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PubMed2002

A study of skill mix issues in midwifery: a multimethod approach.

BACKGROUND: While skill mix studies are quite commonplace in health care, most have focused on the most effective use of staff and skill distribution in the field of nursing; few relate specifically to the midwifery profession. In Ireland there is no recognized midwifery assistant grade. AIMS: This paper describes a study that investigated the skill mix requirements of a midwifery service based in the Republic of Ireland. The project was built on previous research, which showed that due to undertaking a number of 'nonmidwifery duties', midwives were unable to undertake fully the work for which they were trained. RESEARCH METHODS: Data were collected using a variety of methods. These included postal questionnaires and the Delphi technique. The 'Delphi' was used to gain a level of consensus from hospital midwives (all grades) (n=194) and student midwives (n=79) on what are and what are not nonmidwifery duties. Analysis of secondary data (duty rotas and staff turnover data) was also undertaken. RESULTS: Findings indicate that the respondents spent a large proportion of their time undertaking clerical, domestic, portering and stock duties. They would welcome the introduction of midwifery assistants into the ward team and were able to identify those duties that such persons could undertake. CONCLUSIONS: Skill mix requirements and organizational strategies to deal with the workforce changes are highlighted. Due to the current shortage of midwives in many countries and the dearth of extant research in this area, the results and recommendations have implications for midwives nationally and internationally.

Delphi Technique↗

PubMed2001

Developing a unified language for children's nurses, children and their families in the United Kingdom.

This paper presents a taxonomy of Infant, Child and Adolescent (ICA) nursing diagnoses and clinical outcomes that has been developed with the co-operation of nurses caring for children in the United Kingdom. Three focus group interviews were conducted in one acute care NHS trust in London (referred to as the host trust in this paper) in 1998/99, in which participants were asked to consider nursing and family factors relevant for identifying and providing care. A total of 28 ICA diagnoses, including definitions, defining characteristics and outcomes, were identified for clinical testing and included in the ICA taxonomy. The ICA diagnostic labels and outcomes for care were further tested for their relevance for clinical practice in a Delphi Survey carried out in 1999 and their use in clinical practice began in 1999. This research augments the findings from an initial Delphi survey carried out in 1993 and case study research in 1996. The previous research initiated the development of a unified language for children's nurses, children and their families, to aid communication and decision-making. Implications of this and future research for clinical practice, nationally and internationally, are also discussed.

Attitude of Health Personnel↗

PubMed2002

Combining quantitative and qualitative research to engage stakeholders in developing quality indicators in general practice.

In 2000, the Newcastle Institute of Public Health (NIPH) undertook a project that aimed to review, identify and where necessary, develop a range of indicators of quality service provision in general practice. We describe the way in which quantitative and qualitative research methods (including a Delphi style survey) were combined to investigate consensus amongst stakeholders in defining quality indicators. Over 500 general practice stakeholders were consulted. They included general practitioners (GPs) and their representative groups, academics, policy makers, and consumers. Several important lessons were learnt from the process, including the importance of involving a broad representative group of stakeholders, informing workshop participants in advance, providing adequate response times for the Delphi surveys and using videoconferencing technologies.

Aged↗

PubMedDate not supplied

Emergency calls not requiring an urgent ambulance response: expert consensus.

OBJECTIVES: This study sought expert consensus about which categories of patients from 248 Medical Priority (MPDS) ambulance dispatch codes might be appropriate for a nonemergency response or for whom dispatch of an ambulance might be appropriately denied if the patient were referred to a more suitable health care provider. METHODS: A Delphi technique was used. Ten physicians, from the specialities of emergency medicine, general practice, and pre-hospital care formed the expert panel but were blinded to each other's identity. Participants received a written description of the operation of the MPDS and the Delphi technique and voted independently by mail. RESULTS: Using majority voting, 54 dispatch codes (22%) were recommended for a nonemergency response/referral. This equates to 12.44% of annual emergency calls in a typical UK ambulance service (n = 9,021; 95% confidence interval, 12.21 to 12.69%). The kappa statistic (chance-corrected proportional agreement) between members of the expert panel was 0.62 (substantial). CONCLUSIONS: The recommended dispatch codes for non-emergency response or referral represent a significant proportion of emergency ambulance calls. Theoretically, the implementation of nonemergency responses could have the benefit of reducing accidents involving emergency ambulances and could lead to improved response times for critically ill patients by freeing up resources. It could also support the targeting of patients to appropriate health care providers on first contact with the health service. However, given the poor reliability of expert opinion, further research using clinical outcome data is required to validate the recommendations made in this article before changing existing ambulance response systems.

