Identifying cancer nursing research priorities using the Delphi technique

BACKGROUND: Nursing research is an integral component of improving the care of people with cancer. However, for research to be successfully integrated and applied to practice, ownership and identification must come from those in practice. The need for local and national strategies for cancer nursing research and the importance of establishing priorities for cancer nursing research have been repeatedly acknowledged. STUDY AIM: The aim of the study was to facilitate a strategic approach to cancer nursing research by identifying the research priorities of cancer nurses. RESEARCH METHOD: A three-round Delphi survey was administered to nurses (n = 112) attending a cancer nursing research conference in Northern Ireland. Participants were asked to identify five research questions that they considered a high priority for cancer nursing. A response rate of 54% (60 delegates) was obtained for round one and this generated 117 statements. These statements were content analysed. Two subsequent quantitative rounds followed this. RESULTS: The top priority areas identified were psychosocial issues, for example communication and information needs; professional issues relating to nurse burnout, stress and nurse-led care; and context of care issues including continuity of care. LIMITATIONS: A potential limitation of the study is the use of conference delegates. However, it is argued that these are the people we wanted to target as they could be considered as experts who already had an interest and clinical background in both cancer research and practice. CONCLUSION: These priorities have helped to provide both direction and focus for the development of a cancer nursing research strategy for Northern Ireland. It is recommended that future research questions should be focused around the highest ranked priorities.     

Research priorities for parenting and child health: a Delphi study

AIM: This paper is a report of a study to identify research priorities of clinical staff working with families at a Western Australian centre for parenting. BACKGROUND: Australian centres for parenting focus on children's needs while working in partnership with parents, families and their communities. These agencies incorporate primary healthcare strategies in their unique approach with families. Clinicians' research priorities at these centres have not been explored in an Australian context. METHOD: In 2005, a Delphi study was conducted in which clinicians were asked to provide a list of five important issues relating to care provided to children, parents and their families. Research topics identified were then ranked for their importance to the family and clinicians. Finally, the top 10 research topics were ranked for priority. FINDINGS: In round 1, 148 research topics were identified. Thirty-six topics were removed, due to the availability of existing evidence. Content analysis was used to collapse statements into 26 research questions, which were further classified into seven categories: parenting issues; sleep and settling issues; postnatal depression; evaluation and impact of programmes; staffing issues; centre marketing services and others. Issues relating to sleep and settling and postnatal depression were rated as top research priorities. CONCLUSION: The priorities of clinicians working with families provide research direction for this Western Australian centre and potentially other centres in Australia and similar settings elsewhere in the world. The Delphi approach in determining clinicians' perceptions of relevant research areas may be useful to direct research in other contexts.     

Impact of the role of nurse, midwife and health visitor consultant

AIM: This paper describes the findings from one aspect of an evaluation study of the role of the nurse, midwife and health visitor consultant and the consultants' perceived impact of their role on services and patient care. BACKGROUND: The nurse, midwife and health visitor consultant role was established in 2000 in England to improve patient care, strengthen leadership and provide a clinical career opportunity for nurses, midwives and health visitors. An evaluative study was commissioned to report on the role 4 years after the new consultant posts were first established. METHOD: A multimethod evaluation was undertaken in 2002-2003 combining focus groups, telephone interviews and a comprehensive questionnaire survey of all the consultants in England. Four hundred and nineteen consultants responded to the questionnaire, 22 volunteered for the focus groups and 32 participated in the interviews. RESULTS: Nearly half (44%) the consultants who responded to the survey reported having a substantial impact on their service and 55% reported having some positive impact. High reported impact increased to 71% for those who had been in post for 2 years or longer. Consultants felt that they had been most successful in providing better support to staff, but only 10% said that they had a major impact on reducing unnecessary expenditure within the service. Factors associated with high levels of reported impact included engagement in a wide range of activities, perceived competence in the role and strong medical support. Those reporting most impact also reported the greatest dissatisfaction with salary. CONCLUSION: As consultants become more established in their posts, they are able to identify improvements in practice, service reconfiguration and educational advantages for staff. Our findings suggest that the true influence of these posts will become clearer over time as the impact of consultants on long-term organizational change becomes more apparent.     

Identifying research priorities for the health care of children and adolescents

In an effort to identify priority statements for research into the healthcare of children and adolescents a search of multiple research databases and the Internet was undertaken. There is a considerable body of literature outlining research priorities that are built around specific disorders or specialist services, which are not readily applicable to the general healthcare of children and adolescents. A few general statements of research priorities were identified, but these were mainly developed to inform research programs in the US. In addition there was little evidence that these agendas had incorporated the needs of the consumers of this healthcare namely, children and adolescents, and their families. Therefore, there is a need to address the needs of a broader community in regards to the research agenda for the healthcare of children and adolescents. The advantage of an agenda developed by multiple stakeholder groups is that it will have broader meaning to a wider community. However at this stage, there is no such statement that can readily inform a general program of reserch into the healthcare of children and adolescents.     

