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PubMedDate not supplied

Persistent vegetative state: which sensory-motor variables should the physiotherapist measure?

This study used a modified Delphi technique to establish a list of core items which should be included in the measurement, by the physical therapist, of sensory-motor capacities of persons in a persistent vegetative state. Twenty-eight physical therapists with a mean of 5.9 years of experience working with this clientele participated in the study and identified 105 items as being important in the evaluation of the PVS patient (Round I). The study planning committee reduced these to 20 categories and asked the therapists to rate each category of items (a 5-point scale) as to it's importance (Round II). Physiotherapists identified 14 variables as being 'extremely' or 'very important' to include in such an evaluation. These included: tonus, voluntary movement on request, postural reactions, passive range of motion, tolerance to verticalization and postural status. These results are being used to develop a quantitative assessment instrument to be used by the physical therapist working with the PVS patient.

Arousal↗

PubMed1996

Nasal smear eosinophilia for the diagnosis of allergic rhinitis and eosinophilic non-allergic rhinitis.

OBJECTIVE: To evaluate nasal smear eosinophilia for the diagnosis of allergic rhinitis and eosinophilic non-allergic rhinitis in general practice. DESIGN: Nasal smear eosinophilia was assessed and compared with 'consensus diagnoses' made by three experts in a modified Delphi method. SETTING: Nineteen general practices in The Netherlands. SUBJECTS: 363 consecutive patients aged 12 years or over who visited their general practitioner because of chronic or recurrent nasal symptoms between 1 March 1990 and 1 March 1991. MAIN OUTCOME MEASURES: The predictive value of nasal smear eosinophilia for allergic rhinitis; the prevalence of eosinophilic non-allergic rhinitis. RESULTS: The positive predictive value of nasal smear eosinophilia (> or = 10% eosinophils) for allergic rhinitis was 30/37 = 81% (95% confidence interval (CI): 65-92%), the negative predictive value 172/312 = 55% (95% CI: 50-61%). Addition of the result of nasal smear eosinophilia to the information that was already obtained from the medical history resulted in a significant but very small improvement in the discrimination between patients with and without allergic rhinitis. The prevalence of eosinophilic non-allergic rhinitis was 7/349 = 2.0% (95% CI: 0.8-4.1%). CONCLUSION: Nasal smear eosinophilia contributes significantly to the diagnosis of allergic rhinitis; however, this contribution is very small and considered clinically irrelevant. Eosinophilic non-allergic rhinitis has a low prevalence; identifying this disorder is of minor importance. In conclusion, nasal smear eosinophilia is not recommended for use in general practice.

Adolescent↗

PubMed1993

Perceived client and program moderators of successful therapeutic community treatment for drug addiction.

Research examining moderators of therapeutic community treatment outcomes has tended to emphasize the importance of length of stay in programs. To this extent the research literature implies a causal role for treatment in the determination of treatment outcomes. Using the Delphi technique, a panel of residents, staff members, and other drug treatment agency staff involved with the Odyssey House therapeutic community in Melbourne were surveyed regarding their perceptions of factors moderating successful treatment in this program. Examination of the perceptions of those involved with the delivery of therapeutic community treatment suggested a strong respect for the importance of client motivational factors in the determination of treatment outcomes. It is suggested that future research in this area could profitably focus on attempts to quantify the separate contribution of treatment and nontreatment factors in explaining treatment outcomes.

Adolescent↗

PubMed1998

Opioid toxicity recurrence after an initial response to naloxone.

OBJECTIVE: To determine the frequency and potential predictors of opioid toxicity recurrence after a response to naloxone in adult Emergency Department patients. METHODS: A retrospective case-control study of naloxone-treated patients with opioid toxicity over an 8-year period. Both the patient response to naloxone and recurrence of opioid toxicity was determined by an expert Delphi Panel. The frequency of opioid toxicity recurrence was compared by the duration of opioid effect, the route of opioid exposure, and the presence of other CNS depressant drugs. RESULTS: Ninety of 221 (41%) cases with a discharge diagnosis of opioid toxicity were treated with naloxone; six patients were excluded because of a lack of toxicity. There was a response to naloxone in 50% of the 84 cases, and recurrence of toxicity in 31% (95% CI 17-45%) of naloxone responders. The most common opioids were codeine, heroin, propoxyphene, and oxycodone/hydrocodone. Recurrence of toxicity was more common with long-acting opioids (p = 0.04), and was not associated with the route of opioid exposure (p = 0.42), or presence of ethanol and other CNS depressants (p > or = 0.87). CONCLUSION: Opioid toxicity recurrence after a response to naloxone occurred in approximately 1/3 of adult Emergency Department opioid overdose cases. Recurrence was more common with long-acting opioids and was not associated with the route of opioid exposure. Other clinically useful predictors of toxicity recurrence were not identified.

