Using the Delphi technique to identify the content and context of nurses' continuing professional development needs

A Delphi consensus among experts on assessment and treatment of disruptive mood dysregulation disorder

Objective

The aim of this study was to explore consensus among clinicians and researchers on how to assess and treat Disruptive Mood Dysregulation Disorder (DMDD).

Methods

The Delphi method was used to organize data collected from an initial sample of 23 child psychiatrists and psychologists. Three rounds of closed/open questions were needed to achieve the objective.

Results

Fifteen experts in the field completed the whole study. Finally, 122 proposals were validated and 5 were rejected. Globally, consensus was more easily reached on items regarding assessment than on those regarding treatment. Specifically, experts agreed that intensity, frequency, and impact of DMDD symptoms needed to be measured across settings, including with parents, siblings, peers, and teachers. While a low level of consensus emerged regarding optimal pharmacological treatment, the use of psychoeducation, behavior-focused therapies (e.g., dialectical behavior therapy, chain analysis, exposure, relaxation), and systemic approaches (parent management training, family therapy, parent-child interaction therapy) met with a high degree of consensus.

Conclusion

This study presents recommendations that reached a certain degree of consensus among researchers and clinicians regarding the assessment and treatment of youths with DMDD. These findings may be useful to clinicians working with this population and to researchers since they also highlight non-consensual areas that need to be further investigated.

Development and Application of a Reference Manual for Diagnosis and Rational Use of Antimicrobial Agents for Outpatient Primary Care (Digestive System Part): A Delphi Study

Purpose

To establish a concise and easy-to-understand reference manual for outpatient primary care providers, promoting correct diagnosis of digestive system diseases and rational antimicrobial use.

Methods

The establishment of the manual encompassed two processes: the development of a draft manual and the validation of the manual. The development process was based on a literature review and expert discussion. The manual comprises portions for disease diagnosis and rationality of antimicrobial use. The validation process employed a two-round Delphi technique, collecting consensus through paper-based or mail-based communications. The response of the Delphi group was assessed by the level of authority and commitment of the panelists and the degree of agreement among them. Furthermore, the manual was preliminarily applied among primary care physicians.

Results

A total of 29 panelists completed the Delphi working process. They were authoritative in their professional fields with authority coefficients of 0.813 and 0.818 for the two portions of the manual, respectively. The level of commitment of the panelists was measured by response rates, which were 100.00% and 96.67% for Round 1 and 2. After two rounds, a consensus was achieved with the consensus rates for the two portions of the manual being greater than 65% and 70%, respectively. Kendall W-tests had P-values < 0.001 in both rounds. This reference manual provides 200 diagnostic indicators for 29 common digestive diseases and recommendations for the rational use of antimicrobial agents for 13 categories of digestive diseases. The primary care physicians who used the reference manual reported high satisfaction and frequent usage.

Conclusion

Based on a collective consensus of professionals, a reference manual has been established, to provide a concise and easy-to-understand guide specifically for physicians and pharmacists in outpatient primary care. It could facilitate rapid learning to improve the accuracy of diagnosis and treatment for digestive disorders.

[Not Available]

Introduction&#160;: The continuing professional development of nurses remains a key issue within the health context.Context&#160;: The Questionnaire - Professional Development Nurses (Q-PDN) was developed to understand the opinions and beliefs of nurses regarding continuing professional development is essential to improving the quality of care and optimizing job satisfaction. With this in mind, researchers from the Netherlands developed the Questionnaire &#8211; Professional Development Nurses (Q-PDN).Objectives&#160;: Adapt the Q-PDN to a French-Canadian context according to recognized guidelines.Method&#160;: The six stages of the Beaton et al. (2000) cross-cultural adaptation process were followed to produce a tool adapted to the French-Canadian context.Results and discussion&#160;: This study describes the different steps necessary for the cross-cultural adaptation of the Q-PDN tool to the French-Canadian context. Following the adaptation, minor content adjustments were made to the original version. General comments have highlighted the clarity and simplicity of the questionnaire.Conclusion&#160;: This first step in the cross-cultural French-Canadian adaptation of Q-PDN has enabled the development of a tool to identify gaps and priorities for action to promote the continuing professional development (CPD) of nurses.

Factors Hampering the Participation of Nursing Staff in the Continuing Education Activities of Hospitals Centers in the Casablanca-Settat Region

Aim:

This study aimed to identify the factors hampering the participation of nurses in the activities of CE sessions at the level of hospitals in the region of Casablanca.

Background:

Continuing education (CE) for nursing staff represents a strategic asset for hospitals, identifying the constraints of nursing staff participation in continuing training could help improve the quality of care for patients and the population in general.

Objective:

This study aimed to identify the factors hampering the participation of nurses in the activities of CE sessions at the level of hospitals in the region of Casablanca.

Methods:

The study used a two-phase mixed method design. First of all, a questionnaire was administered to 930 nurses belonging to 9 hospital centers in the Casablanca-Settat region in order to explore and estimate the frequencies of the factors hindering the participation of nurses in the activities of the FC sessions at the level of hospitals, and a semi-structured interview with 9 persons in charge of continuing education from these different hospitals to complete and explain the data collected by the questionnaire.

