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PubMed2003

Enhancing evidence-based practice--a controlled vocabulary for nursing practice and research.

Evidence-based practice requires flexible systems for information retrieval. Search processes in electronic databases must be based on terms, which are familiar to professionals and describe accurately the problem to be solved. The paper describes the process of evolving a controlled nursing vocabulary for indexing and information retrieval purposes. The vocabulary is based on terms of the Medline thesaurus the medical subject headings (MeSH) by National Library of Medicine and the International Classification for Nursing Practice by the International Council of Nurses. The created vocabulary consists of 10 themes central to nursing domain. The content was compiled using Delphi technique. The expert panel had four rounds and at the first stage the vocabulary consists of 558 terms. The validity of the vocabulary has been tested for indexing nursing research and based on the validation the expert panel has made some changes for the hierarchy and content. The vocabulary will be added as an independent theme to the Finnish thesaurus the FinMeSH.

Clinical Nursing Research↗

PubMed1999

Validating a decision support system for anti-epileptic drug treatment. Part I: initiating anti-epileptic drug treatment.

In this contribution the validation of a prototype decision support system that implements a model of expertise for initiating anti-epileptic drug treatment is described. Since domain experts were of the opinion that prescribing was a rather straightforward process we used only one expert neurologist for knowledge elicitation. To determine the correctness of the system we intended to compare the contents of the system's prescriptions with the majority decision of three neurologists. Because of a large variation in prescribing a majority decision could not be obtained in many cases. Even a Delphi procedure did not yield a majority decision in a large number of cases. Therefore a consensus meeting was organised to discuss cases where discrepancies remained. In the process the participating neurologists formulated prescription guidelines. These guidelines were used as a reference to determine the correctness of the prescriptions of both the system and of the neurologists. The acceptability of all prescriptions for each case was rated by the two neurologists who did not write a prescription for that case. From both comparisons it could be concluded that the system was at least as good in prescribing as individual neurologists.

Adolescent↗

PubMed2003

Development of explicit criteria for total knee replacement.

OBJECTIVES: To develop and test an appropriateness of indications tool for total knee replacement (TKR) in patients with osteoarthritis. METHODS: Criteria were developed using a modified Delphi panel judgment. Another panel rated the same indications, and the 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. A classification tree was developed. RESULTS: The procedure was considered appropriate in 167 (26.8%) scenarios, and there was agreement on 112 (67.1%) of them. When the rates of the main panel were compared with those of a second panel, the result was a kappa statistic of 0.75. The test-retest kappa for the main panel was 0.78. Neither in the first case nor in the second was there an instance in which a scenario classified as appropriate shifted to inappropriate or vice versa. The regression models showed that symptomatology and radiology were the variables that explained most of the variability of appropriateness as determined by panelists. In the classification tree performed, the probability of misclassification was 3.8% with 150 scenarios, of the 156 analyzed and classified correctly. CONCLUSIONS: The previous parameters tested showed acceptable results for an evaluation tool. These results support the use of this algorithm as an aid in formulating clinical practice guidelines and to promote the appropriateness of TKR.

Algorithms↗

PubMed1999

Teaching medical ethics: a review of the literature from North American medical schools with emphasis on education.

Efforts to reform medical education have emphasized the need to formalize instruction in medical ethics. However, the discipline of medical ethics education is still searching for an acceptable identity among North American medical schools; in these schools, no real consensus exists on its definition. Medical educators are grappling with not only what to teach (content) in this regard, but also with how to teach (process) ethics to the physicians of tomorrow. A literature review focused on medical ethics education among North American medical schools reveals that instruction in ethics is considered to be vitally important for medical students. Agreement by medical educators on a possible "core curriculum" in ethics should be explored. To develop such a curriculum, "deliberative curriculum inquiry" by means of a targeted Delphi technique may be a useful methodology. However, the literature reveals that medical curricular change is notoriously slow. General implications for medical ethics education as a discipline are discussed.

Curriculum↗

PubMed1997

A human resource planning model for hospital/medical technologists: an analytic hierarchy process approach.

This paper deals with the development of a human resource planning (HRP) model for hospital laboratory personnel. External and organizational factors impacting the demand and supply of clinical laboratory personnel in an urban academic health center are identified by a Delphi process. These factors are structured into a hierarchy for the application of the Analytic Hierarchy Process (AHP). Computer software, Expert Choice, was used in model hierarchy development and judgmental elicitation process. The model result can be applicable to eliciting the perceptions, insights, and understanding of health-care decision-makers for strategic human resource planning.

Academic Medical Centers↗

PubMed1999

The identification of agreed criteria for referral following the dental inspection of children in the school setting.

