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PubMed2006

The development of an evaluation questionnaire for the Newcastle Crisis Assessment and Home Treatment Service: finding a way to include the voices of service users.

The views of users of services have traditionally been sought through the use of 'patient satisfaction' surveys. Because such surveys are often devised by service providers there are concerns that their use as evaluation tools may be flawed due to issues of power and passivity, and that they do not represent active involvement by service users in the feedback loop. The Newcastle Crisis Assessment and Treatment Service offers treatment at home to people in mental health crisis who would otherwise be admitted to hospital. This article reports on the process of inviting previous users of a home treatment service to give their views about what was most important to them about receiving the service. A participatory research approach combining a two-stage modified Delphi study and semi-structured interviews conducted by service user interviewers were employed to gather rich data to inform the construction of a service evaluation questionnaire. The questionnaire is now in routine use for every person who is in receipt of treatment at home. The feedback obtained from the questionnaire will be used to shape and refine the service provided by the team. As a 'live' document through use and feedback, the questionnaire will continue to evolve in order to retain its sensitivity and relevance.

Attitude to Health↗

PubMed2004

Clinical indicators as measures of mental health nursing standards of practice in New Zealand.

This paper discusses the utility of Consumer Notes Clinical Indicators (CNCI) as a means to monitor mental health nursing clinical practice against the Australian and New Zealand College of Mental Health Nurses' (ANZCMHN) Standards of Practice for mental health nursing in New Zealand. CNCI are statements describing pivotal mental health nursing behaviours for which evidence can be found in the nurses' case notes. This paper presents 25 valid and reliable CNCI that can be used to monitor mental health nursing practice against the ANZCMHN's Standards of Practice for mental health nursing in New Zealand. The bicultural clinical indicators were generated in focus groups of Maori and non-Maori mental health nurses, prioritized in a three-round reactive Delphi survey of expert mental health nurses and consumers, pilot tested, and applied in a national field study. This paper reports the development and validation of the CNCI, for which achievement is assessed by an audit of the nursing documentation in consumer case notes. The CNCI were tested in a national field study of 327 sets of consumer case notes at 11 District Health Board sites. The results of the national field study show wide variation in occurrence of individual indicators, particularly in the areas of informed consent, information about legal rights, and provision of culturally safe and recovery-focused care. We discuss the implications of using the CNCI to assess the professional accountability of mental health nurses to provide quality care. Recommendations are made regarding the application of the clinical indicators and future research required, determining appropriate benchmarks for quality practice. The CNCI could be adapted for application in other mental health nursing and other mental health professional clinical settings.

Clinical Competence↗

PubMed1996

Clinical research priorities in oncology nursing: an Australian perspective.

The aims of the research project were to identify areas for research in oncology nursing that have potential for improvement in patient care and to advise about nursing-research policy and priorities that have relevance to areas of patients' needs. Research participants included 10 Clinical Nurse Consultants (CNC) representing 10 area health authorities in New South Wales, Australia. The Delphi method was used to obtain the most reliable consensus of the specialist nurses, and more than 31 high priorities were identified. Quality of life and symptom management emerged as the top two priority categories in the study. The findings of the study provide direction for clinical nursing research in oncology.

Adult↗

PubMed2002

Undergraduate public health education: a workforce perspective.

OBJECTIVE: To describe the career paths of students who majored in public health at the undergraduate level and to assess the skills and knowledge these graduates believed were most useful to them in the public health workforce. METHOD: A telephone survey was conducted of all graduates from Adelaide University's Bachelor of Health Sciences degree from 1992-99 who had majored in public health (124 graduates). RESULTS: The response rate to the graduate survey was 71%. Using the definition of public health functions from the National Delphi Study on Public Health Functions to delineate the public health workforce, 59% of respondents were employed in public health. Graduates working in public health valued generic skills such as communication and collaboration more highly than more specific public health skills and knowledge areas. However, they also believed their undergraduate course would have been improved by a more practical orientation. CONCLUSIONS: A high proportion of graduates from this generalist degree who major in public health find employment in the public health workforce. They greatly value the generic skills associated with their undergraduate public health education and believe their entry into the workforce would have been further facilitated by stronger links between their academic program and the working environment of public health professionals. IMPLICATIONS: Studies of workforce training programs in public health must differentiate between the educational needs of undergraduate and postgraduate students. In particular, strategies need to be developed to provide stronger links between undergraduate students and the public health workforce.

Adult↗

PubMed2006

Recommendations for the use of etanercept in psoriasis: a European dermatology expert group consensus.

