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[Communication barriers with the HIV+ patient perceived by health personnel].

The purpose of this study was to identify major communication barriers between health professionals and patients infected with HIV. Information from 17 experts on AIDS across Spain was gathered using the Delphi technique. A total of 24 barriers were identified and compounded into groups in relation to the provider, the patient, the message and the context wherein the communication process takes place. Major communication barriers were associated to the lacking of specific skills on the provider's side and to certain health professional's and patient attitudes towards each other and from both towards some emotional aspects related to AIDS.

Attitude of Health Personnel↗

PubMed1995

Establishing priorities for research in education within one college of nursing and midwifery.

The educational provision for nurses and midwives is currently undergoing immense change. These innovations encompass the organizational structure, the process of delivery and the projected outcomes for professional education within the UK. There is, however, a dearth of published research evidence designed to evaluate these educational changes. Nevertheless, anecdotal evidence suggests that within individual institutions small-scale, educationally-focused research is currently being conducted. These are usually 'one off' studies which address questions of personal interest to individual researchers rather than issues of importance to the organization or to the professions as a whole. the net result is a diverse research portfolio which, by its very nature, is wasteful in terms of lost opportunity to commission larger-scale research which might influence educational practice and in failing to direct effectively the energies and skills of researchers. In an attempt to address these issues and to set an agenda for research priorities within one college of nursing and midwifery, a four-round Delphi survey was conducted. This is the first of its kind to be reported in the UK literature. Fifty six of the teaching staff (77% of the total number of teaching staff) initially identified 213 issues which were grouped into 14 categories. The interrater reliability of the categorization process was checked on three separate occasions. In successive rounds, high response rates were maintained. To test for the manipulative effect of providing respondents with controlled feedback of their score in round 2, the third questionnaire was completed "blind' to previous scores. In the final round, participants were provided with feedback and invited to re-score and rank the items. The final round yielded 28 prioritized items. It was notable that the top ten issues primarily focused upon the pre-registration (Project 2000) provision encompassing both the preparation of students for professional practice and the changing role of the nurse/midwife teacher. This paper explores the implications of these findings for setting a research agenda within the organization.

Curriculum↗

PubMed1998

A conceptual model of the food and nutrition system.

The food system is a widely used concept, but few systematic frameworks model the full scope and structure of the food and nutrition system. Bibliographic searches, a modified Delphi technique, focus groups and interviews with experts on the topic were conducted to identify existing models of agriculture, food, nutrition, health and environmental systems. These models were examined, classified and synthesized into an integrated conceptual model of the food and nutrition system. Few existing models broadly described the system and most focused on one disciplinary perspective or one segment of the system. Four major types of models were identified: food chains, food cycles, food webs and food contexts. The integrated model developed here included three subsystems (producer, consumer, nutrition) and nine stages (production, processing, distribution, acquisition, preparation, consumption, digestion, transport, metabolism). The integrated model considers the processes and transformations that occur within the system and relationships between the system and other systems in the biophysical and social environments. The integrated conceptual model of the food and nutrition system presents food and nutrition activities as part of a larger context and identifies linkages among the many disciplines that deal with the food and nutrition system.

Agriculture↗

PubMed2000

Measurement of community beliefs about colorectal cancer.

Few educational campaigns have focused on bowel cancer, though studies have indicated that members of the community need and want current information about relevant issues. In order to facilitate research in this area, reliable and valid measures of community attitudes are needed. Content validity of a survey instrument was obtained through use of a Delphi process with Directors of Education from the Australia Cancer Council and focus group discussions with informed members of the public. The subsequent survey of community perceptions about colorectal cancer included a broad range of content areas related to the risk of bowel cancer, preventing and coping with bowel cancer and beliefs about susceptibility and severity. The construct validity of these content areas was investigated by use of a factor analysis and confirmation of an association with related predictor variables. Two measures related to personal influence and anticipated coping responses showed favourable psychometric properties, including moderate to high levels of internal consistency and test-retest reliability. A test of the concurrent validity of these measures requires further development of instruments related to colorectal cancer or adaptation of measures from other areas of health research.

Adult↗

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

Evaluation of explicit criteria for total hip joint replacement.

We tested an appropriateness of indications tool for total hip joint replacement in patients with osteoarthritis. Criteria were developed using a modified Delphi panel judgment process. Ratings were analyzed regarding level of agreement among panelists. Another panel rated the same indications; results were compared with the main panel. Test-retest of the main panel was performed. Regression models were used to assess the contribution of each algorithm variable. Appropriateness indication judgment was applied to 84 patients and compared to health-related quality-of-life improvement before and 3 months following intervention. Main panel ratings compared to those of a second panel resulted in a kappa statistic of 0.77. Test-retest kappa for the main panel was 0.81. Patients considered appropriate candidates for surgery, based on their composite indication scores, showed more improvement in health-related quality of life after 3 months than those considered inappropriately by composite indication scores. The previous parameters tested showed acceptable results for an evaluation tool. These results support the use of this indications algorithm as a screening tool for assessing the appropriateness of hip replacement surgery in osteoarthritis.

