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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↗

PubMed2006

Identification of intervention categories for physical therapy, based on the international classification of functioning, disability and health: a Delphi exercise.

BACKGROUND AND PURPOSE: Disability or limitations in human functioning are universal experiences that concern all people. Physical therapists aim to improve functioning and prevent disability. With the approval of the new International Classification of Functioning, Disability and Health (ICF), we can now rely on a globally recognized framework and classification to be used in different health care situations by all health care professionals in multidisciplinary teams. The objective of this study was to identify ICF categories that describe the most relevant and common patient problems managed by physical therapists in acute, rehabilitation, and community health care situations taking into account 3 major groups of health conditions: musculoskeletal, neurological, and internal. SUBJECTS: The subjects were physical therapists who were identified as possible participants by the heads of physical therapy departments who were members of the Swiss Association of Physical Therapy Department Heads or who were recruited from the membership of the Swiss Association of Physiotherapy. METHODS: A consensus-building, 3-round, electronic-mail survey with 9 groups of physical therapists was conducted using the Delphi technique. RESULTS: Two hundred sixty-three physical therapists participated in at least one round of the Delphi exercise. They had consensus levels of 80% or higher for categories in all ICF components (Body Functions, Body Structures, Activities and Participation, and Environmental Factors 1 and 2). DISCUSSION AND CONCLUSION: This study is a first step toward identifying a list of intervention categories relevant for physical therapy according to the ICF. The ICF, designed as a common language for multidisciplinary use, is also a very helpful framework for defining the core competence for the physical therapy profession.

Delphi Technique↗

PubMed1995

The development of the Australian Basic Intensive Care Knowledge Test.

The Basic knowledge Assessment Tool (BKAT), a test developed in the United States, has been presented as a valid and reliable test of basic knowledge for critical care nursing. However, it was necessary to determine the BKAT's validity and reliability in the Australian intensive care (IC) context. The Delphi technique, utilising a panel of eleven experts, was used to determine the content validity of the BKAT. The Delphi process resulted in the development of a test with 105 questions. These questions consist of 49 original BKAT questions, 25 original BKAT questions slightly modified, 3 original BKAT questions with major modifications and 28 new questions. A criterion group design was used to establish the modified test's reliability and decision validity. Item analysis was undertaken using item difficulty and item discrimination indexes. The modified test was completed by 14 registered nurses with no IC experience, 18 registered nurses with intermediate IC experience and 25 registered nurses qualified as intensive care specialists. The mean score (and standard deviation) for the test for each of the respective groups was 41(9), 69(9) and 86(7). These results were significantly different (p < 0001). The reliability was established with a Cronbach Alpha coefficient of .96. The modified test is a reliable and valid measure of IC basic knowledge and can be used as a valuable adjunct in the assessment of IC orientation programs.

Australia↗

PubMedDate not supplied

[Consensus doesn't always mean agreement: limitations of consensus methods in health services].

Taking decisions in uncertain situations has led to a high use of the consensus methods (Nominal Group Technique, Delphi Method, and Consensus Conferences) in the health services. The review made in this article shows that the appropriate use of these techniques requires a high degree of methodologic precision, especially in relation to the financer's declaration of objectives, the appropriate selection of the participants, previous realization of a synthesis of the preexistent information, the definition of the agreement degree which leads to the consensus and in the evaluation of its impact.

Centers for Disease Control and Prevention, U.S.↗

PubMed2001

[Practical clinical skills in medical education 2--internship. A Delphi survey].

INTRODUCTION: The aim of the present study was to use the Delphi technique to identify standards of quality for the curriculum of basic clinical skills in the pre-registration internship. METHOD: The Delphi method was used with a selected panel of 52 experts to set a level of competence for 213 practical clinical skills in a series of three questionnaires. RESULTS: For the pre-registration internship, the panel reached a 75% level of consensus for 80% of the basic clinical skills. A total of 47 basic clinical skills were identified (97% level of consensus) as core skills that should be mastered by the time of registration. DISCUSSION: The study suggests that further investigations should be performed to identify a core curriculum of basic clinical skills common to all pre-registration internists. In addition, a curriculum of electives should be based on the special characteristics of each training department.