Results:

The data analysis confirmed that the work overload is the first individual difficulty hindering the participation of nurses in CE sessions, i.e., 85.4%. The most mentioned organizational difficulties are schedule recommended in the FC not encouraging and not suitable, i.e., 23%, non-targeted content (does not meet the needs of the nursing staff), i.e., 66.7%. Finally, the absence of support measures in terms of monitoring and evaluation to maintain the knowledge and skills acquired during FC sessions in real situations at the workstation occupied is the first institutional difficulty mentioned by the interviewed (88%).

Conclusion:

Those responsible for training should take into account the factors nurse’s face in participating in continuing education sessions when designing, developing, and implementing continuing education sessions.

Adapting and validating the Autism Diagnostic Interview - Revised for use with deaf children and young people

LAY ABSTRACT

Autism assessment processes need to improve for deaf children as they are currently being diagnosed later than their hearing counterparts and misdiagnosis can occur. We took one of the most commonly used parent developmental interviews for autism spectrum disorder the Autism Diagnostic Interview-Revised and adapted it using international expert advice. Modifications were proposed and agreed by the expert panel for 45% of items; the remaining 55% of items were unchanged. We then tested the revised version, adapted for deaf children (Autism Diagnostic Interview-Revised Deaf Adaptation), in a UK sample of 78 parents/carers of deaf children with autism spectrum disorder and 126 parents/carers with deaf children without autism spectrum disorder. When compared to National Institute for Health and Care Excellence guideline standard clinical assessments, the Autism Diagnostic Interview-Revised Deaf Adaptation diagnostic algorithm threshold scores could identify those deaf children with a definite diagnosis (true autism spectrum disorder positives) well (sensitivity of 89% (79%-96%)) and those deaf children who did not have autism spectrum disorder (true autism spectrum disorder negatives) well (specificity of 81% (70%-89%)). Our findings indicate that the Autism Diagnostic Interview-Revised Deaf Adaptation is likely to prove a useful measure for the assessment of deaf children with suspected autism spectrum disorder and that further research would be helpful.

Factors affecting the value revitalization of Qajar religious schools in Tehran

Nowadays, due to natural erosion and urban development, Qajar religious schools in Tehran have undergone adverse physical changes. Moreover, the semantic and intangible values of them have faded over time, such that their position in society has declined. The religious schools need the conservation and revitalization of their values. Various research has been conducted on the philosophy of education, and the spatial evolution history of Tehran's religious schools. However, since no study has been carried out on the value revitalization of them, the present study, as an exploratory and novel study, mainly aims to experimentally investigate experts' views to revitalize the value of Qajar religious schools in Tehran. Delphi research method and Q-type factor analysis were used to identify and classify experts' views, respectively. Participants were selected through the purposive non-probability sampling technique. The sample size was selected to be 25, which was confirmed according to the Kaiser-Meyer-Olkin test used for sampling adequacy. To collect data from experts, a questionnaire was used in three rounds based on the Delphi method. Data obtained from the questionnaires were analyzed using the Q method. Based on the obtained results, up to 73.267% of factors affecting the value revitalization of Qajar religious schools in Tehran were identified and interpreted with certainty based on interviews with the experts. The experts were divided into eight groups or factors based on their views, and seven of which introduced common variables and concepts, named based on their constituent variables. Based on the value of the coefficient of variation, the identified effective factors included climatic architecture (20.51%), resilient architecture (13.45%), spiritual architecture (8.98%), environmental aesthetics (8.12%), educational architecture (6.87%), structural architecture (6.450%), and site visiting (4.566%). It was concluded that in the value revitalization of the religious schools, paying serious attention to these seven effective factors underlies the conservation process.

Modifying and validating the social responsiveness scale edition 2 for use with deaf children and young people

A Delphi consensus methodology was used to adapt a screening tool, the Social Responsiveness Scale– 2 (SRS-2), for use with deaf children including those whose preferred communication method is sign language. Using this approach; 27 international experts (The Delphi International Expert Panel), on the topic of autism spectrum disorder (ASD) in deaf people, contributed to the review of item content. A criterion for agreement was set at 80% of experts on each item (with 75% acceptable in the final fourth round). The agreed modifications are discussed. The modified SRS-2 research adaptation for deaf people (referred to here as the “SRS-2 Deaf adaptation”) was then translated into British Sign Language using a robust translation methodology and validated in England in a sample of 198 deaf children, 76 with Autism Spectrum Disorders (ASD) and 122 without ASD. The SRS-2 Deaf adaptation was compared blind to a NICE (National Institute for Health and Care Excellence) guideline standard clinical assessment. The area under the Receiver Operating (ROC) curve was 0.811 (95% CI: 0.753, 0.869), with an optimal cut-off value of 73, which gave a sensitivity of 82% and a specificity of 67%. The Cronbach Alpha coefficient was 0.968 suggesting high internal consistency. The Intraclass Correlation Coefficient was 0.897, supporting test-retest reliability. This performance is equivalent to similar instruments used for screening ASD in the hearing population.

