professional and cross-organisational collaboration.

Key words: caring, Delphi study, nurses, nursing, research, research in practice

Introduction

Nurse researchers have been studying different aspects of

macro and micro healthcare problems in the world for many

years. Nursing, as an empirical science and practical disci-

pline, has traditionally focused on exploring the needs of the

vulnerable, needy, disenfranchised and oppressed individuals

and groups in society (Meleis 1991). During the past two

decades, the major shifts in providing health care, economic

cutbacks in the healthcare organisation and technological

developments have brought about increasing demands for

qualified nursing care. The emphasis on community-based

care, the focus on health promotion and risk reduction and the

increased severity of illness coupled with major cost reduc-

tions and restructuring, as well as the growing number of

older people, will affect the demands placed on future nursing

research (Hinshaw 2000). To expand nursing’s scientific

knowledge base, it has been suggested that nursing research

should focus more on studying principles for effective and

efficient nursing practice and factors affecting perceptions of

health and well-being among individuals, families, communi-

ties and healthcare services (Hinshaw 2000, Evers 2003).

Background

In the beginning of the 1980s, research priority-setting

became an international trend, focusing foremost on the

development of infrastructures to support the dissemination

of nursing research results at the international, national,

regional and institutional levels. As definitions were created

and the scientific base of nursing was explicitly identified,

more substantive research priorities began to evolve

(Hinshaw 2000).

The priority-setting process accelerated as a result of

important collaborative activity among the early scientists in

the discipline of nursing, a process repeated over the world to

develop depth in the scientific knowledge base for nursing

practice. According to Hinshaw (2000) a synthesis of

knowledge from priority-setting is one way of translating

scientific knowledge into nursing practice.

Formal research agenda identifying nursing research pri-

orities proposed by nurse scholars, professional organisations

or federal governments were developed in several countries.

Research priorities for the USA were presented in the

National Nursing Research Agenda in 1989 (Hinshaw

1995). When analysing priority-setting internationally, Hin-

shaw (2000) identified four areas of common current

importance among countries and regions, i.e. promoting

health, caring for older people, studying healthcare systems

and managing symptoms.

In the Nordic countries, the first priority list for nursing

research was created by the Northern Nurses Federation and

the World Health Organisation in 1966, but it was not until

1995 that the Nordic countries established a formal agenda

for nursing research (Hamrin 1995, Lorensen 1995). Accord-

ing to Heyman (1994), research carried out by Swedish

nurses differed in terms of type of thesis, research fields,

scientific perspectives, approaches, tools and technique, thus

developing nursing knowledge. Influence from the medical

field is considered to have productively illuminated research

in clinical practice (Hamrin 1995). Elucidating the nurse

professional’s unique view of science in conjunction with

priority-setting is considered essential to achieve multidisci-

plinary, communicative cross-fertilization of ideas. Develop-

ing clinical research based on the nursing/caring science

paradigm is also regarded as necessary to expand substantive

knowledge in nursing practice (Eriksson 1995). This has been

made possible during the last two decades because of the

development of doctoral education programme within nurs-

ing science (Svensk Sjukskoterskeforening 2001). Currently,

over 700 registered nurses out of 100 000, have a PhD degree

in Sweden (Heyman, Uppsala University, personal comm.).

This small number of nurse researchers cannot be responsible

for this continuing process alone. Strengthening the nursing

profession’s research commitment is thus imperative. Nurs-

ing research priority-setting is regarded as one of the main

strategies to ensure excellence in nursing science and to

direct nursing research and develop healthcare practice

accordingly (Hinshaw 1989). To involve nurses in research

activities in clinical practice is crucial and of great importance

S Back-Pettersson et al.

2222 � 2008 The Authors. Journal compilation � 2008 Blackwell Publishing Ltd

to patients/relatives, to the healthcare organisations as well as

to the nursing profession itself (Clark & Hockey 1992).

Nursing clinicians are expected to possess the requisite

wisdom to differentiate between top-priority, secondary and

trivial clinical issues (Meleis 2007). There is a need for

research that answers top-priority questions that are known

by clinicians, leaders and researchers in conjunction with

unanswered research questions defined from systematic

reviews of literature (Hughes 2006).

In Sweden, there were no previous studies concerning

priority-setting of important research areas in clinical nursing

with participants from clinical practice, education/research

and administration. Therefore, this study was initiated to

explore nurses’ common research interests. The main aim of

the study was to illuminate essential areas for future patient-

related nursing research. The secondary aim was to stimulate

nurses to explore important research areas based on clinical

practice.