Clinical Competence↗

PubMed2006

Resource consumption and management associated with monitoring of warfarin treatment in primary health care in Sweden.

BACKGROUND: Warfarin is used for the prevention and treatment of various thromboembolic complications. It is an efficacious anticoagulant, but it has a narrow therapeutic range, and regular monitoring is required to ensure therapeutic efficacy and at the same time avoid life-threatening adverse events. The objective was to assess management and resource consumption associated with patient monitoring episodes during warfarin treatment in primary health care in Sweden. METHODS: Delphi technique was used to systematically explore attitudes, demands and priorities, and to collect informed judgements related to monitoring of warfarin treatment. Two separate Delphi-panels were performed in three and two rounds, respectively, one concerning tests taken in primary health care centres, involving 34 GPs and 10 registered nurses, and one concerning tests taken in patients' homes, involving 49 district nurses. RESULTS: In the primary health care panel 10 of the 34 GPs regularly collaborated with a registered nurse. Average time for one monitoring episode was estimated to 10.1 minutes for a GP and 21.4 minutes for a nurse, when a nurse assisted a doctor. The average time for monitoring was 17.6 minutes for a GP when not assisted by a nurse. Considering all the monitoring episodes, 11.6% of patient blood samples were taken in the individual patient's home. Average time for such a monitoring episode was estimated to 88.2 minutes. Of all the visits, 8.2% were performed in vain and took on average 44.6 minutes. In both studies, approximately 20 different elements of work concerning management of patients during warfarin treatment were identified. CONCLUSION: Monitoring of patients during treatment with warfarin in primary health care in Sweden involves many elements of work, and demands large resources, especially when tests are taken in the patient's home.

Anticoagulants↗

PubMed1997

Management competencies for medical practice executives: skills, knowledge and abilities required for the future.

The purpose of this study was to obtain a consensus of opinion from a large and diverse population of experienced ambulatory health care administrators regarding the essential ambulatory health care management competencies, and their related skills, knowledge and abilities (SKA) requirements, that will be required for successful management performance in ambulatory health care delivery settings in the next five years. A literature review suggests limited research in this essential and rapidly developing area for the health care community. The research design and methods employed the Delphi technique. Three hundred and twenty (320) Fellows of the American College of Medical Practice Executives (ACMPE) were asked to respond to two rounds of a Delphi mail survey. The results indicate that the essential ambulatory management competencies could be discretely grouped into six Management Domains, each with related SKAs. The respondents rated leadership and strategic management as the most important Management Domains. The highest rated SKA emphasized interpersonal skills with the next highest SKA relating to ethical and moral dimensions. Patient care management, as well as two SKAs relating to computer skills, were rated lowest.

Ambulatory Care↗

PubMedDate not supplied

Identifying HIV/AIDS research priorities for the next millennium: a Delphi study with nurses in AIDS care.

The purpose of this study was to identify HIV/AIDS research priorities for the next millennium from the perspective of nurses in AIDS care. The study used a three-round Delphi technique, with study participants (the panel of experts) selected from the membership of the Association of Nurses in AIDS Care. In the first round of the Delphi study, 317 nurses identified more than 2,000 topics they viewed as important for overall HIV/AIDS research and for HIV/AIDS nursing research. Using qualitative analysis, 12 priority topics were generated in the overall research category and 12 priority topics in the nursing research category. In Round II of the Delphi survey, study participants ranked the 12 topics in categories (overall and nursing research priorities) identified in Round I. Finally, in Round III, the top five priority topics from Round II were prioritized in each category. The overall HIV/AIDS research topics identified were (a) HIV community-level education and prevention; (b) development of more tolerable drugs; (c) HIV prevention focusing on individual or specific group behavior; (d) vaccine development; and (e) development of new and more effective drugs. The HIV/AIDS nursing research priorities identified were (a) symptom management; (b) community-level HIV education and prevention; (c) quality of life issues in chronic HIV disease; (d) HIV prevention focusing on individual or specific group behavior; and (e) research related to adherence to drug therapy.