AIM: To clarify the function of the school based dental inspection. OBJECTIVE: For representatives of the Community Dental Service, General Dental Service and Hospital Dental Service to identify an agreed set of criteria for the referral of children following school dental inspection. DESIGN: Qualitative research methodology used to establish a consensus for the inclusion of referral criteria following dental screening. SETTING: Ellesmere Port, Cheshire, England. MATERIALS: A Delphi technique was used to establish a consensus amongst the study participants on the inclusion of nine possible criteria for referral following dental screening. All participants scored each criterion in the range 1-9, with a score of 1 indicating that referral of individuals with the condition should definitely not take place, and a score of 9 indicating referral should definitely take place. Referral criteria were accepted only if they achieved a group median score of 7 or more, with an interquartile range of three scale points, with the lower value being no less than 7. RESULTS: Four of the nine possible criteria met the agreed group standard for inclusion: 'Sepsis', 'Caries in the secondary dentition', 'Overjet > 10 mm', and 'Registered & caries in the permanent dentition'. CONCLUSION: It is possible to agree clear criteria for the referral of children following the school dental inspection.

Child↗

PubMedDate not supplied

Creation of a neonatal end-of-life palliative care protocol.

OBJECTIVE: To create a protocol delineating the needs of patients, families, and staff necessary to provide a pain-free, dignified, family-, and staff-supported death for newborns who cannot benefit from intensive, life-extending, technological support. STUDY DESIGN: Using Internet e-mail, a Delphi study with sequential questionnaires soliciting participant response, investigator analysis, and follow-up responses from participants was conducted to build a consensus document. Institutional review was granted and respondents gave consent. Recruitment was conducted at medical, ethics, nursing, and multidisciplinary organization meetings. Synthesis of 16 palliative care/end-of-life protocols developed by regional, institutional, and parent organizations was included. Participants from 93 locations in the US and 4 abroad gave feedback to 13 questions derived from clinical experience and the literature. The data underwent four rounds of analysis with 95% retention of the 101 participants over an 18-month period. RESULTS/CONCLUSION: Specific consensus-based recommendations are presented with a description of palliative care; categories of candidates; planning and education needed to begin palliative care services; relationships between community and tertiary centers; components of optimally supported neonatal death; family care, including cultural, spiritual, and practical needs; ventilator withdrawal, including pain and symptom management; recommendations when death does not occur after cessation of life-extending interventions; family follow-up care; and necessary ongoing staff support.

Clinical Protocols↗

PubMed2003

Classifying general and specialist children's nursing competencies.

BACKGROUND: Whilst there is evidence in the literature to support the continuation of a children's nursing qualification, the distinction between generalist and specialist nursing is insufficiently comprehensive to distinguish children's nursing from other branches of nursing. AIM: To develop a definition of children's nursing and specialist children's nursing in terms of competencies as the basis for differentiating them from other forms of nursing. DESIGN: A multi-method comparative design incorporating a case study approach was used. This included a nominal group technique, focus groups, Delphi survey and semi-structured interviews. Two arms of data collection were undertaken concurrently (during 1998-2000) with children's nurses (n = 146) and specialist children's nurses (children's cancer nurses, n = 37) from a number of centres in the United Kingdom (UK). FINDINGS: The holistic competencies developed from the data exposed characteristics of knowledge, skills, abilities, values and qualities displayed in the context of professional work for both groups of nurses. A classification of competencies was developed inductively from the data by two independent researchers through the labelling, defining and ordering of competencies. The resulting hierarchy of competencies and sub-competencies illustrates relationships between children's nurses and specialist children's nurses and provides a detailed definition of children's nursing and specialist children's nursing. CONCLUSION: There is a significant common element in these two areas of nursing practice, and generalist preparation in children's nursing is the foundation of specialist children's nursing practice. Generalist knowledge and skills are expanded in specialist practice and there is also evidence of specialist practice that is beyond the scope of general nursing practice.

Clinical Competence↗

PubMed2003

Pre-operative screening: criteria for referring to anaesthetists.

Nurses assess patients pre-operatively using screening questionnaires and locally-developed protocols. Our objectives were to determine which questions might identify patients who should be seen by an anaesthetist before the day of surgery. A review of the literature and a preliminary questionnaire to establish questions to be tested was followed by a modified, two-round Delphi questionnaire to determine the level of agreement by anaesthetists. There was agreement for referring patients who gave a positive response to questions that query: restricted exercise tolerance; previous anaesthetic problems; family history of anaesthetic problem; pathology affecting neck movement; angina; arrhythmia; heart failure; asthma; epilepsy; insulin-dependent diabetes mellitus; liver disease and unspecified kidney disease. There was equivocal agreement on questions that report a myocardial infarction over one year ago, cerebrovascular accident, non insulin-dependent diabetes mellitus and thyroid disease. Nurses should use these criteria during pre-operative assessment to decide the timing of evaluation by an anaesthetist.

