A delphi survey of midwives and midwifery students to identify non-midwifery duties

Developing CT workforce competencies: What knowledge and skills should we expect of an early career radiographer?

INTRODUCTION

Individual professions seek to define their professional practice through competencies which describe the behaviours and technical attributes to perform effectively within role. Professional body and regulatory frameworks define universal standards for radiography but there is limited evidence of the technical competencies expected of the workforce in Computed Tomography (CT). This study aimed to address this gap by agreeing the essential competencies for the early career radiography workforce who have CT as part of their clinical responsibilities. This is the first step in developing a competency framework for CT across all radiography expertise levels.

METHODS

A modified e-Delphi study was used to identify and gain agreement on essential practice competencies for this group. Structured surveys over two rounds were completed by an expert panel with CT knowledge and experience. Participants were asked to rate the essentiality of competencies for the novice CT workforce. Structured feedback was provided between surveys for consensus building, defined by the content validity ratio (CVR).

RESULTS

Survey responses were received from 34 participants across different diagnostic imaging roles and settings. A total of 56 competency statements were agreed as essential for the early career CT workforce, including some appropriate to assistant radiographer practitioner roles. Competencies could be divided into those that were relevant to diagnostic radiography but could be applied to the CT setting (n = 32) and technical attributes unique to the CT context (n = 24).

CONCLUSION

CT competencies for this group centre around understanding technical concepts of image formation and image quality optimisation; patient preparation and contrast media administration.

IMPLICATIONS FOR PRACTICE

The competencies presented in this research represent the agreed minimum standards for the workforce in CT. Further work is required to validate competencies in practice.

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.

Establishing a Standardized Clinical Consensus for Reporting Complications Following Lateral Lumbar Interbody Fusion

Background and Objectives: Mitigating post-operative complications is a key metric of success following interbody fusion. LLIF is associated with a unique complication profile when compared to other approaches, and while numerous studies have attempted to report the incidence of post-operative complications, there is currently no consensus regarding their definitions or reporting structure. The aim of this study was to standardize the classification of complications specific to lateral lumbar interbody fusion (LLIF). Materials and Methods: A search algorithm was employed to identify all the articles that described complications following LLIF. A modified Delphi technique was then used to perform three rounds of consensus among twenty-six anonymized experts across seven countries. Published complications were classified as major, minor, or non-complications using a 60% agreement threshold for consensus. Results: A total of 23 articles were extracted, describing 52 individual complications associated with LLIF. In Round 1, forty-one of the fifty-two events were identified as a complication, while seven were considered to be approach-related occurrences. In Round 2, 36 of the 41 events with complication consensus were classified as major or minor. In Round 3, forty-nine of the fifty-two events were ultimately classified into major or minor complications with consensus, while three events remained without agreement. Vascular injuries, long-term neurologic deficits, and return to the operating room for various etiologies were identified as important consensus complications following LLIF. Non-union did not reach significance and was not classified as a complication. Conclusions: These data provide the first, systematic classification scheme of complications following LLIF. These findings may improve the consistency in the future reporting and analysis of surgical outcomes following LLIF.

Report of a Delphi exercise to inform the design of a research programme on screening for thoracic aortic disease

Objectives

To inform the design of a clinical trial of a targeted screening programme for relatives of individuals affected by thoracic aortic disease, we performed a consensus exercise as to the acceptability of screening, the optimal sequence and choice of tests, long-term patient management, and choice of trial design.

Methods

Working with the Aortic Dissection Awareness UK & Ireland patient association, we performed a Delphi exercise with clinical experts, patients, and carers, consisting of three rounds of consultation followed by a final multi-stakeholder face-to-face workshop.

Results

Thirty-five experts and 84 members of the public took part in the surveys, with 164 patients and clinicians attending the final workshop. There was substantial agreement on the need for a targeted screening pathway that would employ a combined approach (imaging + genetic testing). The target population would include the first- and second-degree adult (> 15 years) relatives, with no upper age limit of affected patients. Disagreement persisted about the screening process, sequence, personnel, the imaging method to adopt, computed tomography (CT) scan vs magnetic resonance imaging (MRI), and the specifics of a potential trial, including willingness to undergo randomisation, and measures of effectiveness and acceptability.

Conclusion

A Delphi process, initiated by patients, identified areas of uncertainty with respect to behaviour, process, and the design of a targeted screening programme for thoracic aortic disease that requires further research prior to any future trial.