Facebook as a Novel Tool for Continuous Professional Education on Dementia: Pilot Randomized Controlled Trial

BACKGROUND

Social network sites (SNSs) are widely exploited in health education and communication by the general public, including patients with various conditions. Nevertheless, there is an absence of evidence evaluating SNSs in connecting health professionals for professional purposes.

OBJECTIVE

This pilot randomized controlled trial was designed to evaluate the feasibility of an intervention aiming to investigate the effects of a continuous professional education program utilizing Facebook to obtain knowledge on dementia and care for patients with dementia.

METHODS

Eighty health professionals from Hong Kong were recruited for participation in the study and randomized at a 1:1 ratio by a block randomization method to the intervention group (n=40) and control group (n=40). The intervention was an 8-week educational program developed to deliver updated knowledge on dementia care from a multidisciplinary perspective, either by Facebook (intervention group) or by email (control group) from October 2018 to January 2019. The primary outcomes were the effects of the intervention, measured by differences in the means of changes in pre- and postintervention scores of knowledge assessments from the 25-item Dementia Knowledge Assessment Scale (DKAS) and formative evaluation of 20 multiple choice questions. Other outcome measurements included participant compliance, participant engagement in Facebook, satisfaction, and self-perceived uses of Facebook for continuing professional education programs.

RESULTS

Significantly more intervention group participants (n=35) completed the study than the control group (n=25) (P<.001). The overall retention rate was 75% (60/80). The mean of changes in scores in the intervention group were significant in all assessments (P<.001). A significant difference in the mean of changes in scores between the two groups was identified in the DKAS subscale Communication and Behavior (95% CI 0.4-3.3, P=.02). There was no significant difference in the total DKAS scores, scores of other DKAS subscales, and multiple choice questions. Participant compliance was significantly higher in the intervention group than in the control group (P<.001). The mean numbers of participants accessing the learning materials were 31.5 (SD 3.9) and 17.6 (SD 5.2) in the intervention and control group, respectively. Polls attracted the highest level of participant engagement, followed by videos. Intervention group participants scored significantly higher in favoring the use of Facebook for the continuing education program (P=.03). Overall, participants were satisfied with the interventions (mean score 4 of a total of 5, SD 0.6).

CONCLUSIONS

The significantly higher retention rate, together with the high levels of participant compliance and engagement, demonstrate that Facebook is a promising tool for professional education. Education delivered through Facebook was significantly more effective at improving participants' knowledge of how people with dementia communicate and behave. Participants demonstrated positive attitudes toward utilizing Facebook for professional learning. These findings provide evidence for the feasibility of using Facebook as an intervention delivery tool in a manner that can be rolled out into practical settings.

Wie kann die Dokumentation in der Physiotherapie durch die Digitalisierung effektiver und effizienter werden? – Eine Delphi-Studie

Hintergrund Die physiotherapeutische Dokumentation spielt im Therapieprozess eine wichtige Rolle, erfolgt jedoch auf unterschiedlichste Weise. Es existieren derzeit eine Vielzahl von Softwarelösungen für die physiotherapeutische Dokumentation, welche sich jedoch in ihren Funktionalitäten stark unterscheiden.

Ziel Mithilfe einer Befragung soll ein Konsens von Experten aus der Physiotherapie im Themengebiet der softwarebasierten Dokumentation ermittelt werden. Anhand der Ergebnisse wird ein Anforderungskatalog für die Entwicklung einer neuartigen und benutzerorientierten Dokumentationssoftware erstellt.

Methode Online-Delphi-Befragung mit neun Experten über drei Befragungswellen.

Ergebnisse Hinsichtlich der Anforderungen an die Anamnese konnte ein Konsens erzielt werden. Bei der Gliederung des Befundes kam es zu keiner Übereinstimmung der Experten. Das Ergebnis lässt sich durch unterschiedliche manualtherapeutische Konzepte erklären, die für die Befunderhebung verwendet wurden.

Schlussfolgerung Eine softwarebasierte Dokumentation sollte standardisierter als bisher erfolgen, um den Clinical-Reasoning-Prozess zu unterstützten. Gleichzeitig ist dabei eine gewisse Flexibilität geboten. Die gesammelten Anforderungen können für die Entwicklung einer neuartigen und benutzerorientierten mobilen Anwendung zur Effizienzsteigerung in der physiotherapeutischen Dokumentation verwendet werden.

Perceptions and experiences of nurses and midwives in continuing professional development: a systematic review protocol

REVIEW QUESTION/OBJECTIVE

The objective of this systematic review is to explore the perceptions and experiences of nurses and midwives in undertaking continuing professional development.

Preparing for community development practice: A Delphi study of Canadian occupational therapists

Background.

Increasingly, community development is recognized as an important process for occupational therapy practice. However, occupational therapists working in community development report feeling unprepared.

