Using the Delphi technique to design a self-reporting triage survey tool

Use of the Delphi Method in the Construction of the Temperature Chain Management Scheme for Da Vinci Robot-Assisted Urological Surgical Patients

The study aimed to construct a temperature chain management scheme in patients undergoing Da Vinci Robot-assisted surgery in urological surgical patients by the Delphi method, providing a reference for the prevention and treatment of the inadvertent perioperative hypothermia. First, instructing by the Joanna Briggs Institute (JBI) Evidence-Based Healthcare model and systematically reviewing literature related to the prevention and treatment of perioperative hypothermia in Da Vinci robot-assisted surgery patients in the urological surgical patients from guideline-related websites and professional association websites. Second, carrying out the qualitative interviews, which were conducted with medical staff in the urology department and the Da Vinci robot-assisted surgery team in a teaching hospital. Third, a temperature chain management scheme draft was obtained by a panel meeting. Finally, using the Delphi method to evaluate the draft, demonstrating its scientificity and feasibility, and obtaining the final scheme. The temperature chain management scheme constructed by a Delphi method, embraced seven links from preoperative ward, preoperative transfer, anesthesia waiting room, operating room, postanesthesia recovery room, postoperative transfer, and postoperative ward. The enthusiasm degree of both rounds of expert consultation was 100%, with expert authority levels of 0.875 and 0.888, respectively, indicating good representativeness and authority. Kendall's coefficient in two rounds was 0.220 and 0.400, respectively, indicating a trend toward consensus among experts, which indicated the scheme had a high degree of credibility and feasibility. The temperature chain management scheme for Da Vinci robot-assisted surgery patients in the urology department, constructed by the Delphi method, is both scientific and feasible.

Korean Triage and Acuity Scale education using role-playing and its effects on triage competency: A quasi-experimental design

Triage is the process of prioritizing patients in the emergency department (ED). This has a pivotal role in ensuring patient safety and that the ED operates smoothly; therefore, triage training education is an important aspect of triage nurses' preparedness in different emergency situations. This study employed a quasi-experimental research design using a non-equivalent control group pre-post-test design to verify the effect of the Korean Triage and Acuity Scale (KTAS) education using role-playing on the knowledge of triage, triage performance ability, and triage competency in nursing students. Participants were 78 fourth-year nursing students from Shinseong University in South Korea; 39 were assigned to the experimental group, and 39 to the control group. The intervention was conducted for three weeks, from January 31 to February 16, 2024. The experimental group received KTAS education through role-playing, whereas the control group received triage education through lectures. Triage knowledge (t = 2.94, p = .004) and triage performance ability (t = 3.11, p = .003) were significantly improved in the experimental group. However, there was no significant difference in triage competency between groups (t = 1.32, p = .192). The post-test score of triage record in the experimental group showed a significant improvement over time (t = 0.56, p < .001). This study demonstrated that KTAS education using role-playing was more effective in improving triage knowledge and performance ability than traditional lecture methods for nursing students. Triage education programs should be developed considering the effectiveness of various teaching methods.

Developing a pediatric nursing simulation scenario template in South Korea: applying real-time Delphi methods

PURPOSE

This study aimed to describe the process of developing a validated pediatric nursing simulation scenario template using the real-time Delphi method.

METHODS

A panel of 13 pediatric nursing experts participated in a real-time Delphi survey conducted over two rounds. Initially, 83 items were included in the questionnaire focusing on the structure and content of the simulation scenario template. Data analysis involved calculating the content validity ratio (CVR) and the coefficient of variation to assess item validity and stability.

RESULTS

Through iterative rounds of the Delphi survey, a consensus was reached among the experts, resulting in the development of a pediatric nursing simulation scenario template comprising 41 items across nine parts. The CVR values ranged from 0.85 to 1.0, indicating a high consensus among experts regarding the inclusion of all items in the template.

CONCLUSION

This study presents a novel approach for developing a pediatric nursing simulation scenario template using real-time Delphi methods. The real-time Delphi method facilitated the development of a comprehensive and scientifically grounded pediatric nursing simulation scenario template. Our template aligns with the International Nursing Association for Clinical Simulation and Learning standards, and provides valuable guidance for educators in designing effective simulation scenarios, contributing to enhanced learning outcomes and better preparation for pediatric clinical practice. However, consideration of cultural and contextual adaptations is necessary, and further research should explore alternative consensus criteria.

Design and validation of a conceptual model regarding impact of open science on healthcare research processes

INTRODUCTION

The development and use of digital tools in various stages of research highlight the importance of novel open science methods for an integrated and accessible research system. The objective of this study was to design and validate a conceptual model of open science on healthcare research processes.

METHODS

This research was conducted in three phases using a mixed-methods approach. The first phase employed a qualitative method, namely purposive sampling and semi-structured interview guides to collect data from healthcare researchers and managers. Influential factors of open science on research processes were extracted for refining the components and developing the proposed model; the second phase utilized a panel of experts and collective agreement through purposive sampling. The final phase involved purposive sampling and Delphi technique to validate the components of the proposed model according to researchers' perspectives.