Counseling Competencies in Audiology: A Modified Delphi Study

Purpose Counseling practices in audiology play a critical role in helping patients and families understand, accept, and adjust to the dynamic impacts ear-related disorders have on their lives. The purpose of this study was to identify what competencies (i.e., knowledge, skills, and attitudes) are important for audiologists to possess to provide effective counseling in practice. Method A modified Delphi study design was used to survey a panel of 33 professionals with expertise in audiologic counseling from 5 different countries. In the 1st survey round, experts were asked to respond to 3 open-ended prompts. Responses were condensed and revised into items experts were asked to rate during the 2nd and 3rd survey rounds, on a 6-point Likert scale of importance. Results A total of 819 items were generated from the open-ended prompts. A total of 72 items were included in the 2nd and 3rd rounds of survey instruments. Consensus was met on 64 audiologic counseling competency items. Conclusions The competency items identified in this study reflect important knowledge, skills, and attitudes that are important to audiologic counseling. Items that met consensus in this study can inform competencies audiology students can acquire during graduate training. Practice guidelines in the field currently lack the necessary clarity and detail needed for implementation of counseling competencies in clinical education. Future research is needed to explore factors important for implementation of evidence-based counseling training in graduate audiology programs.

Framework of behavioral indicators evaluating TB health promotion outcomes: a modified Delphi study of TB policymakers and health workers

Background

Although TB health promotion directed at policy makers and healthcare workers (HCWs) is considered important to tuberculosis (TB) control, no indicators currently assess the impact of such promotional activities. This article is the second in a series of papers that seek to establish a framework of behavioral indicators for outcome evaluation of TB health promotion, using the Delphi method. In the first article, we sought to establish a framework of behavioral indicators for outcome evaluation of TB health promotion among TB suspects and patients. The objective of this second article is to present an indicator framework that can be used to assess behavioral outcomes of TB health promotion directed at policy makers and HCWs.

Methods

A two-round, modified Delphi method was used to establish the indicators. Sixteen experts who were knowledgeable and experienced in the field of TB control were consulted in Delphi surveys. A questionnaire was developed following 4 steps, and involved ranking indicators on a five-point Likert scale. The consensus level was 70 %. Median, mode, and Coefficient of variation (CV) were used to describe expert responses. An authority coefficient (Cr) was used to assess the degree of each expert’s authority.

Results

Consensus was achieved following the two survey rounds and several iterations among the experts. For TB health-promotion activities directed at policymakers, the experts reached consensus on 2 domains (“Resource inputs” and “Policymaking and monitoring behaviors”), 4 subdomains (“Human resources” among others), and 13 indicators (“Human resources per 100,000 person” among others). For TB health-promotion activities directed at HCWs, the experts reached consensus on 5 domains (“Self-protective behaviors” among others), 6 sub-domains (“Preventing infection” among others), and 15 indicators (“Average hours of daily workplace disinfection by ultraviolet radiation” among others).

Conclusions

This study identified a conceptual framework of core behavioral indicators to evaluate TB health-promotion activities directed at policymakers and HCWs involved in TB control. Validation in other parts of the world could lead to global consensus on behavioral indicators to evaluate TB health promotion targeted at policymakers and HCWs.

Electronic supplementary material

The online version of this article (doi:10.1186/s40249-015-0087-4) contains supplementary material, which is available to authorized users.

Framework of behavioral indicators for outcome evaluation of TB health promotion: a Delphi study of TB suspects and Tb patients

Background

Health promotion for prevention and control of Tuberculosis (TB) is implemented worldwide because of its importance, but few reports have evaluated its impact on behavior due to a lack of standard outcome indicators. The objective of this study was to establish a framework of behavioral indicators for outcome evaluation of TB health promotion among TB suspects and patients.

Methods

A two-round modified Delphi method involving sixteen TB control experts was used to establish a framework of behavioral indicators for outcome evaluation of TB health promotion targeted at TB suspects and patients.

Results

Sixteen of seventeen invited experts in TB control (authority score of 0.91 on a 1.0 scale) participated in round 1 survey. All sixteen experts also participated in a second round survey. After two rounds of surveys and several iterations among the experts, there was consensus on a framework of indicators for measuring outcomes of TB health promotion for TB suspects and patients. For TB suspects, the experts reached consensus on 2 domains (“Healthcare seeking behavior” and “Transmission prevention”), 3 subdomains (“Seeking care after onset of TB symptoms”, “Pathways of seeking care” and “Interpersonal contact etiquette”), and 8 indicators (including among others, “Length of patient delay”). For TB patients, consensus was reached on 3 domains (“Adherence to treatment”, “Healthy lifestyle” and “Transmission prevention”), 8 subdomains (including among others, “Adherence to their medication”), and 14 indicators (including “Percentage of patients who adhered to their medication”). Operational definitions and data sources were provided for each indicator.