Method

The Delphi method

The importance of involving nurses in setting research

priorities is well documented when it comes to accomplishing

the above-mentioned goal. A review of the literature, based

on databases (CINAHL and PubMed) as well as references

from books and articles, revealed that the use of the Delphi

technique is regarded as valuable to facilitate involvement

and generate new ideas in this context. Several nurse

researchers have used the Delphi method for many years to

involve professional nurses in identifying clinical priorities in

nursing research (Lindeman 1975, Bond & Bond 1987,

Goodman 1987, MacMillan et al. 1989). Recent Delphi

studies on the subject have been conducted in different

countries and clinical settings, e.g. oncology nursing (Browne

et al. 2002, McIlfatrick & Keeney 2003, Cohen et al. 2004),

critical and intensive care nursing (Daly et al. 1996,

Leino-Kilpi & Suominen 1997, Lopez 2003), palliative care

nursing (Chang & Daly 1998), emergency nursing (Bayley

et al. 2004, Rodger et al. 2004), paediatric nursing (Schmidt

et al. 1997) and district nursing (Annells et al. 2005).

Powell (Powell 2003) concludes that the major strengths of

the method are the likelihood of achieving consensus in areas

and contexts in which empirical knowledge is required and in

the process of controlled feedback. The approach is regarded

as democratic, structured and consolidative of collegial

knowledge; it is thus considered to facilitate communication

among professionals (Powell 2003). The lack of clarity in the

consensus-reaching process is regarded as the method’s

foremost methodological weakness. Poor response rate,

accountability and scientific respectability are other described

limitations. The findings should be regarded as expert opinions

rather than indisputable data and the validity and credibility of

the research depends on the accuracy of conducting and

reporting in the study. It is also important to be aware that the

results only represent one moment in time (McKenna 1994,

Powell 2003). To assess study results, the demographics and

educational characteristics of the panel members must be

thoroughly described. This description of the panel members is

regarded as crucial to enable assessment of their credibility

(Kennedy 2004). Successive rounds of the questionnaire

increase the validity; the validity of results will be ultimately

affected by the response rates (Hasson et al. 2000).

Study population

Approval for the study was obtained from each participating

healthcare organisation in Fyrbodal in the Vastra Gotaland

Region of western Sweden. A reference group was created,

consisting of nursing leaders and researchers representing

hospitals, primary healthcare centres and community nursing

as well as researchers/teachers at the Department of Nursing

and Health Sciences at Trollhattan/Uddevalla College. The

reference group’s assignment was to be operative in the

selection process, to convey information to panel members

and to serve as referees during the study. The study design

and invitation to participate were simultaneously conveyed

verbally and online to executives of the participating health-

care organisations. A total of 2665 nurses was employed in

the region at the time of the study. As the panel members

were not invited personally, the number reached by the

invitation is difficult to estimate.

One hundred and eighteen nurses, representing all health-

care institutions from different perspectives and communities

in the above-mentioned area, responded positively to the

invitation. These respondents were regarded as a convenient

group of informed individuals and specialists with the requisite

expert knowledge to verify important research priorities in

patient-related nursing, thus qualifying them as panel mem-

bers (McKenna 1994, Keeney et al. 2001, Powell 2003).

Information about the study, including assurance of confiden-

tiality, was distributed by e-mail or fax to the 118 head and

staff nurses, teachers/researchers and administrators.

Study design

Round I (creating)

In the first round participants were asked to identify five

primary areas/questions of importance to patient-related

Research issues Research priorities in nursing


nursing research and to provide demographic and educa-

tional data. The panel members identified 380 primary areas/

questions (items). The data were content analysed to describe

and quantify specific phenomena systematically and objec-

tively (Krippendorff 2004). The analysis of the primary areas/

questions emerged inductively through coding and catego-

rising (Graneheim & Lundman 2004). This procedure makes

it possible to make valid inferences from verbal, visual or

written data which provides interpretations based on sys-

tematic and objective scrutiny of the phenomena of interest

(Downe-Wamboldt 1992). The review, content analysis and

categorisation of data resulted in a 13-page questionnaire

organised in seven main categories and 41 sub-categories.

Round II (categorising)

The questionnaire from Round I in which response scales

were graded from 1–7 (with 1 for low and 7 for high

importance level), was sent to all 118 panel members for

evaluation. Fifteen did not complete Round II because of lack

of time. Furthermore, each item was to be evaluated from

three different perspectives: Importance to Patient Welfare

(IPW), Value to the Health Care Organization (VHCO) and

Value to the Nursing Profession (VNP). Data were analysed

using SPSSSPSS� descriptive statistics (SPSS Inc., Chicago, IL,

USA). The mean value was calculated for every item with a

median score of ‡6. Ranking lists of items with mean scores

‡5Æ5 were created for each perspective: 40 items in the IPW

perspective, 15 items in the VHCO perspective and 28 items

in the VNP perspective.