Ambulances↗

PubMed2003

PERISTAT: indicators for monitoring and evaluating perinatal health in Europe.

BACKGROUND: The PERISTAT project aimed to develop an indicator set for monitoring and describing perinatal health in Europe. The challenge was to define indicators that cover common concerns and have the same meaning within the different European health care systems. METHODS: PERISTAT included i) a review of existing recommendations on perinatal health indicators, ii) a DELPHI consensus process with a scientific advisory committee composed of a clinician and an epidemiologist or statistician from each European member state as well as with a panel of midwives, and iii) a study of the availability of national statistics to construct recommended indicators. This article describes the first two components. RESULTS: The review identified 10 international and 13 national recommended indicator sets. It also included indicators routinely compiled by WHO, EUROSTAT and OECD. Because of the methodological limits to using existing indicators for European comparisons, a high priority was placed on improving indicators already collected. Using the DELPHI method based on the results of the review, the scientific committee achieved a consensus on ten core and 23 recommended indicators, including 12 requiring further development. CONCLUSIONS: The PERISTAT project was successful in identifying a set of indicators, which drew on and consolidated previous work. Consensus was not achieved on precise indicators in areas where uncertainty about appropriate indicators was high, although areas were targeted for future development. Finally, the feasibility study, which is in progress, is an essential part of the project, since it will enable member states to evaluate their capacity to produce these indicators.

Congenital Abnormalities↗

PubMed2001

Online research to guide knowledge management planning.

The current paper describes the process and results of an effort to find a way to effectively manage and diffuse prevention knowledge. This study shows the role that today's communication technologies can play in ensuring collaboration and participation in both the design and use of a knowledge management system (KMS) for prevention research, practice and policy. In the context of this study, 'prevention research' includes primary through tertiary prevention efforts consistent with general applied public health research in the US. An online Delphi study was used to engage a set of prevention research constituencies in the design of a mechanism to enhance the potential for effective technology transfer. A three-round Delphi was conducted with 58 stakeholders and key informants involved in prevention: government-level policy makers, researchers and front-line practitioners. The study resulted in consensus on 34 functions and 32 output/content elements of a proposed web-based KMS called PreventionEffects.net. The paper also describes the implications of both the processes of development and the benefits of the proposed system for those interested in prevention.

Delphi Technique↗

PubMed1998

How well are patients treated in family practice? Quality of consultations for non-acute abdominal complaints.

OBJECTIVE: To describe the application of weighted review criteria, developed by the Delphi technique, for the assessment of the quality of consultations concerning non-acute, abdominal complaints. DESIGN: Descriptive study in two parts: (i) comparison of actual family doctor (FD)-performance with predefined review criteria; (ii) calculation of quality scores per consultation, utilizing the weighted criteria. SETTINGS: Sixty-two family practices across The Netherlands. SUBJECT: Eight-hundred and forty consultations concerning non-acute abdominal complaints, first encounters. MAIN OUTCOME MEASURES: The percentage of consultations in which each criterion was met; quality scores per consultation and their distribution. RESULTS: (i) Little effort was made to trace risk groups for gastrointestinal malignancies (< 50% of the consultations concerned); medication was often described without dietary advice (17%); inappropriate activities were not carried out on a large scale (6%). (ii) Quality scores were normally distributed. CONCLUSIONS: The Delphi technique yields a useful instrument for assessment of the quality of consultations. The review criteria for quality assessment of FD performance used in this study made it possible to distinguish quite clearly between high- and low-quality consultations. Some important deficiencies in daily practice emerged.

Abdomen↗

PubMed2006

Considered judgement in evidence-based guideline development.