Conclusions

The findings of this study provide the basis for debate among international experts on a framework for achieving global consensus on outcome indicators for TB health promotion interventions targeted at TB patients and suspects. Such consensus will help to increase effectiveness of TB health promotion, while ensuring international comparability of outcome data.

Metal allergy screening prior to joint arthroplasty and its influence on implant choice: a delphi consensus study amongst orthopaedic arthroplasty surgeons

Purpose

This study was undertaken to obtain a consensus amongst joint arthroplasty experts with regards to metal allergy screening prior to joint arthroplasty and the choice of implant in patients with potential metal allergy.

Materials and Methods

A web based Delphi consensus study was used including orthopaedic surgeons that had previously published on the topic of knee, hip or shoulder arthroplasty. Two rounds of questionnaires were sent via electronic mail. Consensus was considered reached if agreement was 60% or higher.

Results

Eighteen surgeons responded to the first and 17 to the second round of questionnaires. There was consensus that patients having metal arthroplasty surgery should not be routinely questioned about metal allergy prior to surgery. There was consensus that patch testing is not necessary even if metal allergy is suspected. Most respondents agreed in proceeding with cobalt chromium or stainless steel implant in patients suspected of metal allergy regardless of the results of cutaneous patch testing.

Conclusions

This consensus study suggests that routine metal allergy screening prior to joint arthroplasty is not essential. The use of traditional cobalt chromium/stainless steel implants is recommended regardless of the patient's metal allergy status based on expert opinion through this study.

Selection of drug-laboratory result pairs for an inpatient asynchronous alert program: results of a Delphi survey

PURPOSE

Combinations of drugs and laboratory values ("drug-laboratory pairs") that represent practical high-priority targets for potential use in a daily asynchronous inpatient clinical decision-support (CDS) alert report were identified.

METHODS

A list of 654 drug-laboratory pairs compiled through a literature review was evaluated by a multidisciplinary expert panel in a modified Delphi procedure. After initial evaluation to narrow the list to 89 drug-laboratory pairs, panelists used Likert scales to rate the remaining pairs on six dimensions (frequency of alert, likelihood of harm, severity of harm, preventability, ameliorability, and global impression of usefulness) in Delphi survey rounds until consensus emerged. Final selection of pairs for potential use as CDS tools was based on global-impression-of-usefulness scores. Correlations between impression of usefulness and other evaluative dimensions were determined.

RESULTS

The Delphi process yielded a final list of 24 high-priority drug-laboratory pairs. The highest-ranked pairs were heparin- low platelet count, potassium supplement- high serum potassium, angiotensin-converting-enzyme inhibitor-high serum potassium, and heparin-positive heparin platelet factor 4 antibody test. Medications on the final list included nine anticoagulants, six cardiologic agents, four antimicrobials, and two electrolytes. Most of the selected drug-laboratory pairs related to renal function, serum potassium levels, hematologic results, or pregnancy. Panelists' impression of usefulness was significantly correlated with severity-of-harm ratings (p < 0.0001).

CONCLUSION

Expert review of drug- laboratory value pairs for potential inclusion in an asynchronous monitoring program yielded 24 high-priority and practical pairs for monitoring. About 25% of the pairs had not been the focus of previous laboratory-pharmacy CDS at the study panelists' home institutions.

Benchmarks for effective primary care-based nursing services for adults with depression: a Delphi study

AIM

This paper is a report of a study conducted to identify and gain consensus on appropriate benchmarks for effective primary care-based nursing services for adults with depression.

BACKGROUND

Worldwide evidence suggests that between 5% and 16% of the population have a diagnosis of depression. Most of their care and treatment takes place in primary care. In recent years, primary care nurses, including community mental health nurses, have become more involved in the identification and management of patients with depression; however, there are no appropriate benchmarks to guide, develop and support their practice.

METHOD

In 2006, a three-round electronic Delphi survey was completed by a United Kingdom multi-professional expert panel (n = 67).