Round III (prioritising)

The three questionnaires from Round II were sent to 103 panel

members, of whom 95 (92%) responded. The panel members

were asked to rank, from each perspective, the 15 most

important areas for patient-related nursing research. The

highest rank was given 15 points and so forth, on a descending

scale, to facilitate mean value calculation. Finally, the mean

values were re-calculated and re-ranked. The instructions and

questionnaires were distributed to each panel member in all

three rounds by e-mail/fax. Three weeks after the question-

naires had been distributed, an e-mail/fax was sent to thank

the participants and remind non-respondents. Three panellists

did not complete Round III, four questionnaires were

incomplete and were excluded and one panel member

responded too late.

Results

Demographic and educational characteristics of the panel

members who responded to all three questionnaires are

presented in Table 1. A majority of the panel members was

female and ranged in age from 25–67 (mean 49). Three

educational periods are defined, according to shifts in the

national nursing education programmes. Nurses who com-

pleted their nursing education after 1996 have the opportu-

nity to obtain diploma as well as academic-level degrees

(Higher Education Act Law 1992:1434, Hogskoleforordnin-

gen 1993:100).

In Round I, the request for five primary areas of impor-

tance to patient-related nursing research resulted in 380

areas. The content analysis was inductively organised into

seven main categories, including 41 sub-categories and items

(Table 2). The suggested areas/questions comprise a broad

spectrum of nursing research topics, from basic nursing

treatment and interventions to philosophical issues necessary

to develop caring values in nursing, as well as research

questions on collaboration between healthcare providers and

nurses’ professional roles and positions.

Round II was completed by 103 (87%) panel members.

The most important research areas appeared in three main

categories: Patient needs/problems; Nursing, treatment and

rehabilitation interventions and Interaction/collaboration

between healthcare providers. When it came to the important

research priorities, 40 of 137 items were top-ranked in the

IPW perspective, 15 of 74 items were top-ranked in the

VHCO perspective and 28 of 86 items were top-ranked in

the VNP perspective (Table 3). Continuity in care, caring

attitudes and behaviours and common humanistic values

and attitudes in nursing were priority items in the IPW

perspective. Nurses’ need for professional development and

Table 1 Demographic characteristics of the panel members

Variable

Round I

n (%)

Round II

n (%)

Round III

n (%)

Number of participants 118 (100) 103 (87) 95 (81)

Gender (female/male) 111/7 98/5 91/4

Age (range) 49 (25–67) 50 (25–67) 49 (25–67)

Area

Hospital 53 43 40

Primary health and

community care

50 46 42

Administration/education 15 14 13

Level of higher education

Doctoral degree 1 1 1

Master’s degree 14 12 10

Baccalaureate degree 25 23 23

Graduate diploma 78 67 61

Nursing education period

Before 1969 19 17 15

1970–1995 80 71 65

After 1996 19 15 15

Years in nursing (range) 23 (1–40) 24 (1–40) 23 (1–40)



supervision were the most prioritised items in the VHCO

perspective and research about caring attitudes and profes-

sional accountability were ranked highest in the VNP

perspective.

Round III was completed by 95 (81%) of the original panel

members. The panel members’ re-ranking procedure resulted

in 15 items with the highest mean IPW perspective scores, as

presented in Table 4a. The ranking procedure reveals that

nurses give highest priority to research concerning caring

values, caring encounters and communication.

The 15 items with the highest mean VHCO perspective

scores are presented in Table 4b. In this perspective, nurses

prioritise research concerning staff well-being and used,

implementation and evaluation of research in clinical

practice. Research concerning caring values is also ranked

but not as highly as in the IPW perspective.

The 15 items with the highest mean VNP perspective scores

are presented in Table 4c. In this perspective, the panel

members prioritise research concerning the meaning of a

caring encounter as well as professionalisation issues. Deter-

Table 2 Categorisation of research items, Round I

Main categories Sub-categories Items

Patient needs/problem (61)* Access to health care 7

Continuity in care 4

Patient’s role as decision maker 3

Caring attitudes and behaviours 8

Patient/relatives communication/dialogue 20

Patient information 7

Patient instruction/teaching 12

Nursing treatment and rehabilitation interventions (88)* Satisfy basic needs 3

Nutrition 6

Sleep 5

Elimination 7

Satisfy mental and spiritual needs 3

Experiences of nursing 7

Caring environment 9

Specialised nursing 17

Care of the older 15

Care and rehabilitation of cancer patients 11

Palliative care 5

Philosophy and theory of nursing (29)* Humanistic caring values and attitudes in nursing 8

Theories as a tool in nursing 3

Environment and public health 1

Safety, respect and humanistic care 7

Integrity 2

Gender perspective 2

Culture/ethnicity 6

Method development, implementation, evaluation (53)* Developing methods in clinical practice 20

Implementing research in clinical practice 6

Evaluating research in clinical practice 27

Healthcare organisation/administration (55)* Leadership and development of professional competence 8

Team building 8

Organisational models, quality of health care 4

Office nursing 10

Individual care plan 8

Nursing records 4

Nursing documentation 13

Interaction/collaboration between healthcare providers (23)* Common humanistic values and attitudes in nursing 7

Collaboration within the healthcare system 9

Collaboration for continuity of patient care 7

Nurse’s professional role (22)* Professional accountability 9

Nurse’s role in the healthcare team 7

Nurse’s need for professional development and supervision 6

*The numbers of research areas are indicated in parenthesis.