Algorithms↗

PubMed1989

Identifying nursing research priorities: a first step in program development.

This study determined nursing research priorities and focused on the development of a nursing research program within a single institution. Of the 715 nurses within the Department of Nursing, 286 (40%) responded to the first round of a two-round Delphi technique, and 137 (48%) responded to the second. The following clinical priorities were determined: prevention and treatment of pressure sores, pain management, treatment of nosocomial infections, and patient education. Nonclinical priorities included staffing and its effects on turnover and patient care, job satisfaction, and factors influencing the quality of nursing care. Serendipitous findings underscored the relevance of the Department of Nursing's conceptual framework to nursing practice and research, revealed the need for dissemination of current research results, and suggested that nurses want to participate in research without assuming responsibility beyond their expertise.

Delphi Technique↗

PubMed1996

A study of clinical nursing research priorities of renal specialist nurses caring for critically ill people.

The aim of this pilot research project was to identify priority areas for clinical nursing research for renal specialist nurses practising in general critical care. Research participants in the study included Clinical Nurse Specialists (CNSs) and Clinical Nurse Consultants (CNCs), n = 12. The study sample was national with representation from a number of major metropolitan teaching hospitals in Australia. The Delphi technique was used to obtain the most reliable consensus of the specialist nurses. Research priorities emerged in four areas: 1) clinical research which is of highest value to patients; 2) clinical research which is of highest value to CNSs/CNCs; 3) clinical research which would provide improved community care and 4) research that would be of value for CNSs/CNCs professional needs. In the final phase of the study nine high priorities were identified. The findings of the study suggest directions for clinical nursing research which would benefit renal specialist nurses and their patients.

Adult↗

PubMed1999

Roles of the allocated nurse and shift leader in the intensive care unit: findings of an ethnographic study.

In the UK, recent policy guidelines emphasize the role of nurses in managing the minute-by-minute care of critically ill patients (Department of Health 1996). This article reports on a study that explored the extent to which the nurse at the bedside (the allocated nurse) and the nurse in charge of the shift (the shift leader) make decisions about the needs of children who are critically ill. The study also identified areas of need using a modified Delphi study and explored how nurses perceive and act on the needs of critically ill children. These aspects are presented elsewhere.

Anthropology, Cultural↗

PubMed2004

The role of the clinical nurse specialist in epilepsy. A national survey.

PURPOSE: To review and describe the key roles of the UK clinical nurse specialist in epilepsy (CNSE), and to identify the specialist nurses' contribution to care through an exploration of CNSE's perceptions of their roles. METHOD: Using the Delphi technique [Applied Project Design and Analysis, 3rd ed., Churchill Livingstone, London, 2000, p. 243] a national survey of all known UK CNSEs was completed. One hundred and thirty questionnaires identifying nine key hypotheses central to the role of the CNSE were distributed and 76 valid questionnaires returned. RESULTS: The response rate was 63% and was geographically representative of the UK population of CNSEs. CNSEs were employed in a range of hospital and community settings with differing patient groups. Seventy-two percent of respondents held higher academic nursing qualifications but only 36% had previous epilepsy or neurology experience. Thirty percent of respondents had been employed in the role of CNSE for more than 5 years and 84% were employed as a G or H grade nurse. Only 39% of CNSEs held nurse-led clinics and of those 32% were responsible for all decisions made during their clinic. Furthermore, 40% of CNSEs saw new patients who had not previously been reviewed by one of the medical team. The level of responsibility for drug management was mainly at a monitoring and advisory level but a small number of CNSEs held much greater responsibility. The responses to the nine hypotheses were compared using cross tabulations. CONCLUSION: The findings of the study and the review of the CNSE in the UK revealed that the key roles of the CNSE were difficult to define. Yet, the respondents identified that there were common core features central to their contribution to care as specialist nurses.

Delphi Technique↗

PubMed1995

Research priorities in vascular nursing.

This study was initiated by the Society for Vascular Nursing (SVN) Research Committee for the purpose of establishing priorities in vascular nursing research. With a three-round Delphi technique for this study, 176 SVN members were asked the question: What are the most significant problems or questions affecting the welfare of patients with vascular disease that can be solved or answered through nursing research? In round I, experts in vascular nursing (n = 43) identified 182 items that were edited by the investigators into 135 researchable questions and 15 categories. In round II, the expert panel (n = 35) rated each item on a 1 to 7-point scale regarding impact on patient welfare. For round III, panelists (n = 34) were asked to rerate each item, taking into consideration their individual and group mean on each item. Participants who responded to all three rounds were generally experienced advanced practice vascular nurses. The number one research priority identified by this panel was the following: What are the most important barriers to compliance with treatment regimens (diet, cessation of smoking, etc) in the patient with vascular disease? Other top research priorities were concerned with nursing standards, patient education, risk factor modification, pain management, decreasing length of stay, nursing education, stress and anxiety in the preoperative period, and providing care at less expense. The research priorities identified by this study are intended to provide direction for the SVN and its members in their efforts to foster future research in vascular nursing.

