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Results for “Delphi Technique”

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PubMed2004

What do doctors think their caseload should be to maintain their skills for delivery care?

OBJECTIVES: To seek the opinions of doctors on what they thought the minimum, maximum and optimum annual caseload should be for the maintenance of skills and competence in a variety of obstetric procedures. METHODS: An expert panel of respondents from Africa and Asia was asked to give their opinions on what they believed the minimum, maximum and optimum caseload should be for 11 obstetric procedures via a series of structured questionnaires (Delphi exercise). In subsequent questionnaires, participants were asked if they wished to reconsider their opinions in light of the group response. RESULTS: The median values of responses given for the minimum, maximum and optimum caseloads for the 11 obstetric procedures did not change substantially over time, though greater consensus was developed as indicated by reductions in the size of inter-quartile ranges in later rounds. CONCLUSIONS: We encountered several problems associated with using the Delphi technique in this context, which throws doubt on the validity and usefulness of our results. Caseload is just one of many factors, as indicated by our expert panel that need to be considered when planning the delivery of obstetric services in remote areas. High quality training, continued medical education, appropriate quality assurance procedures, and provision of a supportive enabling environment are also important requirements. In addition, the views of clinicians need to be balanced against more objective evidence of quality of care and patient outcome in relation to procedural volume. Such evidence is lacking in the field of obstetrics and requires further investigation.

Africa↗

PubMedDate not supplied

The alcoholic family: a nursing diagnosis validation study.

This study was designed to develop and validate a new nursing diagnosis, altered family processes: alcoholism. The Delphi technique was used to obtain nurse experts' (N = 201) ratings of terms for the definition, related factors, and defining characteristics. Degree of consensus was determined by analyzing the mean, frequencies, and Fehring's (1987) Diagnostic Content Validity Index for items. Findings supported a proposed definition and related factors including family history of alcoholism and lack of problem-solving skills. Defining characteristics were grouped into three categories: feelings (e.g. mistrust, insecurity, powerlessness, unhappiness), roles, and relationships (e.g. disturbed family dynamics, inconsistent parenting, marital problems), and behaviors (e.g. impaired communication, dependency, denial). Future research includes the proposal and testing of nursing interventions for alcoholic families.

Adult↗

PubMedDate not supplied

Preventability of infant mortality in a rural community.

Preventability of infant mortality in a rural southern county was examined with a Delphi technique using case summaries of infant deaths during a selected four-year period. The first two rounds were aimed at developing a consensus of panelists' opinions about problems leading to the high infant mortality rate in the study area. From these opinions, an Infant Mortality Preventability Decision Tree and a Problem List was developed. Panelists used these in Rounds III and IV to evaluate the case summaries. There were significant differences in the preventability ratings between physicians and nurses, indicating the importance of assessing individuals' philosophies of preventability when working with an interdisciplinary team of health care providers.

Birth Certificates↗

PubMed1991

Maintaining competence for first-line nurse managers: an evaluation of the use of the literature.

The use of nursing literature is frequently advocated as a means of maintaining competence. The purpose of this study was to compare the frequency of references to competencies in the literature with those retained for the role of first-line nurse managers by an expert panel involved in the Delphi technique. In this way, the use of literature in maintaining managerial competence for first-line nurse managers was evaluated. When the 20 most frequently mentioned competencies in the literature were compared with the highest mean scores and those ranked as most important by the expert panel, only two competencies appeared on all three lists. Fifteen competencies were frequently mentioned in the literature but were not identified by the expert panel as important to the role of first-line nurse managers. A further three competencies identified in the literature were excluded by the expert panel, indicating they were not perceived to be a function of first-line nurse managers.

Clinical Competence↗

PubMed2006

Breast cancer survivorship: expressed needs of black women.