Purpose.

This study aimed to identify the knowledge, skills, and experiences that occupational therapists need for practice in community development.

Method.

Using the Delphi technique, the researchers developed statements from the Round 1 ( n = 8) responses of occupational therapists involved in community development practice or scholarship. Rounds 2 ( n = 14) and 3 ( n = 12) sought to establish consensus among the occupational therapists on the areas of focus.

Findings.

Participants rated the importance of 64 statements grouped into 11 domains. After three rounds, researchers eliminated six statements by analyzing the median, interquartile range, and percentage of agreement. Participants reached consensus on 58 statements.

Implications.

Many of the competencies identified were relevant to all areas of practice, while others were specific to community development, suggesting a need for specialized education and training in this area. The results provide information that can be used to enhance the preparation of occupational therapists for practice in community development.

A Delphi Study on Staff Bereavement Training in the Intellectual and Developmental Disabilities Field

The Delphi technique was used to obtain expert panel consensus to prioritize content areas and delivery methods for developing staff grief and bereavement curriculum training in the intellectual and developmental disabilities (IDD) field. The Delphi technique was conducted with a panel of 18 experts from formal and informal disability caregiving, nursing, and hospice and bereavement service provision. Results showed that training should help staff identify and support service users experiencing grief. Importantly, staff also needs help in managing their own grief. Organizational policies and resources should be instituted to support the grief processes of both service users and staff. Practice-based applications are discussed, and research implications are presented for training evaluation.

A modified Delphi method to create a scoring system for assessing team performance during maternal cardiopulmonary arrest

BACKGROUND

Maternal cardiopulmonary arrest is a rare but often fatal emergency. The authors used a modified Delphi method to create a checklist of tasks for practitioners.

METHODS

Within each round, experts ranked tasks on a scale from zero through five. Consensus was defined a priori as 80% exact agreement.

RESULTS

Three rounds were required to achieve consensus resulting in a checklist of 45 tasks. Round One results revealed five tasks, Round Two included 25 tasks, and Round Three resulted in 29 tasks with 80% exact agreement.

CONCLUSIONS

The modified Delphi method resulted in a weighted scoring system that can be used to objectively assess team performance.

Reconsidering Planning and Management of Medical Devices Procurement in Public Health Services in Cyprus

Hospital procurement is a crucial field for any health care system, not only for economic reasons but also for reasons related to the quality and safety of the services provided. That is why the process of procurement is, in most countries, governed by a strict legal framework and policy mechanisms. This study investigates the problems and inefficiencies associated with the procurement of medical devices in public hospitals in Cyprus and formulates empirically documented proposals for improvement. Using the Delphi method, a group of 38 experts approach the procurement system in Cyprus from different angles, achieving high rates of consensus on 35 different statements on the weaknesses and problems of the current medical device procurement system, as well as presenting proposals and recommendations for improvement. The findings are highly valuable for future policy initiatives in Cyprus in the light of the economic crisis and the expected implementation of the new General Health Insurance System (GeSY), which the Government of the Republic of Cyprus and the Troika has agreed.

Self–directed learning and portfolio development for nurses: Developing workbooks as a facilitative tool

Workbooks are often used for discipline-specific learning in academic institutions but there is growing recognition of their potential usefulness in the clinical setting to promote learning and professional development. The purpose of this paper is to share some tips/guidelines for those clinical staff interested in developing self-directed learning programs using a workbook approach. Combined with skilled facilitation, custom designed workbooks based on adult learning theories can enhance skills and encourage portfolio development in the clinical setting. This cost and time effective approach utilises existing resources to cater to diverse needs and topics, building sustainable collaborations. This paper will argue that the proposed program has the potential to contribute to healthcare improvement by promoting skill development amongst staff and contributing to evidence-based practice.

Continuing professional development training needs of medical laboratory personnel in Botswana

BACKGROUND

Laboratory professionals are expected to maintain their knowledge on the most recent advances in laboratory testing and continuing professional development (CPD) programs can address this expectation. In developing countries, accessing CPD programs is a major challenge for laboratory personnel, partly due to their limited availability. An assessment was conducted among clinical laboratory workforce in Botswana to identify and prioritize CPD training needs as well as preferred modes of CPD delivery.

METHODS

A self-administered questionnaire was disseminated to medical laboratory scientists and technicians registered with the Botswana Health Professions Council. Questions were organized into domains of competency related to (i) quality management systems, (ii) technical competence, (iii) laboratory management, leadership, and coaching, and (iv) pathophysiology, data interpretation, and research. Participants were asked to rank their self-perceived training needs using a 3-point scale in order of importance (most, moderate, and least). Furthermore, participants were asked to select any three preferences for delivery formats for the CPD.