Table 3 The research process

Panel members Questionnaire Measures Research areas

Round I (creating) 118 Five priority topics in nursing research Content analysis 380 primary areas/items

7 main categories

41 sub-categories

Round II (categorising) 103 Importance for Patient Welfare Statistical analysis 40/137 (IPW)

Value to the Health Care Organization 15/74 (VHCO)

Value to the Nursing Profession 28/86 (VNP)

Round III (prioritising) 95 Importance for Patient Welfare Statistical analysis 15/40 (IPW)

Value to the Health Care Organization 15/15 (VHCO)

Value to the Nursing Profession 15/28 (VNP)

In relation to professional and educational

background

The highest ranked areas

Table 4 (a) Research areas given the highest mean IPW perspective scores by the panel members (n ¼ 95); (b) Items given the highest mean

VHCO perspective scores by the panel members (n ¼ 95); (c) Items given the highest mean VNP perspective scores by the panel members

(n ¼ 95)

Research areas Rank Mean

(a)

Establish relationships that preserve human

dignity at all levels in geriatric care

1 8Æ9

Explore the meaning of a caring encounter 2 7Æ5Describe attitudes and actions that make the patient feel

respected and listened to

3 6Æ6

Explore the meaning of therapeutic touch, nurturing, comfort and sleep in relation

to healing and well-being

4 5Æ4

Establish caring relationships when organising healthcare 5Æ5 5Æ1Explore the meaning of empowerment dialogue and its implication for

healing power and health

5Æ5 5Æ1

Examine the meaning of communication skills when presenting

unpleasant information

7 4Æ9

Explore the meaning of efficiency in continuity of patient care 8 4Æ8Explore how transfer from hospital care to primary care can be effected with dignity 9 4Æ6Explore the meaning of compassion in patient-related nursing 10 4Æ1Examine the meaning of continuity in care when long-term health care is required 11 4Æ0Explore means of inspiring patients to make necessary lifestyle changes 12Æ5 3Æ9Find means to improve access to primary healthcare centres 12Æ5 3Æ9Develop humanistic standards in health care 14 3Æ8Describe the characteristics of a caring encounter 15 3Æ6(b)

Access the relationship between good nursing practice and the nursing staff ’s well-being 1 12Æ2Determine means for use of research in clinical practice 2Æ5 10Æ0Determine effective means of communicating and implementing nursing

knowledge in clinical practice and evaluating the beneficence to the patient

2Æ5 10Æ0

Establish relationships that preserve human dignity at all levels in geriatric care 4 9Æ6Explore the meaning of efficiency in continuity of patient care 5 9Æ0Determine means to evaluate the relationship between supervision of nurses and

quality improvement in nursing

6 8Æ9

Explore the meaning of coordination and continuity in care when several caregivers are involved 7 8Æ2Describe the characteristics of a caring encounter 8 7Æ9Explore how transfer from hospital care to primary care can be effected with dignity 9 7Æ5Establish a common values system in the interaction between caregivers 10 7Æ4Find means to improve access to primary healthcare centres 11 7Æ1



mining means for using research in clinical practice, improv-

ing quality of nursing care through supervision and preserv-

ing the nursing paradigm in the medically oriented

organisation are ranked the highest.

Finally, when the 15 highest-ranking items from the IPW

perspective were compared with the corresponding list

from the VHCO and VNP perspectives, five items were

also ranked highest in the VHCO perspective and nine in

the VNP perspective. Moreover, three of the items (1, 9

and 15, i.e. the importance of preserving human dignity in

geriatric care, ensuring a dignified transfer from hospital to

primary health care and exploring the meaning of a caring

encounter, respectively) were accorded high rank in the

VHCO and VNP perspectives by clinicians with academic

degrees as well as by administrators/teachers/researchers

(Table 5).

Discussion

This study highlights the essential areas for future patient-

related nursing research, suggested by a panel of nurses in

clinical practice, administration and education in the Fyrb-

odal healthcare region. The response rate of 81% can be

considered high, compared with other three-round Delphi

surveys (McIlfatrick & Keeney 2003, Bayley et al. 2004,

Annells et al. 2005). This could be as a result of systematic

preparatory work to introduce the Delphi technique, the

panel members’ interest in exploring patient-related nursing

issues or in being involved, for the first time, in priority-

setting as well as the commitment to and support for this

study on the part of the executives of the participating

healthcare organisations. We deliberately avoided abstraction

of the panel members’ wordings but did do some minor

editing in the second round which may also have affected the

panel members’ willingness to complete all three rounds

(Hasson et al. 2000).