Studies have reported that race/ethnicity, socioeconomic status, access to care, early diagnosis, quality of care, and spirituality are important prognostic factors for a breast cancer diagnosis. This exploratory study seeks to identify the perceived needs of Black middle-income breast cancer survivors. The Delphi Technique, a qualitative research approach (for deriving cultural consensus), was used to assess needs of 62 Black middle-income socioeconomic position survivors. Survivors' expressed needs were to have (1) affordable, accessible, acceptable, and appropriate medical and support services; (2) a caring and loving family; (3) contacts for information regarding breast cancer symptoms or related health problems; (4) an intimate relationship with God; and (5) adequate resources for self and family care. This pilot study suggests Black breast cancer survivors, regardless of a middle-income socioeconomic position (SEP), experience similar socioecological stressors as low-income SEP survivors.

Adult↗

PubMed1986

Physician satisfaction with patient encounters. Reliability and validity of an encounter-specific questionnaire.

While patient satisfaction has been studied extensively and considered an outcome measure of physician-patient encounters, physician satisfaction has received limited consideration. The reliability and validity of an "encounter-specific" physician satisfaction scale were examined. The Delphi technique was used to develop a 39-item questionnaire comprising four hypothesized domains of physician satisfaction: interactive, personal, professional, and contextual. Factor analysis supported two of the four hypothesized categories. Exclusion of all items not contributing to the reliability of the two subscales or differentiating between high and low scores in an item analysis allowed a condensation of the scale. This 16-item scale was tested in a second phase of the study, which supported the reliability and validity of the two-dimension encounter-specific physician satisfaction scale. Further use of the scale may prove useful in exploring this neglected component of physician-patient encounters.

Attitude of Health Personnel↗

PubMed1997

The research and educational priorities of rural occupational therapists.

The aim of this pilot research project was to identify the research and educational priorities of occupational therapists practising in rural New South Wales. Eight participants were recruited in the south-western region of the State. The Delphi technique was used to obtain the most reliable consensus of the research participants. Priorities emerged in four designated areas: (1) research that would be of value to clients; (2) research that would be of value in providing community care for clients; (3) research that would be of value in facilitating health promotion and disease prevention; and (4) research that would be of value to professional and educational needs. In the final phase of the study, 23 high priorities were identified. The findings of the study suggest directions for research and continuing education in occupational therapy which may benefit rural practitioners and their clients.

Attitude of Health Personnel↗

PubMedDate not supplied

A Delphi survey of clinical nursing research priorities in Western Australia.

In 1989-1990 an investigation was undertaken to ascertain which problems WA nurses considered required researching. A modified Delphi technique was employed to obtain data from nurses in hospitals and health care agencies throughout the metropolitan and rural regions in the state. Participants worked in areas of acute care, mental health, paediatrics, gerontology, community health and domiciliary services and addictions. Problems identified were categorised into three streams; clinical, management and staff development. Respondents were required to assign a value to items according to their importance to nurses and to patients. They were also asked to indicate whether they considered there was an adequate research base relevant to each item. Results reported here are based on the 10 priority items identified in the clinical stream.

Clinical Nursing Research↗

PubMed1998

Treatment systems guidelines for primary rectal cancer from the 1996 Patterns of Care Study.

PURPOSE: The Patterns of Care Rectal Cancer Committee was formed to develop consensus recommendations for patients with adenocarcinoma of the rectum limited to the pelvis. METHODS AND MATERIALS: The Committee was composed of a multidisciplinary group of oncologists, and clinical scenarios were chosen to address most of the major treatment controversies in the combined modality treatment of rectal cancer. A literature search was then conducted and the major articles were identified. A modified Delphi technique was used to arrive at consensus. Serial surveys were conducted by distributing questionnaires to the Committee members to consolidate expert opinion. Voting was conducted using a scoring system and opinions were unified to the highest degree possible. RESULTS: Consensus voting was performed for 4 clinical scenarios. Acceptability ratings for treatment were grouped into 3 broad categories: not acceptable, acceptable, and most acceptable. Based on the treatment options, a decision tree was developed that reflects the consensus of the committee. CONCLUSION: These options may help guide treatment decisions in rectal cancer.

Adenocarcinoma↗

PubMed2000

A Delphi survey to identify activities of nurse practitioners in primary care.