BACKGROUND: Psoriasis is a chronic, inflammatory skin disorder that has a significant impact on quality of life and, particularly in moderate to severe cases, adversely affects the patient's overall health and well-being. Biological treatments, such as etanercept, are being widely adopted across Europe for treatment of moderate to severe psoriasis due to favourable safety and efficacy profiles. The increase in usage, combined with a growing body of clinical evidence, has identified a need to clarify the best use of etanercept within its current treatment label. OBJECTIVE: To prepare a series of recommendations agreed by an expert group of dermatologists, relating to the most effective use of etanercept for psoriasis in Europe, within the product license. METHODS: An expert panel of dermatologists from across Europe completed a Delphi survey to address the current use of etanercept in psoriasis in Europe. In June 2005 the results were presented to the expert panel at their nominal group meeting, and a consensus was agreed. RESULTS: It was recommended that, where possible, patients are initiated on the 50 mg twice-weekly (BIW) dose. Etanercept should be given until remission is achieved (maximum 24 weeks) and retreatment should be initiated according to the physician's judgement. Before commencing treatment, contraindications, such as infection or previous malignancy (within 5 years), should be ruled out. CONCLUSIONS: The consensus presented herein provides valuable clarification of use of etanercept according to the label, which may have wider implications relating to the use of all biological therapies in psoriasis.

Adolescent↗

PubMed1997

Development and reliability of a system to classify gross motor function in children with cerebral palsy.

To address the need for a standardized system to classify the gross motor function of children with cerebral palsy, the authors developed a five-level classification system analogous to the staging and grading systems used in medicine. Nominal group process and Delphi survey consensus methods were used to examine content validity and revise the classification system until consensus among 48 experts (physical therapists, occupational therapists, and developmental pediatricians with expertise in cerebral palsy) was achieved. Interrater reliability (kappa) was 0.55 for children less than 2 years of age and 0.75 for children 2 to 12 years of age. The classification system has application for clinical practice, research, teaching, and administration.

Activities of Daily Living↗

PubMed2005

A comparison of clinically important differences in health-related quality of life for patients with chronic lung disease, asthma, or heart disease.

OBJECTIVE: On the eight scales of the Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36), Version 2, we compared the clinically important difference (CID) thresholds for change over time developed by three separate expert panels of physicians with experience in quality of life assessment among patients with chronic obstructive pulmonary disease (COPD), asthma, and heart disease. STUDY DESIGN: We used a modified Delphi technique combined with a face-to-face panel meeting within each disease to organize and conduct the consensus process among the expert panelists, who were familiar with the assessment and evaluations of health-related quality of life (HRQL) measures among patients with the panel-specific disease. PRINCIPAL FINDINGS: Each of the expert panels first determined the magnitude of the smallest numerically possible change on each SF-36 scale, referred to as a state change, and then built their CIDs from this metric. All three panels attained consensus on the scale changes that constituted small, moderate, and large clinically important SF-36 change scores. The CIDs established by the heart disease panel were generally greater than the CIDs agreed on by the asthma and COPD panels. CONCLUSIONS: These panel-derived thresholds reflect possible differences in disease management among the represented panel-specific diseases, and are all greater than the minimal CID thresholds previously developed for the SF-36 scales among patients with arthritis. If confirmed among patients with the relevant diseases and those patients' physicians, these disease-specific CIDs could assist both researchers and practicing clinicians in the use and interpretation of HRQL changes over time.

Asthma↗

PubMed1993

Vision for the future of public health nursing: a case for primary health care.

Canada has embraced the goal of the World Health Organization to achieve health for all. This has created a paradigm shift from a focus on direct care to include health promotion and community development, consistent with a primary health care approach. Nevertheless, a clearly articulated vision for the role of public health nurses (PHNs) is lacking. Despite the fact that PHNs make up the largest group of health care workers in the community, their collective opinions and ideas regarding their own practice are seldom sought in a systematic manner. We conducted a survey of public health nurses in British Columbia. Using a two-wave Delphi approach, PHNs were asked to define issues for the future of public health nursing, and to state publicly their preferences for change and transformation. The responses were rank ordered, analyzed, and compared with recent nursing and health care literature to interpret their content. The PHNs' visions for tomorrow agree with concepts of primary health care and community development, and have implications for community health nursing's practice and education.

Attitude of Health Personnel↗

PubMed1998

An economic appraisal of carbamazepine, lamotrigine, phenytoin and valproate as initial treatment in adults with newly diagnosed epilepsy.