When it comes to reaching consensus, the Delphi study

process’s advantages should be taken into consideration.

Sharing knowledge, being able to make reflective statements

without being personally confronted and obtaining responses

from colleagues in the panel are described as some of the

advantages of the method (Bond & Bond 1987, Hasson et al.

2000, Keeney et al. 2006). On the other hand, it should be

stressed that the panel members affect each other and may

change their point of view during the whole process.

According to Keeney et al. (2006) there is a difference

between the extent to which each participant ranks an issue

highly and to which s/he agrees with other participants.

Table 4 (Continued)

Research areas Rank Mean

Determine the possibility to replace doctor’s consultation with office nursing 12 6Æ3Explore the need for professional competence among the community care staff 13 6Æ0Explore the need for professional competence in community healthcare practice 14 5Æ4Develop a community team of licensed professionals and evaluate the team

process and supportive strategies in terms of patient outcomes

15 4Æ9

(c)

Explore the meaning of a caring encounter 1 8Æ4Determine means for utilisation of research in clinical practice 2 7Æ2Explore means of improving quality of nursing care through supervision of nurses 3 6Æ7Determine means of preserving the nursing paradigm in the medically oriented organisation 4 6Æ6Explore the meaning of supervision, collegial support and cooperation/interaction 5 5Æ9Access relationship between nurses’ documentation and patient safety,

well-being and continuity of patient care

6Æ5 5Æ7

Describe attitudes and actions that make the patient feel respected and listened to 6Æ5 5Æ7Determine the role of the nurse in the healthcare team 8 5Æ0Establish relationships that preserve human dignity at all levels in geriatric care 9 4Æ6Explore the characteristics of a professional nurse, an expert nurse 10 4Æ3Explore means of inspiring patients to make necessary lifestyle changes 11Æ5 4Æ2Explore the meaning of empowerment dialogue and its implication for

healing power and health

11Æ5 4Æ2

Determine means for use of nursing knowledge 13Æ5 4Æ1Describe the characteristics of a caring encounter 13Æ5 4Æ1Explore possibilities and difficulties for use of patient-related

research in clinical practice

15 4Æ0



Table

5T

he

15

most

import

ant

are

as

of

pati

ent-

rela

ted

nurs

ing

rese

arc

hin

rela

tion

topri

ori

ties

made

by

clin

icia

ns,

clin

icia

ns

wit

haca

dem

icdeg

rees

and

adm

inis

trato

rs/t

each

ers/

rese

arc

her

s,em

anati

ng

from

IPW

per

spec

tive

and

addit

ionally

ranked

from

the

VH

CO

and

VN

Pper

spec

tives

Import

ance

toth

ePati

ents

Wel

fare

Valu

eto

the

Hea

lthca

reO

rganiz

ati

on

Valu

eto

the

Nurs

ing

Pro

fess

ion

Tota

l

(n¼

95)

Cli

nic

ians

(n¼

43)

Cli

nic

ians

wit

h

aca

dem

ic

deg

ree

(n¼

28)

Adm

inis

trato

rs/

teach

ers/

rese

arc

her

s

(n¼

24)

Tota

l

(n¼

95)

Cli

nic

ians

(n¼

43)

Cli

nic

ians

wit

h

aca

dem

ic

deg

ree

(n¼

28)

Adm

inis

trato

rs/

teach

ers/

rese

arc

her

s

(n¼

24)

Tota

l

(n¼

95)

Cli

nic

ians

(n¼

43)

Cli

nic

ians

wit

h

aca

dem

ic

deg

ree

(n¼

28)

Adm

inis

trato

rs/

teach

ers/

rese

arc

her

s

(n¼

24)

Rank

Mea

nR

ank

Mea

nR

ank

Mea

nR

ank

Mea

nR

ank

Mea

nR

ank

Mea

nR

ank

Mea

nR

ank

Mea

nR

ank

Mea

nR

ank

Mea

nR

ank

Mea

nR

ank

Mea

n

Est

abli

shre

lati

onsh

ips

that

pre

serv

ehum

an

dig

nit

yat

all

level

sin

ger

iatr

icca

re

18Æ9

19Æ2

18Æ4

19Æ0

49Æ6

68Æ9

210Æ2

410Æ0

94Æ6

11

5Æ0

23

2Æ6

56Æ3

Explo

reth

em

eanin

gof

aca

ring

enco

unte

r

27Æ5

28Æ2

27Æ6

35Æ9

18Æ4

19Æ4

65Æ9

19Æ8

Des

crib

eatt

itudes

and

act

ions

that

make

the

pati

ent

feel

resp

ecte

d

and

list

ened

to

36Æ6

37Æ1

36Æ6

55Æ5

6Æ5

5Æ7

95Æ2

56Æ6

65Æ4

Explo

reth

em

eanin

gof

ther

apeu

tic

touch

.