The practice activities of nurse practitioners (NPs) in primary care have not been well delineated. The purpose of this study is to identify the activities of NPs in the provision of primary care. Patient, practitioner, and healthcare system variables were collected to describe the sample and determine if these factors influenced the activities of NPs. Primary care NPs (n = 139) representing the practice areas of pediatrics (n = 12), family (n = 75), adult (n = 15), and women's health (n = 37) responded to serial questionnaires using Delphi technique asking them to identify activities they perform routinely in their practices. Using frequency analysis, activities common to the practice of all NPs were identified, and using Chi-square, activities of specialty NP practice were identified. Regression analysis was used to correlate NP, patient, and healthcare system variables with the activities performed as part of NP practice. Three lists of activities of NP practice were developed: core activities of all NP practice, specialty activities, and other activities. Initial analyses of variables that might influence NP practice were examined. These results can be useful to healthcare consumers choosing providers, as well as legislators, educators, employers of NPs, and other interested healthcare professionals.

Adolescent↗

PubMedDate not supplied

Critical care competencies.

In the absence of nationally accepted critical care competencies, each educational institution providing critical care programmes is forced to define the essential competencies necessary for practice, leading to variations in expected practice and the emergence of 'postcode' competencies. This research report aims to build upon competency activity for all areas of nursing practice within critical care levels 1, 2 and 3. A functional analysis to elicit core critical care competency statements was conducted and a modified Delphi technique was used to generate consensus opinion from a pan-London purposive sample of nurses working in critical care. The functional analysis group identified four competency statements and elements of competencies. Consensus agreement of 80% was achieved with mean agreement scores that exceed 97%. A core critical care competency framework was refined and developed by expert nurses drawing on their own experience and knowledge of critical care nursing. The framework could be useful to: educationalists designing competency-based curricula; critical care managers as a tool for recruitment and retention and for education and training of staff; individual critical care nurses to facilitate continuous professional development.

Clinical Competence↗

PubMed1986

[Retrospective evaluation of occupational exposure in epidemiologic studies. Use of the Delphi method].

A method, based on the Delphi technique, for evaluating occupational risks in a quantifiable manner was devised in the course of a case-control study on respiratory cancers in the nickel mining and refining industry in New Caledonia. There were four stages in the evaluation process: identification of eleven potential carcinogenic factors in the company during the 1930-1977 period; grouping of a limited number of work-stations; evaluation of exposure levels for the different factors for each workstation; computation of the cumulative value of exposure for each subject under study. A partial validation study shows that this kind of approach may prove useful for future occupational epidemiological studies.

Carcinogens, Environmental↗

PubMed2003

Effectiveness of postexposure vaccination for the prevention of smallpox: results of a delphi analysis.

We estimated the effectiveness of postexposure smallpox vaccination in preventing or modifying disease in naive and previously vaccinated adults, using the formal Delphi technique. For persons not previously vaccinated, the median effectiveness in preventing disease with vaccination at 0-6 h, 6-24 h, and 1-3 days after exposure was estimated as 93%, 90%, and 80%, respectively, and effectiveness in modifying disease among those who develop illness was estimated as 80%, 80%, and 75%, respectively. Effectiveness was greater for those vaccinated previously. High postexposure vaccination effectiveness for preventing or modifying smallpox is consistent with the limited data available, is biologically plausible, and is similar to that seen for other viral vaccine-preventable diseases. These estimates support the Advisory Committee on Immunization Practices recommendations and provide a key parameter for mathematical models on which policy decisions may be based.

Delphi Technique↗

PubMedDate not supplied

Burn nursing Delphi study: pain management.

In 1989 a Delphi study was undertaken to identify the nursing priorities in burn research. The Delphi technique is a series of questionnaires used to reach consensus. Ninety-four nurses involved in burn care completed four rounds of questionnaires containing 101 research questions. This, the seventh and final report, concerns a significant area of burn research, which is pain management. Eleven (10%) of the 101 questions dealt with pain, whereas five were rated among the top 20 priority questions. As a category the questions concerning pain management had a mean score of 5.91 on a 0 to 7 Likert scale. The questions collectively were cited as having the most impact on the welfare of the patient with burns.