BACKGROUND: Clinical practice guidelines should be based on the best available evidence. However, this evidence is often incomplete, controversial, or lacking. Other considerations beyond the evidence are therefore needed to be able to formulate specific and applicable recommendations for clinical practice. OBJECTIVE: The aim of this study is to obtain consensus among experts about a set of domains and items covering the most relevant 'other considerations' to formulate recommendations in evidence-based guideline development. METHODS: An initial list of 10 domains and 49 items for a systematic and considered judgement of scientific evidence was generated from the literature. A panel of Dutch experts in guideline development tested this list using a two-round Delphi consensus technique. Each expert was asked to independently score the relevance of the items on a 4-point Likert scale, ranging from 'very important' to 'not important'. The final list consisted of items that were included by at least 60% consensus. RESULTS: Twenty-eight experts participated in the first Delphi round and 21 of them in the second round. High scoring domains were 'clinical relevance', 'safety', and 'availability of resources'. There was consensus about the relevance of 37 items. The domain 'conflicts of interest by industry' was excluded because of lack of consensus. CONCLUSION: This is the first formal consensus approach towards structuring the considered judgement process in formulating recommendations in clinical guidelines. The final list of items can be used to facilitate the process of guideline development. The next step is to test the practical usefulness and applicability of this list in guideline development.

Consensus↗

PubMed1996

The identification of ethical issues in physical therapy practice.

BACKGROUND AND PURPOSE: The purpose of this study was to identify the current ethical issues facing physical therapists and (2) ethical issues that may be faced in the future by physical therapists. SUBJECTS AND METHODS: The Delphi technique was used as the research design for this study. The panel of experts for the study were selected from Papers submitted by past and present members of the Judicial Committee of the American Physical Therapy Association. A series of three questionnaires were sent to the members of the panel. Following the Delphi technique, the first questionnaire contained broad questions designed to elicit a wide range of responses. The second and third questionnaires were then developed from the information received in the preceding questionnaire. RESULTS: The results of the first question of the study identified 10 current ethical issues as consensus choices by the panel and 3 issues as near-consensus. The panel responses to the second question identified 4 future ethical issues. A combined list of current and future contained 16 issues in physical therapy. CONCLUSION AND DISCUSSION: The 16 issues addressed ethical considerations in different areas of physical therapy practice: 6 issues involving patient rights and welfare, 5 professional issues, and 5 issues relating to business and economic factors. Thirteen of these issues have not been discussed in previous physical therapy literature and would be suggested topics for future study.

Attitude of Health Personnel↗

PubMed2004

Evidence-based recommendations for the role of exercise in the management of osteoarthritis of the hip or knee--the MOVE consensus.

OBJECTIVES: Exercise is an effective and commonly prescribed intervention for lower limb osteoarthritis (OA). Many unanswered questions remain, however, concerning the practical delivery of exercise therapy. We have produced evidence-based recommendations to guide health-care practitioners. METHODS: A multidisciplinary guideline development group was formed from representatives of professional bodies to which OA is of relevance and other interested parties. Each participant contributed up to 10 propositions describing key clinical points regarding exercise therapy for OA of the hip or knee. Ten final recommendations were agreed by the Delphi technique. The research evidence for each was determined. A literature search was undertaken in the Medline, PubMed, EMBASE, PEDro, CINAHL and Cochrane databases. The methodological quality of each retrieved publication was assessed. Outcome data were abstracted and effect sizes calculated. The evidence for each recommendation was assessed and expert consensus highlighted by the allocation of two categories: (1) strength of evidence and (2) strength of recommendation. RESULTS: The first round of the Delphi process produced 123 propositions. This was reduced to 10 after four rounds. These related to aerobic and strengthening exercise, group versus home exercise, adherence, contraindications and predictors of response. The literature search identified 910 articles; 57 intervention trials relating to knee OA, 9 to hip OA and 73 to adherence. The evidence to support each proposition is presented. CONCLUSION: These are the first recommendations for exercise in hip and knee OA to clearly differentiate research evidence and expert opinion. Gaps in the literature are identified and issues requiring further study highlighted.

Contraindications↗

PubMed1997

A curriculum for the ideal orthopaedic residency. Academic Orthopaedic Society.

The Academic Orthopaedic Society met in April 1994 to discuss manpower issues in orthopaedics. The members developed an approach using the Delphi system to define and obtain consensus on the characteristics of the ideal residency. Six categories of educational attributes were included: General; Clinical Management; Skills and Technical Aspects; Rehabilitation; Basic Science and Research; and Educational Environment. The following year a questionnaire was sent to more than 125 programs in an attempt to have residents and staff anonymously self score their residencies according to the standards defined by the Delphi panels. The results obtained from the 745 responders from 73 programs validate effectively the characteristics of the ideal program and also show the variation among the programs.