nurt

uri

ng,

com

fort

and

slee

pin

rela

tion

to

hea

ling

and

wel

l-bei

ng

45Æ4

55Æ7

10

3Æ6

26Æ8

Est

abli

shca

ring

rela

tionsh

ips

when

org

anis

ing

hea

lth

care

5Æ5

5Æ1

45Æ8

74Æ8

12

4Æ0

Explo

reth

em

eanin

gof

empow

erm

ent

dia

logue

and

its

impli

cati

on

for

hea

ling

pow

erand

hea

lth

5Æ5

5Æ1

9Æ5

4Æ5

46Æ0

85Æ1

11

4Æ2

12

4Æ8

16

3Æ8

16

3Æ5

Exam

ine

the

mea

nin

g

of

com

munic

ati

on

skil

lsw

hen

pre

senti

ng

unple

asa

nt

info

rmati

on

74Æ9

84Æ7

65Æ4

10

4Æ6

22

3Æ0

17

3Æ5

22

3Æ0

22

2Æ3

Explo

reth

em

eanin

gof

effici

ency

inco

nti

nuit

y

of

pati

ent

care

84Æ8

65Æ6

14

3Æ3

6Æ5

5Æ3

59Æ0

39Æ6

10

7Æ7

59Æ6



Table

5(C

onti

nued

)

Explo

rehow

transf

er

from

hosp

ital

care

to

pri

mary

care

can

be

effe

cted

wit

hdig

nit

y

94Æ6

9Æ5

4Æ5

94Æ1

6Æ5

5Æ3

97Æ5

78Æ1

87Æ9

13

6Æ1

24

2Æ3

22

2Æ5

25

1Æ3

17

3Æ1

Explo

reth

em

eanin

gof

com

pass

ion

in

pati

ent-

rela

ted

nurs

ing

10

4Æ1

11

4Æ4

15Æ5

3Æ1

94Æ8

23

2Æ9

25

1Æ8

20

3Æ5

10

4Æ2

Exam

ine

the

mea

nin

g

of

conti

nuit

yin

care

when

long-t

erm

hea

lth

care

isre

quir

ed

11

4Æ0

15

3Æ4

13

3Æ4

45Æ7

Explo

rem

eans

of

insp

irin

gpati

ents

to

make

nec

essa

ry

life

style

changes

12Æ5

3Æ9

14

3Æ5

84Æ4

13

3Æ9

11Æ5

4Æ2

13

4Æ5

14Æ5

3Æ9

14

3Æ8

Fin

dm

eans

toim

pro

ve

acc

ess

topri

mary

hea

lthca

rece

ntr

es

12Æ5

3Æ9

74Æ9

15Æ5

3Æ1

17

3Æ0

11

7Æ1

10

7Æ0

11

6Æ8

97Æ6

Dev

elop

hum

anis

tic

standard

sin

hea

lthca

repra

ctic

e

14

3Æ8

12

4Æ0

15Æ5

3Æ1

11

4Æ2

Des

crib

eth

e

chara

cter

isti

csof

a

cari

ng

enco

unte

r

15

3Æ6

16

3Æ3

55Æ9

27

1Æ3

87Æ9

10

7Æ0

69Æ4

87Æ8

13Æ5

4Æ1

85Æ3

14Æ5

3Æ9

23

2Æ2



One described weakness of the Delphi technique is that the

method is time-consuming, especially when the researcher

uses the method for the first time (Keeney et al. 2006). This

study was time-consuming because of the extensive content

analysis of the high amount of suggested primary areas

(n ¼ 380) in Round I.

When interpreting the results, it is important to bear in

mind that a minority of the target population was reached

by the invitation to participate in the study. Nonetheless,

the responding nurses seem to represent the target popula-

tion in terms of age, clinical settings, working area, years in

nursing and level of education; they thus present a variety of

opinions and perspectives which in turn help to increase

content validity (Goodman 1987). Moreover, all suggested

research areas analysed in the first round represent several

important perspectives in clinical practice, traversing

organisational boundaries and they should be debated

among a larger group of nurses within the entire healthcare

organisation.

The panel revealed that nurses’ great degree of concern

about interaction with patients is a central issue in their

everyday clinical practice. To develop and improve good

nursing care, research is required, especially within the areas

of communication/dialogue, patient instruction/teaching and

caring attitudes and behaviours, which is consistent with

several other authors’ findings (Hinshaw 1995, Hasson et al.

2000, Ross et al. 2004).

The meaning of a caring encounter in general, as well as in

relation to different cultures, were considered to be other

central dimensions of future research endeavours in this

study. These research areas concur with research priorities in

current international research agendas (Hamrin 1995, Hin-

shaw 2000, Evers 2003). Continuity of care was also a

priority among stakeholders, as defined by Ross et al. (2004)

and was reported by McIlfatrick & Keeney (2003) to be a

research priority related to cancer patients’ care.

