A DELPHI STUDY: EXPLORING SAUDI FACULTY AND STUDENT PERCEPTIONS OF THE FACTORS PROMOTING NURSING STUDENT RETENTION AND SUCCESS A dissertation submitted to the Kent State University College of Nursing in partial fulfillment of the requirements for the degree of Doctor of Philosophy by Homood A. Alharbi August 2015 Dissertation written by Homood A Alharbi Diploma in Nursing, Burraidah Health Institute, Saudi Arabia, 1999 B.S.N., The University of Jordan, Jordan, 2004 M.S.N., Griffith University, Australia, 2006 Ph.D., Kent State University, USA, 2015 Approved by ________________________, Chair, Doctoral Dissertation Committee Barbara L. Drew ________________________, Member, Doctoral Dissertation Committee Carol A. Sedlak ________________________, Member, Doctoral Dissertation Committee Carolyn J. Murrock ________________________, Member, Doctoral Dissertation Committee Martha C. Merrill ________________________, Member, Doctoral Dissertation Committee Alicia Crowe Accepted by ________________________, Director, Joint Ph.D. in Nursing Program Mary K. Anthony _______________________, Dean, College of Nursing Barbara Broome ii © Copyright, 2015 by Homood A Alharbi All Rights Reserved iii DEDICATION I dedicate this work to all those who supported my educational efforts over the years including: my caring parents, my loving wife, my wonderful children, my brothers and sisters, and my deceased brothers. iv ACKNOWLEDGEMENTS I would like to thank the many people behind this work. I would like to send my sincerest appreciation to my dissertation advisor, Dr. Barbara L. Drew who was a tireless supporter of this research from the beginning, reading draft after draft. Special thanks and acknowledgements to my dissertation committee: Dr. Carol A. Sedlak, Dr. Carolyn J. Murrock, and Dr. Martha C. Merrill; and my graduate faculty representative, Dr. Alicia Crowe. My deepest appreciation to Dr. Ahmad Aboshaiqah, the dean of nursing college at King Saud University (KSU) for his support during the data collection of my dissertation. I would also like to thank the Curriculum Committee members in the nursing college at KSU and the students who participated in this study. v TABLE OF CONTENTS Page DEDICATION…………………………………………………………………………....iv ACKNOWLEDGMENTS…………………………………………...………………...….v LIST OF CONTENTS …………………………...………………………………………vi LIST OF TABLES …………………………...………………………………………...viii CHAPTER I. INTRODUCTION ...........................................................................................................1 Purpose of the Study.....................................................................................................4 Background..................................................................................................................6 Theoretical framework................................................................................................15 Significance of the Study............................................................................................16 Research Questions....................................................................................................17 II. REVIEW OF LITERATURE .......................................................................................19 Overview of Undergraduate Student Retention and Success ....................................19 Concepts Related to Student Retention and Success..................................................20 Factors Contributing to Student Retention and Success............................................23 Summary....................................................................................................................41 III. METHODOLOGY .....................................................................................................45 Setting and Subjects...................................................................................................46 Procedures for Data Collection..................................................................................47 Plans for Data Management and Analysis.................................................................55 Human Subjects..........................................................................................................63 IV. RESULTS ...................................................................................................................65 Analyses.....................................................................................................................65 Results in Phase I.......................................................................................................65 Results in Phase II......................................................................................................89 Summary…………………………………………………………………………..112 V. DISCUSSION ............................................................................................................114 Results and Existing Literature…………..………………………………………...115 Limitations of the Study…………….………………………………………..….....148 vi Conclusions…………….……………………………………………………..…...149 Directions for Future Research…………….……………………………..…..........151 Implication of the Study…………….………………………………………..……152 REFERENCES ...............................................................................................................156 APPENDICES A. List of Factors Promote Student Retention and Success.....................................177 B. Faculty Recruitment E-mail Text .....................................................................181 C. Factors Promoting Student Retention and Success Survey/ 1st Delphi Round………………………………………………………………....183 D. Informed Consent to Participate in a Research Study/Students..........................189 E. Factors Promoting Student Retention and Success /Student survey....................192 F. Demographic Data Form: Faculty Survey ..........................................................200 G. Demographic Data Form: Student survey ..........................................................202 vii LIST OF TABLES Table Page 1. Demographics Characteristics of Experts’ Panelists....................................................66 2. Results from Round One for the Importance of Factors Promoting Retention and Success………………………………………………………..68 3. Results from Round Two for the Importance of Factors Promoting Retention and Success………………………………………………………..73 4. Results from Round Three for the Importance of Factors Promoting Retention and Success.....................................................................................78 5. Consensus about Factors Importance was Achieved in these Factors…….……………………………………………………………………..…83 6. Frequencies Statistics for Students’ Employment Status………………………….….90 7. Student Perceptions about the Important Of Factors Promote Retention and Success..…………………………………………………….…..91 8. Responses for the First Open-Ended Question……………………………………….97 9. Responses for the Second Open-Ended Question……………………….……….....101 10. Comparing Faculty Perceptions with Students Perceptions……………………......108 viii Alharbi, Homood, Ph.D. August, 2015 NURSIN A DELPHI STUDY: EXPLORING SAUDI FACULTY AND STUDENT PERCEPTIONS OF THE FACTORS PROMOTING NURSING STUDENT RETENTION AND SUCCESS Director of Dissertation: Barbara L. Drew Student retention and success are major concerns for nurse educators and society, particularly given the need to address the global nursing shortage. Many studies have identified factors that promote student retention and success. However, it is unknown if these factors are culturally relevant to nursing education in Saudi Arabia. The purpose of this study was to determine Saudi faculty and student perceptions of the factors that promote nursing student retention and success in Saudi Arabia. This study had two phases. The first phase used a Delphi technique to examine the perceptions of an expert panel of Saudi faculty. The panel was asked to rate factors, identified by their own responses to an open-ended question and by an extensive review of the literature, in terms of their importance to student retention and success. This phase produced a list of 67 factors. The second phase examined students’ perceptions using the factors identified by consensus of the expert panel. The results indicated that seven of the 67 factors were not considered important by the students. Furthermore, students added 25 factors they believed to be important. While faculty members focused on the importance of academic factors in a manner that is similar to their Western counterparts, students attended to the impact of the culture on retention and success. CHAPTER ONE INTRODUCTION Introduction and Statement of the Problem Today’s global nursing shortage is having an adverse impact on health systems around the world (Oulton, 2006). Many factors have exacerbated this problem, including student recruitment and retention (Oulton, 2006). In Saudi Arabia, national culture has negatively impacted nursing student recruitment. The perception of nursing in the Saudi society is that it attracts poor, under-educated foreign women (Mebrouk, 2008; Miller- Rosser, Chapman & Francis, 2009). Many women associate nursing with long working hours, working with males (a culturally challenging prospect), and the worry that they might not be able to get married since they would not have time for their family obligations (Al-Omar, 2004). El-Gilany and Al-Wehady (2001) found that 98% of Saudi female nurses preferred not to care for male patients, which suggests that there is a cultural