Iran Journal of Nursing

Introduction
The increasing speed of changes in today’s world has led to the emergence of an era of uncertainty, and has provided an environment full of opportunities and threats. One of the challenges in accurate and macro planning for the future is the uncertainty inherent in the future and rapid changes in various fields of health. A powerful tool that can predict future competitive environments and develop long-term strategies even in environments with the greatest uncertainty is the scenario planning tool. Scenarios are descriptions of future situations and possible events so that a person can move from their current situation to a planned future. The scenarios help us understand the development logic and recognize drivers, trends, and challenges. Drivers are a set of future-shaping forces that affect different futures globally or locally. They perform the task of advancing and solving challenges simultaneously. 
For development and sustainability, nursing education needs drivers. Nursing education in Iran, while facing many challenges, has diverse and somewhat unknown capacities. Part of the existing challenges can be investigated and managed by identifying the drivers and trends of nursing education. Therefore, the current study aims to identify the key factors and the main drivers of nursing education in Iran and then design the desired scenarios for the future to provide a framework for policy-making and flexible planning according to the conditions. 

Method 
This is exploratory research using meta-synthesis, semi-structured interviewing of nursing experts with experience in nursing education, and the Delphi method. Sandelowski and Barroso’s seven-step method was used for meta-synthesis. The Shannon entropy method was used to analyze the content of the codes. The Delphi method was used to confirm and evaluate the drivers identified. A report on the drivers and trends was sent to the panel of experts. For their evaluation, a scale from 0 to 5 was used. This process continued in three consecutive rounds of online and face-to-face visits. In the next step, using influence/uncertainty diagrams, the key axes for writing the scenario were determined. Scenarios were designed by ScenarioWizard software, version 11.4 and strategies were then presented. The validity of the scenarios was examined in terms of four criteria: feasibility, internal consistency, usefulness, and differentiation. All four conditions were acceptable according to the experts.

Results 
After the search, 723 articles were yielded, among which nine articles were used for meta-synthesis. This led to the extraction of 127 codes, based on the semantic similarity, the codes were merged and categorized under a common title. Finally, 24 codes were identified. In the next step, the codes were categorized based on concept. To evaluate their quality, they were given to one of the experts and evaluated by using the Kappa index. Using SPSS software, version 16 software, at a significance level of 0.05, this coefficient was obtained as 0.83, which shows the appropriate reliability of the codes. In the interview phase, 17 nursing professors (2 professors, 6 associate professors, 6 assistant professors, and 3 instructors) with an average clinical experience of 16±1.2 years and an average managerial experience of 6±3.1 years were interviewed. A total of 23 interviews were conducted, each for 25-30 minutes; 15 were conducted over the phone and the rest were conducted in person. In this step, 356 codes were obtained. The content analysis of the codes were done using the Shannon entropy, and the results were entered into the next step for agreement and confirmation. In the third step, the experts agreed on 6 drivers and 31 trends. With five key uncertainties, the scenario was designed with three optimistic, realistic, and pessimistic assumptions. According to the size of the matrix and its dimensions (15×15), four scenarios, including problem-oriented, ethics-oriented, maintaining the status quo, and closed educational system, were reported for nursing education in Iran. 

Conclusion 
In the current study, four different scenarios for the future of nursing education in Iran were designed. Each scenario is believable and has the potential to be realized; however, their occurrence depends on the current planning. Further studies are recommended to obtain indicators for these scenarios. Future planning methods, such as the scenario planning method, can be used as a warning system for awareness of opportunities and threats in Iran’s health system before the crisis. To improve the future of nursing education in Iran, it is recommended to create an expert working group with scenario planning skills for more coordination in the strategic planning of specialized fields of study such as geriatric nursing and for formulating a comprehensive plan to correctly implement future planning projects. The manager or decision maker can experience the serious consequences of different decisions in the form of future scenarios and see future failures from now.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Research Ethics Committee of National Center for Strategic Research in Medical Education (Code: IR.NASRME.REC.1400.095). All participants signed an informed consent form after being informed about the study objectives and methods. Maintaining the confidentiality of their information and allowing them to leave the study at any time were among the ethical principles observed in this study. 

Funding
This article was extracted from a research proposal funded by the National Center for Strategic Research in Medical Education (Grant No.: 992173). 

Authors' contributions
Initial draft preparation: Mansoureh Sepehrinia, Fatemeh Alhani, Atefe Vaezi and Soheil Najafi-Mehri; Data analysis: Alireza Nikbakht Nasrabadi, Masoud Fallahi-Khoshknab, Abbas Ebadi and Farideh Yaghmayi; Writing: Mahboubeh Shali.

Conflict of interest
The authors declare no conflict of interest.

Acknowledgments
The authors would like to thank the participants for cooperating in this research.

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