FINDINGS

From the thematic analysis of 20 interview on the study topic, 385 codes, 38 sub-themes, and 14 main themes were extracted for the initial proposed model. These components were reviewed by expert panel members, resulting in 31 sub-themes, 13 main themes, and 4 approved themes. Ultimately, the agreed-upon model was assessed in four layers for validation by the expert panel, and all the components achieved a score of > 75% in two Delphi rounds. The validated model was presented based on the infrastructure and culture layers, as well as supervision, assessment, publication, and sharing.

CONCLUSION

To effectively implement these methods in the research process, it is essential to create cultural and infrastructural backgrounds and predefined requirements for preventing potential abuses and privacy concerns in the healthcare system. Applying these principles will lead to greater access to outputs, increasing the credibility of research results and the utilization of collective intelligence in solving healthcare system issues.

Crossover design in triage education: the effectiveness of simulated interactive vs. routine training on student nurses' performance in a disaster situation

INTRODUCTION

This study investigates the effectiveness of incorporating simulated interactive guidelines in nursing students' performance during disaster situations, compared to routine training.

METHOD

This study was a crossover design with pre-and post-tests for two groups. Each group consisted of 60 students selected using the census method. SIG and routine (Face-to-Face) training sessions were conducted as a crossover design. Triage knowledge questionnaires were used in the pretest to assess triage knowledge. An OSCE test was administered in the posttest to assess student performance, followed by a triage skills questionnaire. Both questionnaires were highly reliable, as indicated by Cronbach's alpha coefficients (0.9 and 0.95, respectively). Statistical analysis was performed using SPSS version 26 software at a significance level 0.05.

RESULT

The chi-square test showed that the two groups were homogeneous regarding age. Regarding knowledge level, both groups were homogeneous before the intervention (P = 0.99). Nevertheless, the results of the OSCE test showed that the students in Group A had a higher level of skill than the students in Group B (93% versus 70%). Also, 18% of the students in group B had low skills.

DISCUSSION

The study found that student outcomes improved in both groups receiving SIG, suggesting that interaction and simulation improve learning. However, gamification is an ideal precursor to learning and not a substitute for education. Therefore, gamification should not be used as a stand-alone teaching method.

CONCLUSIONS

The crossover study found that simulators and games should not be considered stand-alone teaching methods but can contribute to learning sustainability when used alongside instruction.

A supportive randomized clinical trial on Iranian infertile women with the history of infertility treatments dropout following unsuccessful ART cycle/s: A study protocol

Introduction

Due to high dropout rate of infertility treatments and lack of any intervention for motivating infertile couples to continue treatments, the present study will be conducted with the aim of designing, implementing and determining the effectiveness of the proposed intervention in order to continue infertility treatments.

Methods

& Analysis: We will conduct this study in two stages; a review of literature and past studies will be done to identify interventions that have been performed for infertile couples, and then an appropriate intervention with the aim of continuing infertility treatments for infertile women will be designed. After that a Delphi study will be designed in accordance with collected information of previous stages and will be approved by experts. In the second stage we will implement designed intervention of a randomized clinical trial on two groups of infertile women (control and intervention) with the history of infertility treatment dropout following unsuccessful cycle. We will use descriptive statistic in first and second stage. In second stage Chi square test and independent samples T test will be used to compare variables between groups and variables in study questionnaires before and after the intervention between two groups of study.

Discussion

The present study will be the first study to be performed as a clinical trial on infertile women who have discontinued the treatments, with the aim of continuing treatments. Thereupon, it seems that the results of this study will be the basis for studies around the world to prevent premature cessation of infertility treatments.

Developing a prioritisation framework for patients in need of coronary artery angiography

BACKGROUND

Effective waiting list management and comprehensive prioritisation can provide timely delivery of appropriate services to ensure that the patient needs are met and increase equity in the provision of health services. We developed a prioritisation framework for patients in need of coronary artery angiography (CAA).

METHODS

We used a multi-methods approach to elicit effective factors that affect CAA patient prioritisation. Qualitative data wase collected using semi-structured interviews with 15 experts. The final set of factors was selected using experts' consensus through modifed Delphi technique. The framework was finalised during expert panel meetings.

RESULTS

212 effective factors were identified based on the literature review, interviews, and expert panel discussion of them, 37 factors were selected for modifed Delphi study. Following two rounds of Delphi discussions, seven final factors were selected and weighed by ten experts using pair-wise comparisons. The following weights were given: the severity of pain and symptoms (0.22), stress testing (0.18), background diseases (0.15), number of myocardial infarctions (0.15), waiting time (0.10), reduction of economic and social performance (0.12), and special conditions (0.08).

CONCLUSION

Clinical effective factors were important for CAA prioritisation framework. Using this framework can potentially lead to improved accountability and justice in the health system.