RESULTS

Out of 350 questionnaires that were distributed, 275 were completed and returned giving an overall response rate of 79%. The most frequently selected topics for training in rank order according to key themes were (mean, range) (i) quality management systems, most important (79%, 74-84%); (ii) pathophysiology, data interpretation, and research (68%, 52-78%); (iii) technical competence (65%, 44-73%); and (iv) laboratory management, leadership, and coaching (60%, 37-77%). The top three topics selected by the participants were (i) quality systems essentials for medical laboratory, (ii) implementing a quality management system, and (iii) techniques to identify and control sources of error in laboratory procedures. The top three preferred CPD delivery modes, in rank order, were training workshops, hands-on workshops, and internet-based learning. Journal clubs at the workplace was the least preferred method of delivery of CPD credits.

CONCLUSIONS

CPD programs to be developed should focus on topics that address quality management systems, case studies, competence assessment, and customer care. The findings from this survey can also inform medical laboratory pre-service education curriculum.

Design of a basic system of indicators for monitoring and evaluating Spanish Cooperation's Culture and Development Strategy

OBJECTIVE

This article describes the process implemented in order to define and build up a Basic Monitoring and Evaluation System for Spanish Cooperation's Culture and Development Strategy (CD-S).

RESEARCH DESIGN

Delphi techniques were used to assess a wide catalogue of indicators for each of the strategic areas included in the CD-S. Afterward, those indicators considered most suitable for monitoring and evaluating purposes were selected based on the assessments provided by a panel of experts.

RESULTS

As a consequence, the resulting system, made up by a total of 80 indicators, was designed to be a practical, manageable, and targeted tool for its potential users, who include managers and technical officers who map out strategy together with stakeholders involved in its implementation, and specifically with staff at cultural centers abroad and in technical aid offices.

Continuing professional development: investment or expectation?

AIM

The aim of this study was to explore the reason for nurses' participation in postregistration education.

BACKGROUND

The study was located in one third level institution in Ireland and prospective candidates who applied to undertake a programme of studies were invited to complete the postal questionnaire and return it to the college anonymously in advance of commencing their studies.

METHOD

A descriptive survey research design was adopted with the use of a questionnaire for data collection. The respondents had an opportunity to make additional comments in a questionnaire, which generated some qualitative data.

RESULTS

A total of 243 questionnaires were returned which represented a 46.7% response rate. The major reasons for participating in postregistration education were 'to obtain promotion to a higher grade/position' (99%) and 'to enable me extend my clinical role' (98%).

CONCLUSION

Investment in nursing education should take into account the reasons for participation in continuing education and professional development as identified in this study and in other studies so as to focus efforts that improve planning for long-term continuing education and professional development. The adoption of such a strategic approach by employers will ensure more precise targeting of scarce continuing education and professional development resources. Equally, expectation without adequate investment is not realistic if the profession wants to move forward in this era of rapid change in the delivery of health care.

Using the Delphi technique in economic evaluation: time to revisit the oracle?

BACKGROUND AND OBJECTIVE

Although the Delphi technique has been commonly used as a data source in medical and health services research, its application in economic evaluation of medicines has been more limited. The aim of this study was to describe the methodology of the Delphi technique, to present a case for using the technique in economic evaluation, and to provide recommendations to improve such use.

METHODS

The literature was accessed through MEDLINE focusing on studies discussing the methodology of the Delphi technique and economic evaluations of medicines using the Delphi technique.

RESULTS AND DISCUSSION

The Delphi technique can be used to provide estimates of health care resources required and to modify such estimates when making inter-country comparisons. The Delphi technique can also contribute to mapping the treatment process under investigation, to identifying the appropriate comparator to be used, and to ensuring that the economic evaluation estimates cost-effectiveness rather than cost-efficacy.

CONCLUSION

Ideally, economic evaluations of medicines should be based on real-patient data. In the absence of such data, evaluations need to incorporate the best evidence available by employing approaches such as the Delphi technique. Evaluations based on this approach should state the limitations, and explore the impact of the associated uncertainty in the results.

An evaluation of perceived education and training needs of staff nurses and care officers

This study was carried out to ascertain the specific education and training needs of nursing and care officer staff working at the Central Mental Hospital (CMH) in Dublin, Ireland, which provides national forensic psychiatric services. This is the first time an education and training needs analysis was conducted for all nursing and care officer staff.

A Taxonomy and Economic Consequences of Nursing Home Falls

BACKGROUND

Falls are a primary cause of injury and disability in the nursing home environment and can be costly to treat. We propose a taxonomy of nursing home falls that accounts for both the severity of fall consequences and the duration of the treatment episode. No other systematic approach of this kind has been previously described.

METHODS

We defined a 9-level taxonomy of fall types and outcomes. Components of each fall category include resource use during the acute, convalescent, and long-term phases of treatment. Three variants of each category describe typical, best-case and worst-case fall episodes. Treatment costs were estimated for each fall category by applying unit costs from national databases and published sources to projected medical resource utilisation. Long-term costs reflect adjustment in Medicare per diem reimbursement rates associated with change in patient status subsequent to the fall.