Acquired Immunodeficiency Syndrome↗

PubMed2005

The first images of atopic dermatitis: an attempt at retrospective diagnosis in dermatology.

BACKGROUND: Atopic dermatitis was defined in 1933. Earlier descriptions have yet not been thoroughly studied. OBJECTIVE: Our purpose was to identify the first images of atopic dermatitis among historical illustrations of skin diseases. METHODS: We posted 20 selected images on an Internet site and asked experts in pediatric dermatology to decide whether or not they represented atopic dermatitis. RESULTS: By means of the Delphi technique, a consensus could be reached for 19 of the 20 images. The experts' accuracy was good. LIMITATIONS: Thirty-one experts participated. No validated criteria were used for the selection of the images. CONCLUSION: The first representations of atopic dermatitis are engravings of skin diseases described under the names of strophulus confertus (Willan, 1796), lichen agrius (Willan, 1796), porrigo larvalis (Bateman, 1816), and eczema rubrum (Rayer, 1835). Teledermatology techniques can be reliably applied to retrospective diagnosis.

Anatomy, Artistic↗

PubMed1992

Nursing research priorities for the care of the naval hospital patient: a Delphi survey.

The purpose of this study was to identify priorities for nursing research in a naval hospital using the Delphi technique. A general objective was to provide empirically based information to guide the development of a nursing research program at a regional medical treatment facility. Via a three-round Delphi survey, priority research questions were identified for the nursing department of a naval regional medical treatment facility. A serendipitous result was the identification of nursing research priorities within a deployed naval fleet hospital.

Delphi Technique↗

PubMedDate not supplied

Assessment of computer learning needs and priorities of registered nurses practicing in hospitals.

The purpose of this study was to identify computer learning needs of practicing nurses at the bedside. Knowles' adult learning theory clearly implies that learners have a role in identifying their learning needs. Expert opinion is the second source of needs identification and complements learner input. This principle served to underpin the conceptual framework of this study. A Delphi technique was used to solicit expert opinions from nurse informaticians about the computer learning needs of practicing nurses. A 75 knowledge/skill item questionnaire was developed from the expert consensus of the Delphi and distributed to 150 registered nurses considered to be computer novices. Novices' responses were compared to the experts' responses to identify content essential for nurses to be able to use computers in their practice. Further, sequence for content delivery was postulated through the comparison of expert and novice opinion relative to the essential/nonessential nature of the content.

Clinical Competence↗

PubMedDate not supplied

Nursing research priorities for the care of the client with a gastrointestinal disorder: a Delphi survey.

The purpose of this study was to identify priorities for nursing research in the field of gastroenterology nursing using the Delphi technique. A general objective was to provide empirically based information to guide the development of a nursing research program within a specialty nursing organization focused on gastroenterology. Via a two-round Delphi survey, priority research questions were identified from a sample of the membership. Those research questions are presented as well as demographic information of the sample.

Delphi Technique↗

PubMed2005

Satisfaction with pharmacotherapy for approved and off-label indications--a Delphi study.

BACKGROUND: Prescribing for non-approved uses is widespread in the treatment of AIDS, cancer, and pediatric illnesses, but it is by no means limited to these areas. Few studies have been performed evaluating reasons for off-label prescribing. OBJECTIVE: To explore the satisfaction with drug therapy as one of the potential reasons for off-label uses by testing a hypothesis that the satisfaction with drug therapy for off-label indications is lower than for approved indications. METHODS: The study compared the satisfaction with drug therapy for known off-label indications with a control group of approved indications. Twenty-four of the first 50 single-ingredient drugs, according to their share in the drug cost budget of the Slovenian Compulsory Health Insurance, had 86 different off-label indications eligible for inclusion. A control group of 86 approved indications was randomly selected from the list of all possible approved indications for the same 24 drugs. A 2-round Delphi technique, involving an expert panel of physicians who are members of the drug regulatory agency, was used to evaluate the satisfaction with drug therapy for selected indications. RESULTS: After the second round of the Delphi study, the median scores of satisfaction with drug therapy for approved and off-label indications were 7.00 and 6.50, respectively (p = 0.001). CONCLUSIONS: The study shows that the satisfaction with available drug therapy for off-label indications is lower than for approved indications. The statistical association, biologic plausibility, and coherence with existing information, as well as the temporality of the association, provide supporting evidence that low satisfaction with drug therapy is one of the incentives for off-label use.