Anesthesiology↗

PubMed2003

Generic and specialist nursing roles in the community: an investigation of professional and lay views.

In the UK, a number of policy documents have sought to outline and clarify the role of the community nurse in the past 10 years. Furthermore, the increasing specialisation of community nursing has been the topic of much debate in the UK and Ireland. The present study aimed to investigate the perceptions of community nurses, general practitioners (GPs), members of the public, and senior strategists and policy-makers in relation to specialist and generalist nursing roles within community nursing in Northern Ireland and the Republic of Ireland. Focus groups were undertaken with community nurses (n = 38), GPs (n = 14) and public representatives (n = 8). This was followed by a two-stage Delphi investigation using self-report questionnaires with the same samples. In addition, data were collected from 34 senior policy-makers using a semi-structured interview schedule. The results uncovered a mix of views. While there was much negativity about specialisation, the participants felt that the move away from generalism was unavoidable. There was concern that specialisation, whilst welcome in some areas, would lead to role conflict, role overlap and role confusion. Findings from this study have the potential to inform the specialisation-generalism debate within and outside the UK and Ireland. Recommendations are suggested for future policy and practice.

Attitude of Health Personnel↗

PubMed1997

The establishment of current opinion within consultants in paediatric dentistry in the UK for the taking of dental radiographs of children.

There is an increasing realization that every effort should be made to minimize the exposure to ionizing radiation of patients and members of the dental team. There are, however, few published guidelines to assist the general practitioner in deciding whether or not radiographs are needed. There is even less information concerning the taking of dental radiographs of children. Using the Delphi Technique this study set out to seek a consensus amongst Consultant Paediatric Dentists (n = 36) working in the UK as to when dental radiographs should and should not be taken of children cared for within general dental services. A two-stage questionnaire was used and a response of 94% and 76% was obtained in the first and second questionnaire respectively. A consensus view was reached regarding whether or not radiographs should be taken in a series of 17 specific clinical situations.

Child↗

PubMed1995

Identifying the characteristics of optimum practice: findings from a survey of practice experts in nursing, midwifery and health visiting.

In a questionnaire survey in England of 1221 practising nurses, midwives and health visitors, 18 key characteristics of optimum practice, made up from 77 sub-item categories, were identified by respondents. Five open-ended questions asked respondents to consider various aspects of optimum practice and to comment on factors which encouraged those in practice to deliver care of the highest quality. Consensus of view was obtained through a Delphi approach. The researchers offer commentary on the implications of this research for commissioners, providers and the professions and suggest action for those concerned with the provision of health care.

Adult↗

PubMed1996

The changes in the role of the nurse teacher following the formation of links with higher education.

A national study was conducted in England over a three-year period (1991-1994) to explore the changing role of the nurse teacher. The study used multiple methods of data collection, including a modified Delphi survey and a series of telephone interviews. A wide variety of respondents (nurse teachers, midwife teachers, clinical nurses, health service managers and higher education lecturers) were included in the sample. This paper presents findings relating to the changes in the role of the nurse teacher following the formation of links with higher education. Some of the issues discussed include the difficulties related to academic status and the relationships between nurse teachers and other lecturers in higher education, changes in teaching styles and the place of student nurses within higher education. The implications for nurse teachers which stem from a closer association with higher education are explored.

Burnout, Professional↗

PubMed1997

Computer literacy in nursing: developing the information technology syllabus in nursing education.

This study has two main purposes: first, to identify and describe the computer skills required in nursing; and second, to find out what should be taught about information technology in nursing education. A three-round Delphi survey was carried out with a panel of experts representing nursing practice, nursing education, nurse students and consumers. The panel showed a consensus of opinion on 71% of the items included in the questionnaire designed for the study. The experts agreed that nurses must know how to use the computer for word-processing purposes, for accessing and using the hospital information system, and for e-mailing. Nurses must also be aware of system security and show a positive attitude towards computers. It is concluded that hospital information systems and nursing informatics should be integrated into laboratory and hospital training.

Attitude to Computers↗

PubMed1997

The clinical role of nurse teachers within a Project 2000 course framework.

This paper reports on part of a national study that was conducted over a 3-year period (1991-1994). The overall aim of the study was to explore the changing role of the nurse teacher. Multiple methods of data collection were used, including a modified Delphi survey, a case study and telephone interviews. The sample included a wide variety of respondents (nurse teachers, midwife teachers, clinical nurses, health service managers and higher education lecturers). Findings in relation to the clinical role of the nurse teacher within a Project 2000 course framework are presented. This includes the nature of the clinical role, views on linking theory and practice, and potential barriers to the nurse teacher's clinical role. The future role of nurse teachers within the clinical area is discussed and this includes suggestions for the ways in which a nurse teacher's clinical commitment could be facilitated. Issues relating to the role of lecturer/practitioner are also highlighted.

