This study utilized exploratory sequential mixed methods design that utilized both qualitative and quantitative methods. Creswell [11] characterized this type of design with two phases, which was initiated by a qualitative data gathering and analysis followed by a quantitative process with the determination to generalize the level of wellbeing of Filipino nurse educators in a specific GCC country. The researchers had chosen this design because it could utilize the quantitative findings in analyzing and interpreting the results of the qualitative investigation. Moreover, the researchers believed that it will be useful in testing a newly developed quantitative tool and helped them to identify significant variables for quantitative studies especially when the variables are unspecified [12]. Creswell and Plano-Clark [13] stated about exploratory mixed methods design that it will be beneficial when, “measures or instruments are not available, the variables are unknown, or there is no guiding framework or theory” (p. 75). Another reason why the researchers ended up choosing this research design was that it specifies a deeper understanding of the experiences of Filipino nurse educators. Lastly, this would lead to discovering new insights that would uncover the essence of the phenomenon under investigation and eventually measure its prevalence [11-13].

This exploratory sequential mixed methods study was in three phases. The first phase initiated a phenomenological-based approach. It was chosen for this study because the researchers believed that it was the best way to understand the meaning of an individual’s lived experiences towards a certain phenomenon [11] and in order for a researcher to come up with suitable constructs, the researchers must investigate thoroughly the phenomenon [14]. One advantage of this study was it offered validity [15]. In phase 2, all qualitative themes and contextual categories were used as constructs in developing a survey tool for Filipino nurse educators in the GCC region. The survey tool was evaluated by a panel of experts in the field of nursing for validity and reliability [11]. Lastly, for phase 3 and the final phase, a descriptive cross-sectional survey was done to figure out the level of wellbeing of the Filipino nurse educators working in Saudi Arabia. Thus, this empirical process provided a quantifiable and measurable outcome.

Phase 1 of the study was conducted in selected GCC countries (n=4): Bahrain, Oman, Saudi Arabia, and the United Arab Emirates excluding Qatar and Kuwait since there were few to none nursing institutions in these countries. The participants (n=20) were from: Saudi Arabia (n=6), Oman (n=6), UAE (n=4), and Bahrain (4). For the purpose of homogeneity, inclusion criteria were as follows: (1) A Filipino nurse educator working in government or private nursing college and university in the GCC region; (2) A minimum of 4 years teaching experience regardless of gender, age, religion, and socio-cultural specifications; and (3) Willingness to consent and contribute to the investigation. In selecting the participants, the researchers utilized a purposive sampling method and snowballing technique in gathering the participants for the semi-structured interview. Furthermore, Filipino nurse educators were chosen because they were currently one of the foreign nationalities with the most number of educators in the GCC region. The total number was based upon the data saturation level of the participants’ rich description of the phenomenon under investigation.

For the quantitative phase, participants (n=112) were surveyed through simple random sampling. None of the participants in the first phase joined the third phase [11]. Moreover, the researchers considered only Saudi Arabia amongst other GCC countries since it had the greatest number of Filipino nurse educators in the GCC region.

The research team comprised of one male and two female assistant professors at Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. All researchers (JS, FA, and RA) had experiences in conducting both qualitative and quantitative studies. One researcher (JS) had experience in conducting reviews for both research designs. To ensure that research processes and methods were correctly done, researchers attended several workshops and tutorials to ensure that reporting is accurate and complete.

It is imperative to know the philosophical underpinnings of the study as stressed by Creswell and Plano Clark [13] in order to give a concise overview of the research design used. Patterson [16] mentioned that it is the philosophical foundation that induces mixing of the quantitative and qualitative models into single research. This study had philosophical assumptions too that guided both approaches especially in the data collection and analysis [13]. The pragmatic perspectives of this study used both deductive and inductive logic reasoning in revealing the meaning of the phenomenon. For an instance, an individual mind is incapable of the objectivity that is necessary to uncover the reality existing in the objective reality, so this design will value not only the essence of the objective but the subjective point-of-views as well. More so, combining both approaches in this study will provide a better interpretation of the phenomenon. This paradigm war did not end until pragmatists suggested that instead of delving into the irreconcilability, mitigating the gaps, and the connections between the two paradigms were recommended [17]. Therefore, the pragmatic philosophical groundwork of this study provided an organized implementation of the suitable qualitative and quantitative methods in achieving the aim of this study [18, 19].