Clinical Competence↗

PubMedDate not supplied

Research priorities for burn nursing: rehabilitation, discharge planning, and follow-up care.

Fourteen of the 101 research questions that were proposed in the Burn Nursing Delphi study by Marvin et al. (J Burn Care Rehabil 1991;12:190-7) were concerned with the rehabilitation, discharge planning, and follow-up care of patients with burns. Questions that were ranked as top priorities for patient welfare related to control of postburn itching, prevention of contractures, and effective means of community-based follow-up to meet physical, social, and emotional needs of patients and families. Burn nurses identified the study of nursing interventions that are the most effective means for preparing patients, families, and community nurses for posthospitalization care as the research priority that has the greatest potential impact on the profession of burn nursing. Respondents to the Delphi study favored a collaborative approach to research for most of the questions in the rehabilitation subgroup. Suggestions are made for nurses who wish to take the lead in designing and implementing qualitative and quantitative studies that relate to the increasingly prevalent problems that are encountered by survivors of burn injury.

Aftercare↗

PubMed1999

Outcomes for community health nursing practice.

OBJECTIVE: The purpose of this study was to develop an easy, practical list of outcomes amenable to community health nursing interventions. This study sought to answer the following question: What outcomes are sensitive to nursing interventions in the community health setting? SUMMARY BACKGROUND DATA: Nursing literature discusses many client outcomes. However, available outcome lists are not always sensitive to nursing interventions by community health nurses. Nurses need a precise list to measure client outcomes resulting from contact between nurses and clients in a variety of community health settings. METHODS AND SUBJECTS: The study used a modified Delphi technique to ensure adequate response from the subjects. Initially, focus groups generated items for the Delphi questionnaires. Using items from the focus groups, the researchers developed three rounds of questionnaires. In each round, nurses stated a level of agreement with each item as an outcome for community health nurses. Twenty-two community health nurses in one Southeastern state participated in four focus groups. One hundred fifty-two community health nurses returned round 1 questionnaires, 68 nurses returned round 2 questionnaires, and 48 nurses returned round 3 questionnaires. RESULTS: The researchers grouped the outcomes into four domains: client's psychosocial components of care, client's physiologic components of care, nursing intervention/implementation components of care, and environmental/community safety components of care. CONCLUSIONS: The findings produced an easy, practical list of 48 nursing outcomes for use in decision making and research by community health nurses in all settings.

Community Health Nursing↗

PubMed1987

Assessing a methodology for physician requirement forecasting. Replication of GMENAC's need-based model for the pediatric specialty.

Methodologies for determining levels of U.S. physician requirement are as complex as they are controversial. One long-standing controversy surrounds the advantages of an epidemiologic need-based forecasting model over an economic demand-based model. This paper examines the need-based requirement approach as recently developed by the Graduate Medical Education National Advisory Committee (GMENAC). This approach is assessed for the pediatric specialty by replicating the original model using data derived from three large HMOs. These data were empirically obtained from the computerized visit records of more than 10,000 children at each of the three plans and normatively from Delphi panels consisting of pediatric practitioners at those same sites. Results indicate that if U.S. pediatrician requirement was estimated on the basis of HMO practice data, rather than GMENAC's national ideals, fewer physicians would be needed. The pediatric requirement based on local Delphi panel judgments was lower still, due in great part to the suggestion of increased delegation rates to nonphysician providers. Implications of this comparative analysis for the GMENAC need-based methodology and future physician requirement modeling efforts are discussed.

Boston↗

PubMed2006

Zeitgeists and development trends in long-term care facility design.

Through literature analysis, in-depth interviews, and the application of the Delphi survey, this study explored long-term care resident priorities with regard to long-term care facility design in terms of both physical and psychological needs. This study further clarified changing trends in long-term care concepts; illustrated the impact that such changes are having on long-term care facility design; and summarized zeitgeists related to the architectural design of long-term care facilities. Results of our Delphi survey indicated the following top five priorities in long-term care facility design: (1) creating a home-like feeling; (2) adhering to Universal Design concepts; (3) providing well-defined private sleeping areas; (4) providing adequate social space; and (5) decentralizing residents' rooms into clusters. The three major zeitgeists related to long-term care facility design include: (1) modern long-term care facilities should abandon their traditional "hospital" image and gradually reposition facilities into homelike settings; (2) institution-based care for the elderly should be de-institutionalized under the concept of aging-in-place; and (3) living clusters, rather than traditional hospital-like wards, should be designed into long-term care facilities.