Training for health education with older people: a survey of district nurse and health visitor courses

This paper reports on a survey of the coverage of health issues in relation to older people, on district nurse and health visitor courses. The evidence suggests that only limited coverage is given to issues which affect those in the age group 45 65 years. It is suggested that this group should become an important target for health education in the community. The implications of this for nurse educators are explored.     

Development of a fall-risk checklist using the Delphi technique

Aims and objectives. This study developed a checklist of both intrinsic and extrinsic risk factors for falls among older people based on consensus among a panel of experts and obtained expert content validity. The developed checklist is intended to help nurses better understand risk factors and take effective measures to prevent falls. Background. Ageing involves changes in musculoskeletal and neuromuscular systems that make older people more prone to balance problems and falling. While it is believed that both environmental factors and personal habits play important roles in predisposing older people to falls, few broad‐based approach checklists to identify both intrinsic and extrinsic risk factors have been published. Even fewer checklists addressing psychosocial problems currently exist. The authors developed a preliminary checklist through literature review. Design. This study was designed using the Delphi technique, which is widely accepted as an effective method to secure consensus from experts of different backgrounds and perspectives. Methods. The Delphi technique was used to consolidate and compare the opinions of qualified experts from six different fields over three review rounds. Experts’ content validity index was used to confirm validity. Results. Authors developed a preliminary checklist covering nine domains, which, after using the Delphi technique, was expanded to the 10 domains of demographics, illness, medicine, balance measurement, footwear, nutrition, cognitive function, social support, environment and fear of falling. Changes based on panel member suggestions made in the first review round included clarification of definitions for ‘dim light’, ‘slippery’, ‘doormat’ and ‘clutter’ and revisions to definitions of cigarette and alcohol consumption and types of exercise. Changes made following the second round review included clarification of the meaning and function of social support and the replacement of SPMSQ with MMSE. In the final round, the term ‘physical mental disturbance’ was changed to ‘fear of falling’. The scores of CVI were very high. Conclusions. The Delphi technique was used successfully to refine the author‐developed checklist based on experts’ input. To ensure expert input reliability, concepts were defined by the authors and supported with photographs and videos, as needed. Relevance to clinical practice. The checklist helps assess risk factors and identify older people at higher risk of falls and may help reduce fall risk.     

An approach to consensus building using the Delphi technique: developing a learning resource in mental health

Health service research is best served through the collaboration of researchers and practitioners. This study utilizes a multi-method approach in developing a learning resource in clinical risk management in mental health. Phase one of the project is reported here; using a Delphi Technique to build the learning resource. Using the Delphi enabled a group of 'experts' to explore a complex issue and move towards consensus. In addition, the Delphi technique enabled the researchers to repeatedly access a dispersed group of 'experts' in an economic way. A three round Delphi was undertaken and results were analyzed (medians, means, standard deviations and thematic content analysis) to facilitate consensus building from a range of perspectives. The analytical model chosen is discussed in the context of prior use of the Delphi as a consensus building technique. The researchers conclude that analysis using medians and means to measure the level of agreement/disagreement with the content and structure of the learning pack, standard deviations to measure 'tightening' of the group view and Thematic Content Analysis of qualitative data was an effective approach. They argue that in the education and health fields, group views are particularly important and that this is a central tenet of the Delphi.     

Identifying nurse sensitive indicators specific to haemodialysis nursing: A Delphi approach

BackgroundNurse sensitive indicators measure the quality of care that is specific to the practice of nurses. There are currently few indicators suitable to measure haemodialysis nursing practice.AimTo identify haemodialysis nurse sensitive indicators.MethodsThe Delphi technique, an iterative process, was used to attain consensus from a national expert panel of haemodialysis registered nurses. The panel rated their level of agreement, importance and frequency of nurse sensitive indicators using online surveys that included qualitative feedback. Results of each round shaped subsequent rounds. Consensus was set at greater than 70.0%.FindingsThe 38-member expert panel had a median haemodialysis experience of 17 years (IQR 8.5–22) and 89% had attained a specialist post-registration renal qualification. Round 1 assessed the suitability of 38 nurse sensitive indicators. Those indicators failing to achieve consensus were retested and removed after round 2 (n = 12). Round 3 assessed a modified list of 26 nurse sensitive indicators with all achieving consensus. The fourth and final round was used to both provide feedback to the expert panel and to elicit further qualitative feedback.DiscussionA comprehensive set of quality indicators to measure nursing-sensitive activities in the specialised context of haemodialysis have been developed.ConclusionThese 26 haemodialysis nurse sensitive indicators capture the structures, processes and outcomes which could measure the quality of nursing care provided to people receiving haemodialysis.     

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.