The researchers sought the Ethics Review Clearance from SPUM Institutional Ethics Review Committee (SPUM-IERC). An application was sent with all the pertinent documents needed to grant clearance. The ethics review clearance was given on 06 November 2017. Moreover, the researchers also obtained a National Institutes of Health (NIH) certification regarding protecting human research participants to ensure that ethical considerations would be implemented and followed all throughout the study.

Data were collected from 06 November 2017 to 06 May 2018. Upon identification of the participants and securing of written informed consents for phase 1, the researchers explained the aim and essential details of the study that were needed to be disclosed to show transparency. Methods of collecting data included the use of audio-recording equipment, field notes (personal, transcript, and analytical), and some qualitative documents shown by the participants (optional). In addition, the researchers utilized a semi-structured interview guide consisting of open-ended questions as given in Table 1 [11-13]. This allowed the researchers to ask follow-up questions in order to clarify the participants’ rich narrative descriptions. Probing questions allowed the researchers to have a deeper understanding of the facts presented by the participants [20]. Before conducting the actual interview, three participants were asked to join a pilot study to establish construct validity, which would help the researchers to discover questions that were not clear, were misleading, and/or were inappropriate [20, 21]. The researchers scheduled the date, time, and place of the interview conforming to the available schedules of the participants. Most of the interviews were conducted during the participant’s day-offs. All face-to-face interviews lasted for 30 minutes to 1 hour. Participants were given pseudonym initials (e.g. Simple Rhythm = SR) for privacy and confidentiality. Lastly, all participants were given the autonomy to refuse answering the interview question and they were given the chance to withdraw at any point of the investigation if they felt uncomfortable.

All the themes emerged from the qualitative finding were used as constructs in developing the survey tool that would measure the wellbeing of Filipino Nurse Educators in the GCC region, which will be explained extensively in the data analysis section. After the creation of the survey tool, the researchers immediately conducted a cross-sectional survey using an online platform, Google Docs, in gathering the data.

The role of the researcher was the key element in the qualitative investigation through which the data were gathered and analyzed. Patton [22] reasoned, “credibility of qualitative methods, therefore hinges to a great extent on the skill, competence, and rigor of the person doing the fieldwork” (p. 14). In analyzing the data, the researchers’ biases were bracketed to focus on the inductive process rather than the deductive approach [23, 24]. Data were collected and analyzed through Colaizzi method [25]. After completing the seven data analysis steps of Colaizzi, the researchers sent back the transcriptions and results of the analysis to the participants for comments and clarifications. This gave the participants the chance to explain their original words and texts, expounded what they want to convey, modified misunderstood experiences, added more information, and edited grammatical errors and typos [11-13]. Consolidated Criteria for Reporting Qualitative (COREQ) was utilized to authenticate the final reporting of the results [26].

Themes were defined as patterns across the data sets, which consist of contextual categories [15]. Contextual categories were the results of the deductive formulated meanings of the participants’ significant statements that were organized in the same thematic constructs. In qualitative studies, the themes can independently answer the grand tour question. For instance, the emergent themes of this study can answer the first research question, how did Filipino nurse educators fulfill their wellbeing in the GCC region? As a result, five themes and seventeen contextual categories had emerged as findings of the qualitative investigations given in Table 2. The emergent themes were also explained in the succeeding paragraphs according to its conceptual descriptions followed by some examples of significant statements found in Table 3.

The result of the qualitative investigation generated five thematic domains that were used as survey constructs in the second section of the quantitative tool. The individual survey items were derived from the contextual categories and significant statements seen in Table 4.