Databases, Factual↗

PubMed2005

Defining professionalism in anaesthesiology.

BACKGROUND: The Royal College of Physicians and Surgeons of Canada, through the CanMEDS 2000 project has identified the role of professional as 1 of 7 roles for which physicians are expected to be accountable when dealing with patients. Each specialty is responsible for defining this role relative to their specialty. METHODS: The qualities of professionalism for anaesthesiology were defined through a Delphi process involving Canadian anaesthesiology educators. The panellists took part in 3 rounds that identified qualities in 3 distinct areas of professionalism - humanistic qualities, personal development qualities and anaesthesiology meta-competences. RESULTS: A total of 23 of 29 anaesthesiologists responded (79%) in round 1, with response rates to rounds 2 and 3 being 72% and 69%, respectively. Of the original 36 qualities, some were combined, definitions were changed in 23, 11 qualities were added and 4 were deleted, leaving a list of 40 qualities. DISCUSSION: There is considerable interest in this issue among the Canadian educators in postgraduate anaesthesiology. Consensus on important professional qualities for anaesthesiologists was obtained through the Delphi technique. These qualities will form the basis of identifiable professional behaviours to which anaesthesiologists should aspire.

Anesthesiology↗

PubMed1996

Nursing-care dependency. Development of an assessment scale for demented and mentally handicapped patients.

This article describing the first phase in the development of an assessment scale of nursing-care dependency (NCD) for Dutch demented and mentally handicapped patients focuses on the background to the study and the content validation of the nursing-care dependency scale. The scale aims to characterize the patients' nursing-care dependency as part of the assessment step in the nursing process, and is based on Henderson's 14 human needs. The Delphi technique, using two panels of experts (n = 44), was applied to reach consensus on significant indicators of nursing-care dependency. The experts' reasoning was used to develop criteria for the assessment of nursing-care dependency. Ultimately, the Delphi rounds generated 15 NCD items with their descriptions and item criteria. There was no fundamental difference between the NCD scales for demented and mentally handicapped patients. Nevertheless, there are two versions of the NCD scale because of the need to apply specific concepts in the nursing care of either population. The original Dutch version of the NCD is also available in English and in Norwegian.

Activities of Daily Living↗

PubMedDate not supplied

Promotion criteria for family practice residents: perceptions of program directors.

This study utilized a modified Delphi technique to identify criteria considered important in the promotion of family practice residents. A designated expert panel consisting of the directors of the family practice residency programs in the State of Texas was used as the data source for the study. The Delphi results revealed a marked degree of consensus among the state program directors for 16 of 20 criteria evaluated. The criteria identified did not define comprehensive competency areas or goals. Further studies utilizing this information to develop comprehensive goals or to evaluate a program's current policies are proposed.

Delphi Technique↗

PubMed2002

Research on injury prevention: topics for systematic review.

BACKGROUND: Duplication should be avoided in research and only effective intervention programs should be implemented. OBJECTIVE: To arrive at a consensus among injury control investigators and practitioners on the most important research questions for systematic review in the area of injury prevention. DESIGN: Delphi survey. METHODS: A total of 34 injury prevention experts were asked to submit questions for systematic review. These were then collated; experts then ranked these on importance and availability of research. RESULTS: Twenty one experts generated 79 questions. The prevention areas with the most number of questions generated were fires and burns, motor vehicle, and violence (other than intimate partner), and the least were other interventions (which included Safe Communities), and risk compensation. These were ranked by mean score. There was good agreement between the mean score and the proportion of experts rating questions as important or very important. Nine of the top 24 questions were rated as having some to a substantial amount of research available, and 15 as having little research available. CONCLUSIONS: The Delphi technique provided a useful means to develop consensus on injury prevention research needs and questions for systematic review.

Humans↗

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↗