Administration, Oral↗

PubMedDate not supplied

Australian nurse educators identify gaps in expert practice.

In Australia, nurses face a double-barreled challenge to their role. With the rapid adoption of new health care technologies coupled with increasing economic constraints, they find themselves "doing more with less." In this context of continuous change, it is useful to determine what expert nurse clinicians deem the most essential skills, attitudes and knowledge required for practice in complex technological environments. Separate panels of 28 educators and 43 cardiac nurse clinicians participated in a national Delphi study rating the importance to the nursing role of 107 items drawn from the international literature on expert practice and technology. Indicating the importance of each item in both the "real" and "ideal" worlds of practice, educators identified 58 items where they felt actual practice was substantially far from the ideal. For 16 of these items relating to empowerment of patients, nursing research, and technology policy, the educators rated clinical behavior below the median of the real world scale, indicating substandard performance of a role or inadequate assimilation of a concept. The implications for the definition of expert practice and for curricula development are discussed.

Delphi Technique↗

PubMed2005

Assessing pain as a fifth vital sign in long-term care facilities: Recommendations from the field.

In long-term care facilities, pain management is complex because dementia, delirium, and other reasons for residents' altered communication ability are a significant barrier to pain assessment. The purpose of this study was to explore the status of implementation of pain as a fifth vital sign in a sample of long-term care facilities. A three-round Delphi survey was used to obtain consensus from personnel in 60 long-term care facilities in NY State. Findings are presented in terms of recommendations related to pain criteria, assessment methods, frequency of pain assessment, responsibility for pain assessment, monitoring strategies, education, documentation, and pain management education. The results of this study highlight many important considerations in the treatment of pain as a fifth vital sign in long-term care facilities. Evidence-based practice will be facilitated by further research related to underexplored aspects of pain assessment and management, and further attention to care delivery systems that support continued knowledge acquisition and the implementation of best practices.

Aged↗

PubMed1985

Defining scholarly activity in nursing education.

In an attempt to address the question of what activities should be considered scholarly, thereby warranting their inclusion in a nursing faculty evaluation model, a study was undertaken which surveyed all National League for Nursing accredited baccalaureate educational programs. The items in the instrument were generated utilizing the Delphi method and a pilot study established inter-respondent reliability. A response rate of 73% was attained. Scholarly activity was considered highly important in evaluation for promotion and tenure in over 50% of the schools. There were distinct differences in the activities deemed scholarly when respondents were broken down into categories such as size and type of institution and the existence or non-existence of graduate nursing programs in the same institution.

Colorado↗

PubMed1987

Research in nursing education: assumptions and priorities.

The purposes of this study were: to identify assumptions about the nature of research in nursing education, and to identify and rank order critical research questions regarding nursing education. The Delphi survey technique was used with 121 nurse educators responding to three survey rounds. The panel concurred with the assumptions that research in nursing education can and should meet criteria for scientific merit, should not be viewed as secondary in importance to nursing practice research, should emphasize the clinical nature of nursing, and needs to be less fragmented. Priorities for research included the following topics: integration of research findings into nursing curricula, development of problem solving skills, approaches to clinical teaching, and level of practice of graduates of different basic preparations.

Clinical Competence↗

PubMed1988

Self-evaluation and its relationship to clinical evaluation.

An exploratory study was undertaken in a three-year nursing diploma program to determine instructor and student perceptions of self-evaluation (SE) and its relationship to clinical evaluation. A cross-section of instructors (n = 9) participated in three rounds of a Delphi survey. From this validated data base a questionnaire was developed and distributed to a stratified sample of 145 students. Combined results were then analyzed and compared. Results indicated that both students and instructors perceive self-evaluation more positively than negatively and they see the main purpose as providing direction for learning. Contrary to the literature and perceptions of surveyed instructors, students did not perceive self-evaluation as a factor in promotion of professional growth. Although students value a participatory role in clinical evaluation, the process of self-evaluation generates anxiety and underrating of performance. The authors conclude that self-evaluation is a developmental skill requiring guidelines and practice, and offer recommendations for its use.