This two-part survey consisted of fifty items and called as the ‘Filipino Nurse Educator’s Wellbeing Survey’ (FNEWS), which aimed to assess the five dimensions of the wellbeing of Filipino nurse educators in the GCC region. In part one, it included the demographic profile of the participants (name, gender, age, religion, years of experience, etc.) and in part two, it consisted of the five dimensions of wellbeing. Each survey item described the expectations of the participants’ towards the achievement of ‘highly acceptable’ level of wellbeing. The participants rated the survey items by checking how they perceived and practiced each item. Rating scales were classified as: 5 = highly acceptable, 4 = acceptable, 3 = moderately acceptable, 2 = unacceptable, 1 = highly unacceptable.

The researchers subjected the tool for face and content validity. A total of eight experts facilitated the validation processes. These validators worked in the field of nursing as educators, practitioners, and researchers ranging from 10 to 57 years, with mean years of experience being 35 years, SD±6.4 (n=8).

A descriptive cross-sectional survey was conducted utilizing a simple random sampling to Filipino nurse educators working in Saudi Arabia (n=112). As stated earlier, the survey tool consisted of two parts: (1) demographics and (2) five dimensions of wellbeing. Demographic profiling is essential in conducting a survey tool because it is imperative to know the details of the participants filling-out the survey (Table 6).It also enabled the researchers to determine the actual target audiences in a specific locale.

In analyzing the results, each dimension had survey items (n=10) that were added up accordingly (e.g. physical and physiological dimension = 3.95) and eventually calculated the weighted mean. Weighted mean was used to measure the general responses of the survey samples given in Table 7.

In interpreting the results, the values were referred to the standard 5-point Likert scale with its pre-determined range and interpretation [30]: (1) Highly Acceptable = 4.21-5.0; (2) Acceptable = 3.41-4.20; (3) Moderately Acceptable = 2.61-3.40; (4) Unacceptable = 1.81-2.60; and (5) Highly Unacceptable = 1.0-1.80. The results were ranked from highest to lowest with its corresponding interpretations: (1) RMD = 4.31; highly acceptable; (2) LD = 4.26; highly acceptable); (3) POD = 4.11; acceptable; (4) SD = 4.06; acceptable; and (5) PPD = 3.95; acceptable. The combined total weighted mean of the participants (n=112) was 4.14. Therefore, the researchers concluded that the overall level of wellbeing of the Filipino nurse educators’ in Saudi Arabia was ‘acceptable’ that clearly answered the third research question.

Although a review of the literature stated that nurse educators can straightforwardly amend to a new environment, adaptation varies from person to person [7]. Human adaptation had always been dependent on the individual’s capacity to be accustomed and accept various culture and value system of a certain environment. Yet, research had predetermined judgments on the knowledge indispensable for nurse educators teaching at the tertiary level. There was no literature on gauging prospective Filipino nurse educators’ realization in terms of wellbeing in foreign countries predominantly in the GCC region. However, there was some published research reconnoitering the role of nurse educators abroad but the countless aspects of wellbeing have not been included and discussed in the study.

All the thematic dimensions, (1) Physical and physiological; (2) Learning; (3) Social; (4) Religious and moral; and (5) Professional and occupational, when combined together, would summarize the wellbeing of the Filipino nurse educators in GCC region. Being in a foreign country may have different outcomes depending on how a person deals and accepts changes. For some people, this may lead to detrimental effects on the physical and physiological wellbeing of an individual [31]. In this study, all participants showed ‘acceptable’ healthy living practices and lifestyles, which were evidently seen on their individual accounts and generalized quantitative responses with ‘acceptable’ level of wellbeing (PPD=3.95). However, compared to the remaining four wellbeing measures, it was the lowest. The participants stressed out that due to lack of time and extremes weather changes (extreme hot weather condition), they were not able to do some exercises and other physical activities. Instead they found them spending the rest of their time in the mall, staying at home, and eating out in the restaurants.