Activities of Daily Living↗

PubMed2004

Centers for Disease Control and Prevention injury research agenda: identification of acute care research topics of interest to the Centers for disease Control and Prevention--National Center for Injury Prevention and Control.

BACKGROUND: The purpose of this report is to identify the most important research questions pertaining to the acute care of the injured patient using a Web-based Delphi technique to achieve expert opinion consensus. METHODS: Experts in trauma care from the United States and Canada (n =39) generated structured research questions and then ranked these questions in order of importance, using a Web-based survey for question generation, question ranking, and a Delphi technique of consensus. Guidelines for question construction and ranking specified that participants considered questions that fall within the interest and domain of the Centers for Disease Control (CDC)-National Center for Injury Prevention and Control (NCIPC). RESULTS: One hundred thirty-seven questions in 18 distinct categories of interest were initially generated. After two rounds of merging, collating, reassessing, and ranking by significance and importance, 25 research questions were deemed most important and significant in the care of the injured patient. Ten of these (40%) were considered to be appropriate issues for the CDC-NCIPC to address and fund, dealing with injury prevention strategies, trauma systems design and funding, the epidemiology of injury, and global outcome determinants. These 25 questions were also reviewed with consideration given to the most likely source of federal funding of investigations. CONCLUSION: This report identifies the areas of trauma care in which research efforts might best be directed. Fully 40% of the key research questions could be considered to fall under the interest and auspices of the CDC-NCIPC. The remaining questions cover a broad range of topics and likely funding sources, emphasizing the need for a coordinated oversight of research funding in trauma care.

Acute Disease↗

PubMed1996

Research priorities for nurses caring for persons with multiple sclerosis. Nursing Research Speciality Group of the Consortium of Multiple Sclerosis Centers.

The Delphi technique was used by the Nursing Research Specialty Group of the Consortium of Multiple Sclerosis Centers (CMSC) to obtain consensus on research priorities related to health and nursing care needs of persons with multiple sclerosis (MS) and their families and particular nursing interventions for which effective outcomes needed to be determined. Three rounds of questionnaires were used in obtaining responses from nurses affiliated with the CMSC and nurses affiliated with National MS Affiliated Centers/Clinics and the Veterans Administration Medical Centers (nonCMSC). Round 1, identification of research items, was the basis for developing a 108 item questionnaire for Rounds 2 and 3. Sixteen of 108 research items were selected by 25% or more of the CMSC or nonCMSC nurses. Among the top research priorities identified by both groups of nurses were determining effective programs to promote quality of life and reduce fatigue, stress and emotional difficulties (anger, anxiety, isolation); promote high level of functioning; and develop strategies for effective handling of cognitive deficits. Research priorities identified in this Delphi study provide direction for conducting collaborative research among CMSC and nonCMSC nurses with the aim of improving clinical practice and health outcomes of MS patients.

Cost-Benefit Analysis↗

PubMed2005

National audit of continence care: laying the foundation.

INTRODUCTION: National audit provides a basis for establishing performance against national standards, benchmarking against other service providers and improving standards of care. For effective audit, clinical indicators are required that are valid, feasible to apply and reliable. This study describes the methods used to develop clinical indicators of continence care in preparation for a national audit. AIM: To describe the methods used to develop and test clinical indicators of continence care with regard to validity, feasibility and reliability. METHOD: A multidisciplinary working group developed clinical indicators that measured the structure, process and outcome of care as well as case-mix variables. Literature searching, consensus workshops and a Delphi process were used to develop the indicators. The indicators were tested in 15 secondary care sites, 15 primary care sites and 15 long-term care settings. RESULTS: The process of development produced indicators that received a high degree of consensus within the Delphi process. Testing of the indicators demonstrated an internal reliability of 0.7 and an external reliability of 0.6. Data collection required significant investment in terms of staff time and training. CONCLUSION: The method used produced indicators that achieved a high degree of acceptance from health care professionals. The reliability of data collection was high for this audit and was similar to the level seen in other successful national audits. Data collection for the indicators was feasible to collect, however, issues of time and staffing were identified as limitations to such data collection. The study has described a systematic method for developing clinical indicators for national audit. The indicators proved robust and reliable in primary and secondary care as well as long-term care settings.

Delphi Technique↗