Development and Validation of an Empowerment Training Program for Critical Care Nurses: A Modified Delphi Study

Abstract

Background: Nurse empowerment is a critical factor influencing clinical performance, decision-making, and patient safety in high-acuity critical care settings. However, there is a lack of context-specific, structured empowerment training programs for critical care nurses in Saudi Arabia, highlighting the need for expert-driven educational interventions. Aims: The study aims to develop and validate an empowerment training program for critical care nurses in Jeddah, Saudi Arabia, using a modified Delphi process. Study Design: Delphi study employing a three-round modified Delphi technique. Place and Duration of Study: Critical care nursing experts in Jeddah, Saudi Arabia. Methodology: Ten experts, comprising nurse educators, nursing managers, critical care nurse specialists, and psychologists with at least eight years of experience, participated in the Delphi panel. In Round 1, they rated 20 proposed session topics and contents using a 5-point Likert scale and provided qualitative feedback. Consensus was defined as a percentage agreement score (PAS) of at least 80%, a median of at least 4.00, and an interquartile range (IQR) of 1.00 or less. Emerging topics from panel feedback were incorporated into Rounds 2 and 3. Content validity ratio (CVR) was calculated, with a critical CVR value of 0.62 for the 10-member panel. Results: A participant response rate of 100% was achieved for all three rounds of the Delphi panel. In round 1, all 20 proposed program session content topics met the threshold for consensus, with PASs ranging from 88% to 96% and medians of 4.50 or 5.00. Three additional content topics were derived from the qualitative comments: communication and assertiveness in high-stakes situations, competence in crisis management, and proactive decision-making. Agreement for the revised program content in round 2 increased, with an overall PAS of 93.82% and a mean score of 4.69. In round 3, consensus further increased, with an overall PAS of 98.91%, 17 of the 22 items having a 100% agreement, and all of the items attaining a CVR of 1.00. The final validated program contained 22 content items, comprised 6 sessions, lasted 4 hours, and included quizzes to assess understanding. Conclusion: A legitimate and contextually relevant empowerment training program that addresses a major gap in Saudi Arabia's critical care nursing education was created through the Delphi approach. The program's creative approach to tackling the particular difficulties faced by nurses in hierarchical healthcare settings is demonstrated by its inventive integration of crisis management, assertive communication, and emotional resilience training. The 4-hour modular structure with interactive teaching methods offers practical viability for application within current continuing education frameworks.