From the participants’ accounts and based on the result of the quantitative survey for the learning dimension, majority of the participants agreed that their experience helped them a lot in developing and acquiring new cognitive, affective, and psychomotor skills that they were able to utilize in their activities of daily living (LD=4.26; ‘highly acceptable’) [32]. All participants have positive outlooks as they continue and move forward in achieving their aspirations in life. All core values mentioned in their accounts such as hard work, perseverance, patience, enthusiasm, dedication, etc. made them grounded and protected all possible challenges. They were determined to rise above these challenges in order to provide good life for them and their families.

The participants’ social dimension was one of the lowest with ‘acceptable’ level of wellbeing (SD=4.06) based on the quantitative survey. The results validated the accounts of the participants in the qualitative investigation for having huge impacts in the wellbeing of the Filipino nurse educators particularly in terms of culture, interrelationships, safety and security, and economic stability [33]. The participants mentioned that during their first few years in the GCC region, they faced a lot of struggles such as mild culture shock, stereotyping, discriminations, homesickness, bullying, etc. Instead of giving up, they tried their best to blend with the people, culture and norms, and ways of living. Eventually, they were able to successfully adapt, adjust, and cope with their socio-cultural wellbeing. This had proven that acculturation was essential in their adaption, adjustment and coping process in the GCC region [34].

As to the participants’ religious and moral dimension, they have shown strong religious uphold and moral awareness even though GCC region had always been an Islamic nation and known for implementing strong cultural practices. The participants remained God-fearing and continuously looked for activities that would show their faith [35]. The participants shared in their accounts that they had been attending fellowship services, mass gatherings, bible studies, and prayer meetings. On the other hand, all participants expressed absolute obedience in exercising government and religious rules and regulations implemented inside the GCC region. Moreover, the participants had stated extreme fear in violating any of the rules due to the abominable punishments that can be implemented to all perpetrators that had been circulated through social media. Some of the activities that were not allowed in the GCC region were as follows: drinking alcohol, kissing and holding hands in the public, sharing with an unmarried partner or having same-sex relationships, and talking of single men and women in public places (specifically in Saudi Arabia). Based from the result of the quantitative survey, the participants have a ‘highly acceptable’ level of wellbeing (RMD=4.31), which reflected that Filipino nurse educators had been religiously and morally obedient permanent residents and cautious in everything that they do since no one will be excused from these legislations.

Lastly, in terms of the professional and occupational dimension, it was evident in the participants’ accounts the strong conviction and eagerness to achieve their aspirations by showing hard work, dedication, and perseverance in their assigned workloads. Most of the time, the participants worked extra hours without any remunerations. Even though staff development was limited for foreign educators, the participants had taken innumerable personal and professional developments inside and outside the GCC region. These testimonies were validated by the quantitative survey resulting an ‘acceptable’ level of wellbeing (POD=4.11). Likewise, Filipino nurse educators had developed and shown assortment of good qualities like zealousness, high-spirited, cheerful, patient, and honest that enabled them to have smooth personal relationships with others [36]. Finally, their excellent work ethics guided them to acquire good working relationships, increased commitment and job satisfaction leading to self-contentment [37].

Face and content validity were done; however, construct validity was not implemented due to the limitation of possible participants for this validation process. The researchers contemplated it as the most significant characteristic of validity as survey items generalized and measured should see the relationship with other variables. Consequently, if they are not correlated, it may prop up prospective prejudices in the construct. Future research may also include the rest of the GCC countries not only focusing on one country.

The possibility of using this survey tool for Filipino nurse educators in other GCC countries may also be recommended. Conceptualization of a well-structured and robust program for nurse educators desiring to work overseas should be strategized and implemented, which includes expanded orientation programs embracing personality development, communication and language, cultural awareness, and civil laws. Moreover, creative activities and outlets must be offered by the Philippine consulate partnered by the Filipino nursing organizations based from the identified wellbeing dimensions such as: sports festivities, weekly exercise programs and monthly health check-ups (physical and physiological); competency development such as language training, personality development and new skills acquisition (learning); socio-cultural gatherings and entertainment (social); spiritual retreats and fellowships (religious and moral); and personal and professional training courses and continuing education (professional and occupational).