Curriculum↗

PubMed2000

Nurse-sensitive outcomes of advanced practice.

Advanced practice nurses (APNs) in the USA are registered nurses who hold masters or doctoral degrees in a specialized area of nursing. They provide advanced clinical care to clients, manage health care systems and influence health care decision-making through expert clinical reasoning and research and theory-based action. APN impact on health care outcomes is supported by studies using physician-focused indicators, although a few studies have identified several that are sensitive to or reflective of advanced practice nursing. A modified Delphi survey was conducted during May 1997-December 1998 to determine the outcome indicators APNs recommend for use in measuring their effect on care delivery outcomes. A convenience sample of 66 APNs attending a statewide outcomes conference identified 27 potential outcome indicators. These indicators were included in a mailed survey sent to APNs working in Tennessee. Respondents were asked to rate each indicator for validity, sensitivity, feasibility, utility and cost. In the second round of the survey, they were asked whether or not they agreed with the rank ordering of indicators, which was determined by the means calculated from responses in the first round. The 10 highest ranked indicators were satisfaction with care delivery, symptom resolution/reduction, perception of being well cared for, compliance/adherence with treatment plan, knowledge of patients and families, trust of care provider, collaboration among care providers, frequency and type of procedures ordered and quality of life. APNs identified both direct and indirect measures of effect on care delivery outcomes. Some of these are currently used as indicators of advanced practice, but many are not. Additional research is needed to determine whether the indicators proposed are valid and sensitive to advanced practice care by nurses.

Adult↗

PubMed2001

Intuition: an important tool in the practice of nursing.

AIM: The aim of the study reported here was to evaluate the role of intuition, to examine nurses' understanding of intuition and their perceptions of their use of intuition, and to assess the impact of intuition on nursing practice. BACKGROUND: When we read the dictionary definition of intuition, we have a sense of the meaning but there is also a sense of something still not quite defined. Yet we instinctively know what intuition is. That is, of course, an example of intuition in itself: an understanding of the concept based on our feelings, knowledge and experience. Intuition is a concept neither clearly articulated nor adequately theorized in nursing. There is evidence to suggest that practising nurses use intuition and that its use can change outcomes for patients. Because of its influence on patient well being, it needs to be recognized as an important tool in the practice of nursing. The very nature of intuition determines that there will be little agreement on a precise definition and little empirical evidence to support its existence or worth. Neither of these issues detracts from the fact that intuition is an important part of nursing. METHODS: Grounded theory was used as the overarching theoretical and methodological framework for this study. Using focus group interviews and the Delphi survey technique, data were collected from 262 Registered Nurses who volunteered to take part in the study. FINDINGS: The theory that emerged from this study provides nurses with a way of articulating their understanding of intuition and their perceptions of its use in nursing practice. CONCLUSIONS: Intuition is not some mystical power that appears from nowhere, with no rational explanation or basis. The findings from this study show that it is a product of the synergy that occurs as a result of the interaction of a number of factors.

Attitude of Health Personnel↗

PubMed2003

Critical care nursing research priorities in Hong Kong.

BACKGROUND: Research is vital to nursing practice especially in an area such as critical care, where nursing practice continues to increase in complexity and nurses assume greater responsibility and accountability for patient care. However, without knowledge of what are the most significant problems or questions affecting the welfare of critically ill patients in Hong Kong, nurses' research efforts may be directed to areas that are not of highest priority in today's climate of decreasing health care resources and changing health care provision. AIM: To identify and prioritize research questions of importance to Hong Kong critical care nurses. METHOD: A three-round Delphi technique was used to solicit, identify and prioritize problems for critical care nursing research. RESULTS: Respondents who completed the third round had a mean of 6.25 years of critical care nursing experience. Ninety-one research topics were ranked important or extremely important. Twenty-seven research priorities ranked as extremely important included topics relating to patient care, family care, nursing, technology, alternative interventions, and illness prevention/health promotion research domains. Thirteen research topics were ranked as least important. None of the participants ranked research topics as not important. STUDY LIMITATIONS: Only full-time active members of the Hong Kong Association of Critical Care Nurses participated in this study and they may not necessarily represent the views of all critical care nurses in Hong Kong. In addition, no attempts were made to compare research priorities between specialty groups of nurses. CONCLUSION: With the re-structuring of Hong Kong's health care system, critical care nurses are expected to take an active role in advancing the profession, and to be accountable for improving patient outcomes by use of effective, evidence-based interventions. The research priorities identified in this study may provide impetus and direction for critical care nursing research initiatives.

Adult↗