Analgesics↗

PubMed1990

Establishing pediatric cancer nursing research priorities: a Delphi study.

The purpose of this study was to have pediatric oncology nurses identify and rate topic priorities for clinical nursing research in the specialty and to determine if nurses in a pediatric cancer center identified different priorities than did nursing colleagues in other settings. The sample consisted of 44 nurses from a comprehensive pediatric cancer center and 43 nurses attending the 12th Annual APON Conference. A decision-making method, the classical Delphi technique, was used. Three rounds of soliciting opinions by questionnaires were completed, and data from each round were reviewed and categorized by a research team of six nurses until group consensus was achieved. The majority of priorities identified by both groups concerned nursing procedures, the pediatric oncology patient, and the specialty itself. The least number of priorities were in the categories of care delivery systems and families. One difference between the two groups was that professional issues dominated the cancer center sample, whereas psychosocial issues were more prominent in the APON sample.

Clinical Nursing Research↗

PubMed1998

[National reference centers for surveillance of infectious diseases in Switzerland: results of a delphi study].

The national reference laboratories are one of the tools used by public health authorities to control infectious diseases. The Swiss Confederation supports 9 national reference centers (NC), each dealing with a limited number of infectious agents. The purpose of this study was to evaluate if this network meets present day needs, whether it has to be redefined, and how it can be improved. Using the Delphi technique, 34 experts in the field of infectious diseases were questioned to establish a concept for NC in Switzerland. The main result of this study is that official reference laboratories are considered necessary. However, depending on the type of infectious agent, the following types of laboratories should be used: national reference centers, specialized laboratories and laboratories abroad. The study also defined criteria for the designation of NC, their field of action (general objectives, tasks, duration of the mandate, infectious agent to be monitored), evaluation criteria, and the type of funding. Furthermore, possible improvements in the present system were identified and the establishment of good collaborations with reference centers abroad was proposed.

Communicable Diseases↗

PubMed1997

[The relationship between primary and specialized care].

OBJECTIVES: To find the current situation regarding the relationship between Primary Care and specialist doctors. To find the defects in this relationship and to propose actions to improve the situation. DESIGN: Delphi technique. SETTING: Area Medical Directors, Medical Coordinators of Primary Care Centres, Hospital Medical Directors, Internal Medicine Service chiefs and Casualty directors from the entire Community of Valencia. RESULTS: After a qualitative analysis of the replies given in the first and second questionnaires, the 10 most serious problems for the Primary Care/Hospital relationship were extracted, along with 10 possible solutions to improve this relationship. CONCLUSIONS: The main problems detected between Hospital and Primary Care concerned the professional and organisational areas. The solutions suggested mainly centered on the organisational area. Specific differences were found in the prioritization of the replies, both for problems and solutions, depending on whether the point of view was Primary or Hospital Care.

Community Health Centers↗

PubMed2004

[Innovative potentials and new areas of responsibility for nursing in the service sector of the future--results of a Delphi-study in Germany].

Present reforms and dynamics of development within the health care system have led to different health care needs and new demands on nursing. It has been assumed that in the future a number of innovative potentials and new areas of responsibility will develop. Consequently, new nursing services will also come into being which are to be located at the interface of Nursing and Public Health. Adopting the Delphi technique the Institute for Applied Nursing Research at the University of Bremen carried out nation-wide study which was aimed at experts (n = 41) representing research and development, as well as political interests regarding health and nursing-related institutions of the German health care system. Four areas of responsibility were considered most relevant for the development of new nursing services: consultancy/information work, health promotion/prevention/rehabilitation, management and co-ordination/integration/co-operation. The biggest market is expected within the area of consultancy work. The development of those four areas is closely connected with the grade of professionalisation. Additionally, linking Public Health and Nursing will include a change in the way nursing sees itself. Furthermore, nursing objectives and interventions will be altered, too.

Career Choice↗