When it came to the IPW perspective, there was consid-

erable agreement in both rank and mean for the 15 items

among the entire panel, which is in accordance with

Lindeman (1975). Clinicians with academic degrees ranked

items number 4 (explore the meaning of therapeutic touch,

nurturing, comfort and sleep in relation to healing and well-

being), 8 (efficiency in continuity of patient care) and 10

(compassion in patient-related caring) lower than other

clinicians. Administrators/teachers/researchers ranked item

number 5 (establish relationships when organising health

care) and 15 (describe a caring encounter) lower than

clinicians with and without academic degrees. The item

‘determine means for the use of research in clinical practice’

was ranked high both in the VHCO and VNP perspectives

but was not among the top 15 priorities in the IPW

perspective.

As in Bond and Bond’s (1987) study, several panel

members commented on difficulties in assessing some of the

suggested research areas because of their limited knowledge

of those fields. Others maintained that low scores were given

to items concerning research which already existed. Changes

in the healthcare system during the last decade caused by

technological development and corresponding economical

cutbacks, decreasing resources in primary and municipal care

and increasingly shorter stays in hospital, may have affected

the choice of important research areas.

The findings in this study indicate that caring is an essential

aspect of future nursing research. The nurse panel prioritises

research concerning the being of caring, the meaning of being

a caring person and the importance of studying caring

attitudes in relation to the patients’ welfare, as well as value

to the organisation and the nursing profession. This corre-

sponds to the substantive area of nursing science focusing

on the central concept of caring in nursing (Boykin &

Schoenhofer 1990).

Conclusion

This study reveals that nurses in Fyrbodal, Sweden, were

devoted to patient-related issues and that they prioritise

research that will improve clinical practice and assure

patients’ well-being and a caring environment for all

patients. The results also indicate that nurses were able to

reach consensus on the object of patient-related nursing

research, despite differences in age, workplace, educational

period and level of higher education. In this study, it was

obvious that research areas across the full continuum of

care, from wellness to death, are regarded as important,

with a focus on research needed to preserve humanistic

values and develop collaboration between healthcare pro-

viders across organisational boundaries in the healthcare

system.

Implications

When prioritising important areas for patient-related nursing

research, informed nursing practitioners not only take an

interest in future research, but their commitment will initiate

knowledge development within clinical practice from a

nursing science perspective. It will also expand the possibility

for professional as well as cross-organisational research

collaboration. This will in turn make nurses’ research-based

knowledge imperative when setting and implementing the

research agenda for relevant patient-related nursing.



Acknowledgements

The authors express their gratitude to Valter Sundh for

statistical assistance; Kirsten Pryds Jensen for valuable com-

ments during writing the manuscript and to Par A Larsson for

initiating this study. This research was funded by Fyrbodal

Research Institute and Vastra Gotaland Region, Sweden.

Contributions

Study design: SB-P, EH, CB; data collection and analysis: SB-P,

EH, NS, CB and manuscript preparation: SB-P, EH, NS, CB.

References

Annells M, Deroche M, Koch T, Lewin G & Lucke J (2005) A Delphi

study of district nursing research priorities in Australia. Applied Nursing

Research 18, 36–43.

Bayley EW, MacLean SL, Desy P & McMahon M (2004) ENA’s Delphi

study on national research priorities for emergency nurses in the United

States. Journal of Emergency Nursing 30, 12–21.

Bond S & Bond J (1987) A Delphi survey of clinical nursing research

priorities. Journal of Advanced Nursing 7, 565–575.

Browne N, Robinson L & Richardson A (2002) A Delphi study on the

research priorities of European oncology nurses. European Journal of

Oncology Nursing 6, 133–144.

Boykin A & Schoenhofer S (1990) Caring in nursing: analysis of extant

theory. Nursing Science Quarterly 4, 149–155.

Chang E & Daly J (1998) Priority areas for clinical research in palliative

care nursing. International Journal of Nursing Practice 4, 247–253.

Clark J & Hockey L (1992) Future Research for Nursing. A New Guide

for the Enquiring Nurse, 3rd edn. Scrutari Press, London.

Cohen MZ, Harle M, Woll AM, Despa S & Munsell MF (2004) Delphi

survey of nursing research priorities. Oncology Nursing Forum 31,

1011–1018.

Daly J, Chang EM & Bell PF (1996) Clinical nursing research priorities in

Australian critical care: a pilot study. Journal of Advanced Nursing 23,

145–151.

Downe-Wamboldt B (1992) Content analysis: method, applications and

issues. Health Care for Women International 13, 313–321.

Eriksson K (1995) Priorities in nursing science in Finland. Nordic Sym-

posium: Perspectives on Priorities in Nursing Science, Vadstena, Swe-

den, pp. 29–39.

Evers G (2003) Developing nursing science in Europe. Journal of Nursing

Scholarship 35, 9–13.

Goodman CM (1987) The Delphi technique: a critique. Journal of Ad-

vanced Nursing 12, 729–734.