Alberta↗

PubMed1995

Education and practice collaboration: a strategy for curriculum development.

Five schools of nursing in British Columbia formed a collaborative partnership in 1989; four represented diploma programs, and one a post-RN program. Their partnership benefited each in the development of a baccalaureate nursing curriculum. Committed to the principle of a curriculum being driven by practice, rather than the reverse, the collaborative partners employed a variety of strategies to include nurses from practice in the development of the curriculum. One strategy used by the partnership was a Delphi survey of nurses in practice. This article describes the results of this survey and their implications for nursing curricula.

British Columbia↗

PubMed2000

A consensus statement on critical thinking in nursing.

The purpose of this study was to define critical thinking in nursing. A Delphi technique with 5 rounds of input was used to achieve this purpose. An international panel of expert nurses from nine countries: Brazil, Canada, England, Iceland, Japan, Korea, Netherlands, Thailand, and 23 states in the U.S. participated in this study between 1995 and 1998. A consensus definition (statement) of critical thinking in nursing was achieved. The panel also identified and defined 10 habits of the mind (affective components) and 7 skills (cognitive components) of critical thinking in nursing. The habits of the mind of critical thinking in nursing included: confidence, contextual perspective, creativity, flexibility, inquisitiveness, intellectual integrity, intuition, open-mindedness, perseverance, and reflection. Skills of critical thinking in nursing included: analyzing, applying standards, discriminating, information seeking, logical reasoning, predicting and transforming knowledge. These findings can be used by practitioners, educators and researchers to advance understanding of the essential role of critical thinking in nursing.

Affect↗

PubMed1989

[A survey on elements of an effective hospital infection control program for Korea].

The main purpose of this survey was to identify for elements of an effective hospital infection control program for Korea. Nurses and doctors who had participated in an education program for infection control or were responsible for hospital infection control were selected as data informers. The data were collected from 51 subjects by employing a Delphi technique in a series of three rounds from September 1, 1987, to March 31, 1988. In each round the responses to questionnaires were analyzed and the results were communicated back to the individuals. Finally 32 elements of effective hospital infection control program were reduced to 10 elements. 10 elements are as follows; 1) Hospital administrator's knowledge of importance and necessity for HIC (hospital infection control) 2) Supporting HIC administratively 3) Constituting infection control committee and role of ICC 4) Developing an educational program and providing a work manual for the hospital infection control staff 5) Educating and informing medical staff about hospital infection 6) Surveillance for hospital infection 7) Developing patient care technique 8) Controlling the hospital environment 9) Executing regular health examinations of all medical staff 10) Recruiting the medical staff sufficiently Three rankings of response rate about 32 elements are as follows: 1) Hiring a full time staff member for the HIC (66%) 2) Establishing a hospital policy and standards for the HIC (66%) 3) Activating the infection control committee and taking administrative action to support the ICC (63%) In addition the rankings of importance score by Likert 5 scale are as follows: 1) Washing hands scrupulously (4.88) 2) Nurses participation as key members of the ICC (4.75) 3) Reviewing and evaluating all ongoing aseptic techniques (4.69) In conclusion, first of all, administrative support must be given to hiring a full time staff member and to organization of infection control committee for the HIC in Korea.

Cross Infection↗

PubMed1995

Views of leading nurse educators regarding the comprehensive basic nursing programme.

This article describes a Delphi survey amongst nurse educators in South Africa. The aim was to describe their perceptions regarding the reasons for the comprehensive basic nursing programme (CBNP), its aims and expected outcomes. There was general agreement that the programme was necessary, and that it was designed mainly to produce a nurse who could function in a comprehensive health service. Integration of information and economic arguments were also mentioned. Making available a nurse who can deliver a comprehensive service to all people, was also seen as the main aim of the programme. Independent learning, competency in a whole range of skills, the ability to function in a multidisciplinary team and high level cognitive skills were mentioned as additional aims.