Delphi Technique↗

PubMed2000

Does this patient need to be evaluated today? Designing a guideline-driven triage process to determine the timing of care for adults with respiratory infection symptoms.

BACKGROUND: Physicians and nurses often make judgments about the urgency with which patients require evaluation, yet few explicit process-of-care criteria are available to guide these decisions. Using a multidisciplinary expert physician panel and explicit, quantitative group judgment methods, standardized, clinically detailed deferred care criteria were developed to guide emergency department and ambulatory care triage decisions for same-day versus deferred care for patients with respiratory infection symptoms. METHODS: Using a modified Delphi process, an eight-member multidisciplinary expert physician panel rated the safety of deferred care for standardized clinical scenarios. The ratings were converted into explicit criteria and then compared with usual implicit judgment in terms of nurse triage times. RESULTS: The panel achieved 100% consensus on 36 critical clinical factors, each of which precludes deferring care for a patient with respiratory infection symptoms. Based on combinations of 12 additional clinical factors, 48 clinical scenarios were created that the panel rated for deferred care safety. Panelists' ratings agreed for 90% of clinical scenarios. These were formatted into screening criteria. Near-perfect interrater agreement (kappa = 0.9) was found in reproducibility testing. The difference in mean nurse triage times using the criteria compared with implicit nurse judgment was 0.4 minutes (95% confidence interval = -2.1 to 2.9 minutes). CONCLUSIONS: Application of explicit criteria for deferring care of patients with respiratory infection symptoms did not lengthen triage time. This approach may facilitate more efficient resource management for ambulatory settings. However, widespread use before these criteria's, our systematic criteria-based triage should be validated in multicenter clinical trials against an outcome standard and the more common implicit approach.

Adult↗

PubMed2000

Setting thresholds for quality indicators derived from MDS data for nursing home quality improvement reports: an update.

BACKGROUND: Determining meaningful thresholds to reinforce excellent performance and flag potential problem areas in nursing home care is critical for preparing reports for nursing homes to use in their quality improvement programs. This article builds on the work of an earlier panel of experts that set thresholds for quality indicators (QIs) derived from Minimum Data Set (MDS) assessment data. Thresholds were now set for the revised MDS 2.0 two-page quarterly form and Resource Utilization Groups III (RUGS III) quarterly instrument. SETTING THRESHOLDS: In a day-long session in October 1998, panel members individually determined lower (good) and upper (poor) threshold scores for each QI, reviewed statewide distributions of MDS QIs, and completed a follow-up Delphi of the final results. REPORTING MDS QIS FOR QUALITY IMPROVEMENT: The QI reports compiled longitudinal data for all residents in the nursing home during each quarter and cumulatively displayed data for five quarters for each QI. A resident roster was provided to the nursing home so that the quality improvement team could identify the specific residents who developed the problems defined by each QI during the last quarter. Quality improvement teams found the reports helpful and easy to interpret. SUMMARY AND CONCLUSIONS: As promised in an earlier report, to ensure that thresholds reflect current practice, research using experts in a panel to set thresholds was repeated as needed. As the MDS instrument or recommended calculations for the MDS QIs change, thresholds will be reestablished to ensure a fit with the instrument and data.

Activities of Daily Living↗

PubMed1997

Setting thresholds for MDS (Minimum Data Set) quality indicators for nursing home quality improvement reports.

BACKGROUND: Determining meaningful thresholds to reinforce excellent performance and flag potential problem areas is critical for quality improvement reports. Without thresholds, an organization may interpret its performance as superior to others because it is "better than average" and falsely assume it does not have care problems in certain areas. SETTING THRESHOLDS: The Minimum Data Set (MDS) assessment instrument is mandated for use nationwide in all nursing homes participating in Medicaid or Medicare programs. Since 1993 a research team at the University of Missouri-Columbia has been developing and testing quality indicators (QIs) derived from MDS data as a foundation for quality improvement activities. In July 1996, a cross-section of 13 clinical care personnel from nursing homes participated on an expert panel for threshold setting for QIs derived from MDS assessment data. Panel members individually determined good and poor threshold scores for each QI, reviewed statewide distributions of MDS QIs, and, two weeks later, completed a follow-up Delphi round. Three members of the research team reviewed the results of the expert panel and set the final thresholds. With thresholds established for good and poor scores, MDS QI scores are reported to a sample of Missouri nursing homes using the thresholds. CONCLUSIONS: To ensure that thresholds reflect current practice, threshold setting with another panel of experts will be repeated as needed, but at least biannually. The report format will be revised on the basis of user input, and a statewide study testing different educational support methods for quality improvement using MDS QIs is now underway.