Graneheim UH & Lundman B (2004) Qualitative content analysis in

nursing research: concepts, procedures and measures to achieve trust-

worthiness. Nurse Education Today 24, 105–112.

Hamrin E (1995) Priorities in nursing science from a Swedish perspective.

Nordic Symposium: Perspectives on Priorities in Nursing Science, Vad-

stena, Sweden, pp. 57–61.

Hasson F, Keeney S & McKenna H (2000) Research guidelines for the

Delphi survey technique. Journal of Advanced Nursing 32, 1008–1015.

Heyman I (1994) The Emergence of Nursing Research in Sweden. (SV:

Gange Hatt till…Omvardnadsforskningens Framvaxt i Sverige –

Sjukskoterskors Avhandlingar 1974–1991). Department of Pedagogic,

Goteborg, Daidalos Sweden.

Higher Education Act Law (1992:1434) Ministry of Education and

Science. Stockholm. Available at: (http://www.sweden.gov.se/content/1/

c6/02/15/40/74807ef2.pdf, accessed 24 July 2007).

Hinshaw AS (1989) Nursing science: the challenge to develop knowledge.

Nursing Science Quarterly 2, 162–171.

Hinshaw AS (1995) Building excellence in science: setting priorities for

knowledge development. Nordic Symposium: Perspectives on Priorities

in Nursing Science, Vadstena, Sweden, pp. 15–28.

Hinshaw AS (2000) Nursing knowledge for the 21st century: opportunities

and challenges. Journal of Nursing Scholarship 32, 117–123.

Hogskoleforordningen (1993:100) Bilaga 3. (Higher Education Ordinance

1993:100 suppl. 3. Ministry of Education and Science). Fritze, Stock-

holm, Sweden.

Hughes RG (2006) Research priorities. Applied Nursing Research 19,

223–224.

Keeney S, Hasson F & McKenna HP (2001) A critical review of the Delphi

technique as a research methodology for nursing. International Journal

of Nursing Studies 38, 195–200.

Keeney S, Hasson F & McKenna H (2006) Consulting the oracle: ten

lessons from using the Delphi technique in nursing research. Journal of

Advanced Nursing 53, 205–212.

Kennedy HP (2004) Enhancing Delphi research: methods and results.

Journal of Advanced Nursing 45, 504–511.

Krippendorff K (2004) Content Analysis: an Introduction to its Method-

ology. Thousand Oaks, Sage, CA.

Leino-Kilpi H & Suominen T (1997) Research in intensive care nursing.

Journal of Clinical Nursing 6, 69–76.

Lindeman CA (1975) Delphi survey of priorities in clinical nursing re-

search. Nursing Research 24, 434–441.

Lopez V (2003) Critical care nursing research priorities in Hong Kong.

Journal of Advanced Nursing 43, 578–587.

Lorensen M (1995) Perspectives on priorities in nursing science. Nordic

Symposium: Perspectives on Priorities in Nursing Science, Vadstena,

Sweden, pp. 83–89.

MacMillan M, Atkinson F & Prophit P (1989) A Delphi survey of prior-

ities for nursing research in Scotland. Nursing Studies Research Unit.

University of Edinburgh, Edinburgh, Scotland.

McIlfatrick SJ & Keeney S (2003) Identifying cancer nursing research

priorities using the Delphi technique. Journal of Advanced Nursing 42,

629–636.

McKenna HP (1994) The Delphi technique: a worthwhile research ap-

proach for nursing?. Journal of Advanced Nursing 19, 1221–1225.

Meleis AI (1991) Directions for nursing theory development in the 21st

century. Nursing Science Quarterly 5, 112–117.

Meleis AI (2007) Theoretical Nursing: Development and Progress. Lip-

pincott Williams & Wilkins, Philadelphia, PA.

Powell C (2003) The Delphi technique: myths and realities. Journal of

Advanced Nursing 41, 376–382.

Rodger M, Hills J & Kristjanson L (2004) A Delphi study on research

priorities for emergency nurses in Western Australia. Journal of Emer-

gency Nursing 30, 117–125.

Ross F, Smith E, Mackenzie A & Masterson A (2004) Identifying research

priorities in nursing and midwifery service delivery and organisation: a

scoping study. International Journal of Nursing Studies 41, 547–558.

Schmidt K, Montgomery LA, Bruene D & Kenney M (1997) Determining

research priorities in pediatric nursing: a Delphi study. Journal of

Pediatric Nursing 12, 201–207.

Svensk Sjukskoterskeforening (2001) Omvardnad som Akademiskt amne.

(Nursing as an Academic Subject. The Scientific Advisory Council of the

Swedish Society of Nursing). Sjukskoterskornas vetenskapliga rad inom

Svensk sjukskoterskeforening, Stockholm, Sweden.



Documents

Research priorities in nursing – a Delphi study among Swedish nurses