RESULTS

The most common and least costly fall category was category 1 -- non-injurious, which accounted for 30% of falls and a 1-year cost of US dollars 319 per event (range US dollars 71-550). The least common and most costly was fall category 9 -- multiple injuries, which accounted for 1% of falls and a 1-year cost of US dollars 22,368 (range US dollars 9,969-64,382).

CONCLUSIONS

The falls taxonomy represents a unique approach to estimating the cost of nursing home falls and offers a tool for evaluating the cost-effectiveness of fall prevention strategies. A validation study should be performed to confirm the magnitude of fall frequency and cost estimates.

Developing a disease activity tool for systemic-onset juvenile idiopathic arthritis by international consensus using the Delphi approach

OBJECTIVES

The systemic form of juvenile idiopathic arthritis may present with many diverse symptoms, signs and laboratory abnormalities. Our aim was to elicit and pool items useful for developing a consensus disease activity measure for systemic arthritis in children, using an international pool of respondents.

METHODS

We used a Delphi survey process in two steps. First we surveyed 187 paediatric rheumatologists and allied health professionals. We elicited 2607 items that, when combined with previously elicited items from parents/patients, could be pooled into 107 independent items. We then surveyed the paediatric rheumatologists to determine the frequency and importance of the 107 items.

RESULTS

Our response rate was 83% to both surveys. We identified 29 items as being the most important and most frequently seen indicators of active disease. The most highly rated of these items were: presence of fever, presence of rash, elevated ESR, elevated CRP, requirement for increasing medications, abnormal physician global evaluation and presence of joints with active arthritis.

CONCLUSIONS

Twenty-nine items are thought by medical practitioners to be most relevant in determining disease activity in systemic arthritis. As a next step, the measurement properties of these items will be tested to help develop a disease activity tool.

Development and assessment of indicators of rheumatoid arthritis severity: results of a Delphi panel

OBJECTIVE

To develop a set of indicators for assessing the severity of rheumatoid arthritis (RA) through medical records.

METHODS

A list of 47 potential indicators of RA was reviewed by an expert Delphi panel of 6 rheumatologists. The Delphi method is a formal approach for gathering expert opinion. The 47 potential indicators included items from the following 5 categories: radiologic and laboratory findings, clinical and functional status measures, extraarticular manifestations, prior surgical history, and medications. The panelists rated the potential indicators' relationship to RA disease severity. Each panelist rated each indicator on a scale of 0-6, in which 0 indicated no relationship at all with severe RA and 6 indicated a perfect relationship with severe RA. After a baseline set of ratings, a literature review was distributed to the panelists along with the panel's initial mean ratings and the ranges. The panelists then met to discuss the literature and rerate all indicators.

RESULTS

After repeat ratings and review of relevant literature, the panel rated 28 of 47 (60%) potential indicators as having a strong or very strong relationship to severe RA. These 28 indicators were drawn from all 5 categories of potential indicators. There was agreement among the panelists on ratings for 41 of 47 indicators. Agreement was defined as a range of scores among the panelists </=3.

CONCLUSION

A Delphi panel of rheumatologists agreed that data generally available in medical records may serve as potential indicators of severe RA.

An assessment form for clinical nursing education: a Delphi study

AIM

This paper reports a study to develop further the existing assessment form and to capture new aspects of assessment for the nursing profession of the future for inclusion in the form.

BACKGROUND

Since nursing education became part of the higher education system, the assessment of clinical periods of the programme has become more complicated and requirements are more demanding. Changes in the health care sector, such as demographic changes and shorter hospitalization, create demands upon the independent nursing role of the future. Many educational documents, such as an assessment form, must continuously be up-dated and adapted to changes in society.

METHOD

A Delphi study concerning the content of this assessment form was carried out using two rounds. Through this process, an expert panel gave their opinions about the form and possible changes to it.

RESULTS

There was general acceptance of the content in the current assessment form. Suggested changes were the addition of two factors concerning collaboration with the family and society, and development of the student's independence. Two new area headings were suggested: one about ability to use the nursing process, and the other about development of a professional stance.

CONCLUSIONS

The suggested changes in the assessment form match expected changes in the health care sector and the demands of an academic nursing education.

Training needs analysis. A literature review and reappraisal

Training needs analysis is the initial step in a cyclical process which contributes to the overall training and educational strategy of staff in an organisation or a professional group. The cycle commences with a systematic consultation to identify the learning needs of the population considered, followed by course planning, delivery and evaluation. Although much has been written about training needs analysis in relation to post-registration nursing education, there is disagreement concerning its impact on the training cycle and its potential to influence service delivery. This stimulated the literature review presented below. Initial searches of nursing databases identified 266 works. Twenty three (8.6%) contained empirical findings relating to post-registration nursing education in which assessment of training needs was presented as the major aim. Most of these accounts were concerned with the training needs of nurses in more than one organisation and were classified as macro-level training needs analysis. However, seven studies were concerned with a single, specific organisation (micro-level training needs analysis). Despite their smaller scale and more limited scope, micro-level training needs initiatives demonstrated greater methodological rigour, were more likely to consider the stakeholder perspective, to generate findings which could positively influence the rest of the training cycle and showed the greatest potential for influencing service delivery and quality of patient care. The review drew attention to the similarities between the training cycle and the audit cycle and resulted in the development of a model which could be used to evaluate the effectiveness of the process and outcomes of future training needs analysis initiatives.