We undertook an economic appraisal of four drugs used in monotherapy during the first 2 years of treatment for newly diagnosed patients with epilepsy: carbamazepine (CBZ), lamotrigine (LTG), phenytoin (PHT), and valproate (VPA). We adopted the cost-minimization model because, although no single trial compares all four drugs directly, the clinical trials comparing two or more of these drugs in newly diagnosed cases show no significant difference in efficacy between the drugs in terms of seizure frequency. Considered in the cost analyses were frequency of side effects, retention rates, medical consultations, inpatient and accident and emergency costs, laboratory investigations, and drug changes. A Delphi panel provided the treatment pathways, including frequency of clinical consultations, second-line monotherapy, and side-effects management. A sensitivity analysis was performed, varying the assumptions on which the calculations were based. Analysis was completed for a prospective, intention-to-treat perspective and also for those patients continuing the initial drug. The direct medical costs of 2-years therapy (intention-to-treat analysis) calculated for each trial were pound sterling 795-829 for CBZ, pound sterling 1,525-2,076 for LTG, pound sterling 736-768 for PHT, and pound sterling 868-884 for VPA. A sensitivity analysis provided similar relative estimates. We found that LTG for newly diagnosed patients is significantly more expensive in direct health service costs incurred. This analysis incorporated seizure control, side effects, and tolerability. We recommend that a similar type of analysis be considered as part of all clinical trials of antiepileptic drugs in which efficacy of outcome is similar as a guide to assess optimal cost effectiveness.

Adult↗

PubMedDate not supplied

Identifying priorities for prepared childbirth research.

Priorities for research on prepared childbirth were identified by means of a statewide Delphi Study. Sample groups of childbirth educators and maternity nurses formulated research topics and set priorities among the topics. Overall, 50 items were specified in four categories: Prenatal Education/Preparation, Labor and Delivery (normal), Postpartum, and Complications. Data were analyzed to identify priorities in each category and to determine the levels of consensus among samples. The need for research on specific areas of prepared childbirth, as perceived by these sample groups, is reported. Although a high level of consensus is apparent, interesting differences emerged.

Delivery, Obstetric↗

PubMedDate not supplied

Identifying labor support actions of intrapartum nurses.

OBJECTIVE: To identify specific nursing actions that best characterize labor support from the nurse's perspective. DESIGN: A descriptive survey design using a three-round Delphi technique was used to explore the views of intrapartum nurses in the United States related to labor support. PARTICIPANTS: Five hundred AWHONN members who identified themselves as intrapartum nurses were invited to participate in the survey. One hundred eighty-six nurses agreed to participate. Participants who submitted usable surveys in each round: round one, n = 166; round two, n = 115; and round three, n = 117. Eighty-seven nurses participated in all three rounds of the survey. RESULTS: The participants identified 55 specific nursing actions as supportive care. These interventions ranged from psychosocial support such as remaining with the mother if she is fearful to physical support measures such as position changes. The nurses clearly distinguished between supportive nursing care and the assessment and technical aspects of their job. The nurses also identified the overall goals of intrapartum nursing were to assure a safe outcome for the newborn (82.8% of participants) and for the mother (75% of participants). CONCLUSIONS: The supportive actions identified by this panel of intrapartum nurses were similar to ones identified by mothers in other studies. Nurses made a clear distinction between supportive nursing care and assessment skills or technical tasks.

Delphi Technique↗

PubMed2002

Measuring the quality of hospital-based domestic violence programs.

OBJECTIVE: To obtain consensus among a panel of experts on performance measures useful for evaluating the quality of hospital-based domestic violence (DV) programs. METHODS: The Delphi process of consensus development was used with a panel of 18 experts including DV researchers, program planners, and advocates. Three rounds were conducted over a period of six months, with each round involving the completion of a written questionnaire. Panelists were instructed to concentrate on structure and process measures of DV program performance. Health outcome measures were not considered. During each round, panelists rated (scale of 1-5) their level of agreement with each measure, in terms of the measure's usefulness for evaluating hospital-based DV programs. Data were entered into SPSS on a personal computer and frequency distributions, measures of central tendency, and variance were computed for each measure. Consensus development was defined as a reduction in the item-specific variance from one round to the next. RESULTS: A total of 37 performance measures were agreed upon. These measures fell within nine different domains of DV program activities, including: Policies and Procedures, Hospital Physical Environment, Hospital Cultural Environment, Training of Providers, Screening and Safety Assessment, Documentation, Intervention Services, Evaluation Activities, and Collaboration. CONCLUSIONS: A number of measures have been identified as useful for evaluating hospital-based DV programs. Use of these measures should assist researchers, program planners, and administrators in assessing the quality of hospital-based DV programs.

Consensus↗

PubMed2006

The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus.