Attitude of Health Personnel↗

PubMed1995

A marketing strategy for a nursing college.

The objective of this study is to explore and describe a marketing strategy for a nursing college. An explorative and descriptive research design, within the context of a nursing college and affiliated hospitals, was followed. A literature study of marketing models was undertaken and the Delphi-method was utilised to determine the contribution of marketing staff and the possible content of a marketing strategy for a nursing college. The results were utilised to describe guidelines for such a strategy, consisting of marketers/marketing agents, target market, product, price, promotional activities, place and market research. Recommendations include the planning, implementation and evaluation of strategy, inservice training for potential marketing agents, inclusion of marketing as part of the formal education of tutors and nurse managers, as well as an impact study of the scholar as the main consumer.

Advertising↗

PubMed2002

What does health literacy mean to children?

This study employed the Delphi technique to define the meaning of health literacy to children and to investigate possible ways lead to them to become health literate. According to the experts' perspectives, the meaning of health literacy to children is "to perform physical and psycho-social activities with appropriate standards; being able to interact with people; cope with necessary changes and demand reasonable autonomy so as to achieve complete physical, mental and social well-being". In order to assist children develop healthy physical, psycho-social well-being so as to demonstrate that they are health literate, parents, teachers and significant others have to support and guide the children by demonstrating good practices regarding health-related behaviors. The study serves as a reference for developing healthy childhood that leads to healthy adulthood and healthy elderly.

Age Factors↗

PubMed1999

Hospital restructuring and the changing nature of the physical therapist's role.

BACKGROUND AND PURPOSE: This study was conducted to identify role behavior changes of acute care physical therapists and changes in the organizational and professional context of hospitals following restructuring. METHODS: A Delphi technique, which involved a panel of 100 randomly selected acute care physical therapy managers, was used as the research design for this study. Responses from rounds 1 and 2 were synthesized and organized into exhaustive and mutually exclusive categories for round 3. Data obtained from round 3 were used to develop a comprehensive perspective on the changes that have occurred. RESULTS: Changed role behaviors in patient care and professional interaction, including increased emphasis on evaluation, planning, teaching, supervising, and collaboration, appeared to be extensions of unchanged role behaviors. Reported changes in the structural and professional context of physical therapy services included using critical pathways to guide care, providing services system-wide, and using educational activities and meetings to maintain a sense of community. The importance of professionalism to physical therapists' work was identified and related to specific role behavior changes. CONCLUSION AND DISCUSSION: The changing role of physical therapists in acute care hospitals includes an increased emphasis on higher-level skills in patient care and professional interaction and the continuing importance of professionalism.

Adult↗

PubMedDate not supplied

Strategic stakeholder management. First round results from 'Facing the Uncertain Future'.

Authors summarize preliminary results from the first round of a two-round modified Delphi study called "Facing the Uncertain Future." Health care experts were asked to comment on the status of the health care industry in 1994 when the study began and their predictions for change by 1999. Major findings based on the 580 responses received include: (1) the continued movement of the U.S. health care industry from a primarily private insurance industry to one in which medical groups and hospitals will be members of integrated delivery systems/networks (IDS/N); (2) the increasing dominance of the components of IDS/Ns in 1999 (components are defined as: medical practices, system hospitals, managed care organizations and IDS/Ns); and (3) the potential effects of IDS/Ns on the health care industry, including: increases in cost effectiveness, quality of administrative management and the quality of physician leadership, as well as decreases in availability of advanced medical technology and the duplication of ancillary services, facilities and equipment. The study is being conducted jointly by the Medical Group Management Association and Texas Tech University with funding from Abbott Laboratories.

Delivery of Health Care, Integrated↗

PubMed1996

Research review: Perceptions of curriculum enhancement for baccalaureate programs in health information management.

Chairs of 21 baccalaureate programs in health information management in schools of the allied health professions with membership in the Association of Schools of the Allied Health Professions were surveyed in 1994 via a three-round Delphi process to identify desired competencies for graduates beyond those required for professional accreditation and credentialing and appropriate courses to develop them. Eighteen chairs (86 percent) completed the final questionnaire. Statistical analysis, including one-sample, upper-sided mean Z tests, indicated consensus among the 18 chairs that 27 items of knowledge and skills and 13 courses are most important.

Credentialing↗