Defining the sports medicine specialist in the United Kingdom: a Delphi study

OBJECTIVE

To define the role and responsibilities of the sports medicine specialist using a recognised research technique.

METHODS

A Delphi technique was employed using anonymous postal questionnaires sent to a random sample of 300 members of the British Association of Sport and Exercise Medicine. The questionnaire of 300 putative attributes was developed in a pilot study and the Delphi technique used allowed participants to modify their responses according to the responses of other participants.

RESULTS

There was a 53% response to both rounds of the study with 75.6% of the respondents being male, 39% having a higher qualification in sports medicine, and 45.6% being general practitioners. Some 86.3% strongly agreed that sport and exercise medicine should be a recognised speciality and 90% strongly agreed that it should be available on the National Health Service (NHS). The most important specialist attributes were orthopaedic and soft tissue medicine (83.6% strongly agreed) and emergency medical management (79.7% strongly agreed). More than 75% of respondents did not agree that either research or personal playing experience were relevant.

CONCLUSION

Sports and exercise medicine is an evolving speciality in the United Kingdom. We believe this is the first systematic attempt to define the role and responsibilities of the sports medicine specialist and the findings are of relevance to the future development of a career pathway.

Issues surrounding professional portfolio development for nurses

This article discusses issues that underpin professional portfolio development for registered nurses. The findings were informed by a review of the pertinent literature. The literature was obtained by undertaking searches of a number of electronic databases and hand searches of key journals. It was found that portfolio development has been a requirement for re-registration for a number of years. However, there appears to remain confusion and uncertainty among professionals regarding the meaning and implications of portfolio development for nurses. For example, in the review conducted, the terminology used was often found to be confusing and expectations of how a portfolio should look are unclear. Conclusions can be drawn that practitioners may be in a quandary of how to develop and present evidence in what is now a mandatory requirement for re-registration, the maintenance of a professional portfolio.

The Delphi technique: myths and realities

AIMS

To outline the key concepts and principles of the Delphi technique.

METHODS

Reference is made to a selection of studies that illustrate a variety of methodological interpretations. Drawing on Heshusius's concept of 'goodness criteria', particular emphasis is given to the question of scientific merit and means of evaluation.

CONCLUSIONS

Although the technique should be used with caution, it appears to be an established method of harnessing the opinions of an often diverse group of experts on practice-related problems.

Telephone nurses' experience of problems with telephone advice in Sweden

By telephoning a healthcare call centre, individuals in Sweden can consult a nurse to discuss medical problems and health care accessibility, and to receive professional information on how to find their way about the health care system. The aim of the study was to identify problems, difficulties and disadvantages that telephone nurses with varying degrees of experience had met during their professional careers. The Delphi technique was used with three sets of questionnaires. Twenty-five nurses with varying experience of working with telephone advice from six 24-hours call centres participated in the study. The response rate was 100%. An open-ended question generated 154 statements. Comments were categorized into 24 different problem categories. Ten problem categories were mainly related to the nurse perspective, i.e. the problems experienced were associated with the qualities of the nurse, eight principally to the patient perspective, i.e. problems associated with caller characteristics and six mostly to the organizational perspective, i.e. problems linked to the organization of the national health service. 'Lack of health care resources' was rated as the biggest problem, 'second-hand consultations' as the second and 'always making a decision' as the third biggest problem. Decision-making seems to be the core of telephone advice nursing and problems related to the nurses, patients and organization seem to influence the telephone nurses' working situation. Training should focus on active listening and handling social conflicts.

The impact of part-time post-registration degrees on practice

AIM

This study aimed to identify how graduates from part-time, post-registration degree courses in nursing and midwifery perceived that their practice had changed as a result of the knowledge and skills acquired on their courses.

BACKGROUND

Despite increasing investment in continuing professional education and expansion of nursing roles, little work has been undertaken to assess the impact of graduates' skills on nursing care and clinical outcomes.

METHOD

Postal questionnaires were used to survey all graduates of post-registration Bachelor's and Master's courses in nursing and midwifery from one institution in the United Kingdom (UK) (n=60). Respondents were asked to describe how they felt their graduate skills were used in practice and if this was influenced by any factors in the workplace. Data were analysed descriptively, and by content analysis.

FINDINGS

Forty-three of 58 graduates contacted responded (74%). The majority (33/43, 77%) of respondents felt that their graduate skills were used in practice. Although most felt that their clinical practice had changed as a result of their degree studies, no practical examples of this were given, despite specific questioning. Many examples of academic and research skills acquired on the course were cited, which raises the question of whether the degree courses provided graduates with academic rather than clinical knowledge. There was ambivalence as to their perceptions of barriers in the workplace, which may have impeded the application of knowledge acquired on the courses.