OBJECTIVES: A globally acceptable definition and classification of gastroesophageal reflux disease (GERD) is desirable for research and clinical practice. The aim of this initiative was to develop a consensus definition and classification that would be useful for patients, physicians, and regulatory agencies. METHODS: A modified Delphi process was employed to reach consensus using repeated iterative voting. A series of statements was developed by a working group of five experts after a systematic review of the literature in three databases (Embase, Cochrane trials register, Medline). Over a period of 2 yr, the statements were developed, modified, and approved through four rounds of voting. The voting group consisted of 44 experts from 18 countries. The final vote was conducted on a 6-point scale and consensus was defined a priori as agreement by two-thirds of the participants. RESULTS: The level of agreement strengthened throughout the process with two-thirds of the participants agreeing with 86%, 88%, 94%, and 100% of statements at each vote, respectively. At the final vote, 94% of the final 51 statements were approved by 90% of the Consensus Group, and 90% of statements were accepted with strong agreement or minor reservation. GERD was defined as a condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications. The disease was subclassified into esophageal and extraesophageal syndromes. Novel aspects of the new definition include a patient-centered approach that is independent of endoscopic findings, subclassification of the disease into discrete syndromes, and the recognition of laryngitis, cough, asthma, and dental erosions as possible GERD syndromes. It also proposes a new definition for suspected and proven Barrett's esophagus. CONCLUSIONS: Evidence-based global consensus definitions are possible despite differences in terminology and language, prevalence, and manifestations of the disease in different countries. A global consensus definition for GERD may simplify disease management, allow collaborative research, and make studies more generalizable, assisting patients, physicians, and regulatory agencies.

Delphi Technique↗

PubMed2006

An introductory clinical core course in psychiatric management: an innovative lifespan course blending all nurse practitioner majors.

TOPIC: The prevalence of anxiety, depression, substance abuse, and suicidal ideation is significant in primary care settings across the country. Nonpsychiatric nurse practitioners must be able to recognize symptoms of common psychiatric disorders, know how to treat less complex mental illnesses, and know when to refer to psychiatric mental health nurse practitioners (PMHNPs). PURPOSE: This article describes the course content, assignments, and teaching strategies used in a clinical core course in the nurse practitioner (NP) curriculum that is required for all NP majors at the University of Texas at Arlington. Psychiatric Management for Advanced Practice provides the foundation for later PMHNP major specific clinical courses. SOURCES: Development of the course content was based on NONPF Domains and Competencies for the NP, input from graduate NP faculty using a modified Delphi approach, NP student feedback, review of curriculum from other schools, and review of the literature on depression, suicide, anxiety, and substance abuse disorders in primary care settings. CONCLUSIONS: Since 1999, students from the eight different NP programs at the University of Texas at Arlington have been required to take this course. Student, faculty, and graduate feedback about this course have been consistently positive. Many NP students comment on feeling much more comfortable assessing for depression, suicide, and substance use.

Attitude of Health Personnel↗

PubMedDate not supplied

Classification of nursing interventions for care of the integument.

The Classification of Nursing Interventions research team at The University of Iowa, College of Nursing is building a taxonomy of nursing interventions that will include all of the direct care treatment activities that nurses perform on behalf of patients. This report describes the study in which 12 nursing interventions and their associated activities for care of the integument were extracted from a large database and validated through a two-round Delphi survey. Using an adaptation of Fehring's model for determining diagnostic content validity of nursing diagnoses, a definition, critical activities, and supporting activities were developed for each of the following interventions: Bathing, Bedrest Care, Hair Care, Nail Care, Oral Health Maintenance, Oral Health Promotion, Oral Health Restoration, Positioning, Pressure Management, Skin Care--Topical Treatments, Skin Surveillance, and Wound Care. Further research is needed to validate supporting activities and to continue classifying interventions and activities that nurses use in treating impaired skin integrity (potential and actual) and altered oral mucous membrane integrity (potential and actual).

Delphi Technique↗

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

Risk for suicide and risk for violence: a case for separating the current violence diagnoses.

PURPOSE: To identify accurate descriptive terms for risk for violence and risk for suicide and to provide operational definitions for these terms METHODS: The Delphi technique, with two rounds, was used to differentiate the operational definitions that represent risk for suicide from those that represent risk for violence. The expert panel consisted of 23 healthcare professionals with a minimum of a master's degree. In addition to the expert panel, a control group (N = 11) participated to assess content validity. FINDINGS: Thirty-six definitions were agreed upon for suicide, 39 for violence. CONCLUSIONS: These definitions represent the basic distinctions between the two behavioral manifestations.

Adult↗

PubMedDate not supplied

Toward an unequivocal definition and classification of patient outcomes.

PURPOSE: To determine the extent possible of developing an unequivocal formulation of a conceptual, structural, and contextual definition of "patient outcomes," and the possibility of coming to an agreement on the criteria for classification of patient outcomes. METHODS: An international Delphi survey of 33 experts. FINDINGS: A conceptual, structural, and contextual definition of patient outcomes and priorities for the characteristics of patient outcome classification. CONCLUSIONS: The authors recommend the unequivocalness of nursing terminology, not only for reasons of effectiveness and efficiency, but also to clarify the nursing vocabulary for epistemological reasons.

Attitude of Health Personnel↗