Aged↗

PubMed1998

Periodontitis detection efficacy of film and digital images.

OBJECTIVE: The objective of this study was to evaluate the accuracy of alveolar crestal bone detection in a comparison of unenhanced and enhanced Sidexis (Siemens Medical Systems, Inc., Bensheim, Germany) digital images with Ektaspeed Plus (Eastman Kodak, Rochester, N.Y.) films by means of receiver operating characteristic analysis. STUDY DESIGN: More than 100 proximal and furcal areas in the anterior and posterior areas of the mandible and maxilla of each of three tissue-equivalent human skull phantoms were imaged with film, direct digital images, and contrast- and brightness-enhanced digital images. Alveolar crest status was assessed by a consensus panel of three experts who used the Delphi method and evaluated information from all of the imaging modalities concurrently. Five observers assessed all images for the presence or absence of crestal bone loss using a five-point confidence scale. Receiver operating characteristic curves were generated, and calculated areas (Az) were analyzed by means of analysis of variance. RESULTS: The expert panel determined that of 106 crestal areas, 48 were disease free and 58 exhibited bone loss greater than 2 mm apical to the cemento-enamel junction. Analysis of variance of observer Az scores showed significant differences among readers (p < 0.001) and among readings (p = 0.027), but not among modalities (p = 0.435). Mean Az values for the different modalities were as follows: Sidexis, 0.70; enhanced Sidexis, 0.71; Ektaspeed Plus films, 0.735. CONCLUSION: The Sidexis digital imaging system was not significantly different from Ektaspeed Plus film for crestal bone evaluation in this in vitro study.

Alveolar Bone Loss↗

PubMed1999

The specialist breast care nurse: an evolving role.

The role of the specialist breast care nurse has not previously been described in the Australian context. A study was undertaken, utilising the Delphi technique and focus group interviews to determine the key elements of the role and to describe how these role elements are enacted by the nurses incumbent in these positions in six Australian states. Three rounds of questionnaires to 16 expert nurses established a consensus view as to the essential elements of the specialist breast care nurse's role. The 11 role elements that became significant during analysis of these data were: specialist nurse, supporter, educator, counsellor, adviser, team member, resource person, caregiver, public advocate, manager and researcher. Focus groups were held with nurses from each state and the findings allowed enhancement of the data from the questionnaires. Analysis of the interview data allowed a fuller description of how the nurses actualised their role. This data showed that the specialist breast care nurse co-ordinated the care of the woman and her family during the breast cancer journey. Integral to the role was the support for the woman and her family. It is concluded that in order to perform successfully in the role nurses require specialist education in supportive care, counselling, pathology and treatment of breast cancer, a broad knowledge of oncology nursing, management, research and teaching techniques.

Attitude of Health Personnel↗

PubMed2000

Research needs and priorities in health informatics.

A Delphi study was accomplished on the topic "what is needed to implement the information society within healthcare? and which research topics should be given higher priority than other topics to achieve the desired evolution?", involving 29 international experts. The study comprised of four phases, (I) a brainstorming phase based on a open question; (II) an evaluation phase for mutual commenting; (III) a feedback phase allowing corrections/extensions; and (IV) a phase collecting the ratings of individual issues within a questionnaire synthesised from the previous phases. A total of 110 research items and 58 supplementary barriers were raised, divided into 14 topics grouped according to homogeneity. The emphasised research topics are business process re-engineering, the electronic patient record and connected inter-operating systems, (support for) evidence-based medicine and clinical guidelines, and education. Issues inherent to the healthcare domain often are the kernel of the research recommended. Similarly, methods and 'people'-issues are strongly emphasised among the research issues in general and among those for which the experts' joint opinion was rated as statistically significant. In contrast, only a minority of the research issues emphasised was related to technical issues.

Delphi Technique↗

PubMed2002

Minimum data set development: air transport time-related terms.

The purpose of this research was to identify, name and define a set of concepts to describe specific times and time intervals relevant to patient transport by helicopter. A list of 206 potential terms was identified from 96 patient records. A purposive sample of experts representing nurses, physicians, paramedics, pilots and communication specialists involved in air transport was selected to participate in a five-round Delphi study conducted by email. A set of 19 concepts were identified and defined. Fifteen of the terms were specific times, such as Time of Call, Depart Base and Arrive Location. Four of the terms were intervals, such as Ground Time or Transport Time.

Air Ambulances↗