IMPLICATIONS

The clinical effectiveness of education initiatives depends on the learners, the course and the workplace. To maximize the benefits accruing to patients from continuing professional education and role expansion, further exploration of the contribution of higher education programmes to clinical practice is required.

Assessing the skills for family planning nurse prescribing: development of a psychometrically sound training needs analysis instrument

RATIONALE AND AIMS

Family planning nurses have been identified for early development for prescribing authority in the United Kingdom (UK). Currently, no psychometrically founded training needs analysis instrument exists that can reliably assess the nature and extent of the specific educational provision required for this role. This paper is concerned with the development of an instrument capable of defining the development needs for family planning nurse prescribing.

METHODS

A national survey was conducted with 388 family planning nurses, using a modified training needs analysis instrument. Respondents were required to assess the importance of 40 tasks, firstly for the role of the family planning nurse (FPN), and again for the role of the family planning nurse prescriber (FPNP). The data from each set of ratings were separately factor analysed using orthogonal Varimax rotations and Cronbach's alpha was computed for each factor.

RESULTS

Six factors emerged from the family planning nurse ratings ('professional development', 'managing patient consultations', 'critical appraisal', 'clinical information giving and professional accountability', 'collaborative working and current National Health Service (NHS) issues' and 'dispensing of drugs') and nine factors emerged from the FPNP ratings ('research and practice development', 'prescribing and professional accountability', 'management/leadership', 'clinical decision making and risk assessment', 'advanced health assessment', 'critical appraisal', 'referral processes', 'core nursing skills' and 'dispensing of drugs'. This suggests that the role of the FPNP is more extended and, moreover, that the two roles are configured very differently but in a way that makes logical and coherent sense within existing research and government policy. This indicates that the instrument is valid. Moreover, all but two of the factors had a Cronbach's alpha score of >0.7 and so can be considered reliable.

CONCLUSIONS

The results indicate that the modified instrument is valid and reliable and therefore can be used with confidence to assess the training needs of FPNPs. In addition, the factors have outlined a cogent definition of the role of the FPNP, which can be used both to inform educational programmes and to assess their efficacy.

Educating nurses to care for the dying in Hong Kong: a problem-based learning approach

Caring for dying patients is an essential and major aspect of nursing care. However, previous studies have revealed that nurses felt uncomfortable and inadequate in dealing with the dying patients and their families. This study reports the effectiveness of a problem-based learning approach in death education among a group of registered nurses in Hong Kong. Three problems, with three segmented scenarios related to cancer nursing, were used. Students went through the problem-based learning process and documented their learning throughout the course in journals. A total of 72 sets of journals were collected and analyzed. The strategies of within case and cross-case analysis were employed. The within case analysis explored the learning development of students for each problem. The cross-case analysis compared and contrasted findings of the within case analysis. Three themes have been derived from the findings. They were: nurses acknowledging their emotions in facing death and dying, a need for the nurses to be better equipped in communication and counseling, and a holistic and family-centered approach to care. This study provides evidence showing that problem-based learning is an effective strategy to enhance nurses' self-awareness of death and dying issues, and to stimulate nurses to formulate a plan that addresses the physical, psychological, and social aspects of care. Findings also reveal that nurses need to take into account the particular reactions of death and dying in the Chinese culture when planning care.

A critical review of the Delphi technique as a research methodology for nursing

The Delphi technique is an approach used to gain consensus among a panel of experts. This is normally achieved through a series of rounds where information is fed back to panel members using questionnaires. It has been used extensively within social science research and is being increasingly employed by nurse researchers. This popularity has meant that the technique has been adapted in various ways and there is the possibility that the rigour associated with the original format has been threatened. This signals the need for a critical review of the Delphi as a robust and systematic approach to data collection. While there is a great volume of literature surrounding the "Delphi", there is a dearth of papers critically analysing the technique. This paper aims to examine critically the Delphi technique from a range of perspectives. Discussion will focus on problems of definition and the advantages and disadvantages and the techniques' application in nursing. The critique will be structured through an analysis of the key aspects of the Delphi process. These key aspects include analysis of sampling, anonymity, use of experts, rounds and application. The critical analysis highlights the increasing popularity of the Delphi and the modifications to the process which may cause methodological problems. Ultimately, the Delphi has much to offer in terms of gaining consensus from a wide range of individuals on specific topics.

Using Q methodology to assess the needs of emergency medicine support staff employees

The support staff members of any Department of Emergency Medicine perform a plethora of tasks that are crucial to the productivity of both individual physicians and the department as a whole. It is important to ensure that the personal and professional needs of the support staff are being met. This report describes the use of a relatively new statistical technique, Q methodology, to elucidate the needs of the support staff. This method allowed the investigators to quantitatively reveal the presence of two distinct viewpoints on employee needs among the support staff. Additionally, opinions that were held by the employees concerning their needs were identified. These results allowed for strategies to be tailored to both the individual and the group. The results indicate that Q methodology can have widespread application in the relatively new area of health care quality research.