FINDINGS

Round 1 generated 1216 statements relating to structures (such as training and protocols), processes (such as access and screening) and outcomes (such as patient satisfaction and treatments). Content analysis was used to collapse statements into 140 benchmarks. Seventy-three benchmarks achieved consensus during subsequent rounds. Of these, 45 (61%) were related to structures, 18 (25%) to processes and 10 (14%) to outcomes.

CONCLUSION

Multi-professional primary care staff have similar views about the appropriate benchmarks for care of adults with depression. These benchmarks could serve as a foundation for depression improvement initiatives in primary care and ongoing research into depression management by nurses.

Identifying research priorities for midwifery in Ireland

OBJECTIVE

to identify research priorities for midwifery in Ireland in the short, medium and long term.

METHOD

a three-round Delphi survey design was used to identify midwifery research topics. Issues identified through content analysis formed Questionnaires 2 and 3. Participants rated the importance of each topic (1=low importance to 7=high importance), and a mean score of 6.0 or more was considered a priority issue. A final discussion group set short-, medium- or long-term timeframes for the research topics.

PARTICIPANTS

334 midwives were recruited from a national invitation to all midwives. Response rates were 43% (Round 1; 142/334), 85% (Round 2; 121/142) and 81% (Round 3; 98/121). Nine consumers of maternity services were included in the discussion group workshop.

FINDINGS

participants identified 11 clinical, eight management, and seven education midwifery research topics with six high-priority issues: promoting woman-centred care (management), promoting the distinctiveness of midwifery (education), satisfaction with care (clinical), care in labour (clinical), preparation for practice (clinical), and promoting research/evidence-based practice (education).

KEY CONCLUSIONS

this research sought to achieve consensus amongst a representative sample of midwives on the priorities for midwifery research in Ireland. Midwives can now select topics for graduate or other research studies of importance to practice, management and education. Funding agencies can confidently direct the allocation of national and local funding for priority areas of midwifery research within Ireland.

Do we agree? Using a Delphi technique to develop consensus on skills of hand expression

The Delphi technique provides a structured process for collecting and examining group agreement on a topic. It facilitates anonymity and thus reduces the risk of stronger members dominating the group discussion, and it allows geographical spread of the participants as well as low cost and timely return. This article describes the use of Delphi to examine agreement and lack of agreement among an expert panel on what skills a mother needs to learn for hand expression. A Delphi technique can be used for a variety of topics and participants.

Priorities for midwifery research in Perth, Western Australia: A Delphi study

This paper reports a two-round Delphi study undertaken to identify the research priorities of midwives at five public maternity hospitals in Western Australia's metropolitan area of Perth. In round one, 117 midwives identified 64 different problems or issues for research. Using thematic content analysis, these problems were grouped together and then collapsed to develop 17 specific research topics within four major categories. In round two, 152 midwives were asked to rank how important each of the topic statements were to women, their families and midwives. Research focusing on 'the postnatal experience' was ranked by midwives as the most important to the care of women and their families. From a midwife's perspective, the highest ranked topic was 'examining the professional issues that impact on midwives' clinical practice' (e.g. midwifery and medical collaboration, potential litigation and horizontal violence in the workplace). The results of the study show that Western Australian midwives, like their national and international colleagues, are concerned about the delivery and organization of maternity services, the invisibility of the postnatal experience and how to operationalize evidence-based care in the clinical area.

A qualitative study exploring the support needs of first-time mothers on their journey towards intuitive parenting

OBJECTIVE

to gain an understanding of the experiences of first-time mothers in the early weeks of motherhood in order to elicit what areas of support these women find empowering in easing their adjustment.

DESIGN

a grounded theory approach was used. Data were collected through individual in-depth interviews.

SETTING

an area in the South of England with maternity services provided by a consultant obstetric unit and four midwife-led centres.

PARTICIPANTS

eight primiparous women aged 20-39 years, who had given birth normally at term to a healthy baby.

FINDINGS

five categories 'expert to novice', 'losing touch', 'perceiving expertise', 'restoring balance' and 'falling into place' revealed a journey women travelled as they left behind their comfortable, controlled lives in which they were 'experts' and faced the unknown world of motherhood. Eventually, practice, support and knowledge shared with peers facilitated proficiency and intuitive mothering. Throughout this transition, the overriding concern of the mothers was to develop confidence and skills to give optimal care to their baby. 'Doing it right' emerged as the core category.

IMPLICATIONS FOR PRACTICE

an understanding of the factors women considered to be supportive or inhibitive in easing their adjustment to motherhood might enable midwives to move beyond more traditional forms of postnatal care to explore innovative ways of providing and facilitating access to supportive resources.