Applying real-time Delphi methods: development of a pain management survey in emergency nursing

The modified Delphi technique is widely used to develop consensus on group opinion within health services research. However, digital platforms are offering researchers the capacity to undertake a real-time Delphi, which provides novel opportunities to enhance the process. The aim of this case study is to discuss and reflect on the use of a real-time Delphi method for researchers in emergency nursing and cognate areas of practice. A real-time Delphi method was used to develop a national survey examining knowledge, perceptions and factors influencing pain assessment and management practices among Australian emergency nurses. While designing and completing this real-time Delphi study, a number of areas, emerged that demanded careful consideration and provide guidance to future researchers.

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.

Use of the Delphi method to generate guidance in emergency nursing practice: A systematic review

AIM

To examine the application and methodological quality of the Delphi method used in developing guidance for emergency nursing practice.

BACKGROUND

Emergency nursing scope of practice has rapidly expanded in response to increasing patient acuity, complexity and technological innovation. Determining best practice is crucial for delivering high quality, safe and effective emergency nursing care. The Delphi method has been used to identify, prioritise complex issues and develop evidence-driven guidance in emergency nursing practice. The use and quality of the Delphi method in emergency nursing practice has not been examined.

DESIGN

Systematic literature review.

DATABASES AND DATA TREATMENT

A systematic literature search was conducted using the following databases: SCOPUS, EMBASE, Medline and ProQuest from date of inception to August 2019. The database search was limited to scholarly articles or peer-reviewed journals. No language restrictions were applied. The Cochrane Collaboration method and PRISMA checks were utilized to conduct the review.

RESULTS

Of 246 records identified 22 (8.9%) studies met the inclusion criteria. A modified Delphi method was commonly used (n = 15; 68.2%) and often conducted online (n = 11; 50.0%). Eight practice guidance themes were identified. Overall study quality was high (score 12/14; range 4-13), transparency of reporting varied.

CONCLUSION

Based on this review, the Delphi method is an appropriate method for exploring emergency nursing practice. The studies reviewed demonstrated that knowledge, skills and clinical expertise has progressively expanded in the specialty of emergency nursing. Variation in the application, conduct and transparency of reporting in Delphi studies developing guidance for emergency nursing practice is discussed.

Human- Versus Machine Learning-Based Triage Using Digitalized Patient Histories in Primary Care: Comparative Study

BACKGROUND

Smartphones have made it possible for patients to digitally report symptoms before physical primary care visits. Using machine learning (ML), these data offer an opportunity to support decisions about the appropriate level of care (triage).

OBJECTIVE

The purpose of this study was to explore the interrater reliability between human physicians and an automated ML-based triage method.

METHODS

After testing several models, a naïve Bayes triage model was created using data from digital medical histories, capable of classifying digital medical history reports as either in need of urgent physical examination or not in need of urgent physical examination. The model was tested on 300 digital medical history reports and classification was compared with the majority vote of an expert panel of 5 primary care physicians (PCPs). Reliability between raters was measured using both Cohen κ (adjusted for chance agreement) and percentage agreement (not adjusted for chance agreement).

RESULTS

Interrater reliability as measured by Cohen κ was 0.17 when comparing the majority vote of the reference group with the model. Agreement was 74% (138/186) for cases judged not in need of urgent physical examination and 42% (38/90) for cases judged to be in need of urgent physical examination. No specific features linked to the model's triage decision could be identified. Between physicians within the panel, Cohen κ was 0.2. Intrarater reliability when 1 physician retriaged 50 reports resulted in Cohen κ of 0.55.

CONCLUSIONS

Low interrater and intrarater agreement in triage decisions among PCPs limits the possibility to use human decisions as a reference for ML to automate triage in primary care.

Pain assessment and interventions by nurses in the emergency department: A national survey

AIM

The aim of this study was to examine the knowledge, perceptions and factors influencing pain assessment and management practices among Australian emergency nurses.

BACKGROUND

Pain is the most commonly reported symptom in patients presenting to the emergency department, with over half rating their pain as moderate-to-severe. Patients unable to communicate, such as critically ill intubated patients, are at greater risk of inadequate pain management.

DESIGN

This cross-sectional exploratory study used survey methodology to explore knowledge, perceptions and factors influencing pain management practices among Australian emergency nurses.

METHODS

Australian emergency nurses were invited to complete an online survey comprising 91 items. The response rate was 450 of 1,488 (30.2%). STROBE guidelines were used in reporting this study.

RESULTS

Variations in level of acute pain management knowledge, especially in older, cognitively impaired or mechanically ventilated patients were identified. Poor interprofessional communication, workload and staffing negatively impacted on nurses' intention to administer analgesia. For intubated patients, validated observation pain assessment instruments were rarely used, although respondents recognised the importance of pain management in critically ill patients.

CONCLUSIONS

Emergency nurses recognise the importance of pain relief. The ability to nurse-initiate analgesia, education and training in pain management education is variable. Little education is provided on assessing and managing acute pain in elderly, cognitively impaired or mechanically ventilated patients. Use of validated pain assessment instruments to assess pain in critically ill patients is poor.

RELEVANCE TO CLINICAL PRACTICE

While pain management is the responsibility of all healthcare professionals, in the emergency department, it is a core role of emergency nursing. This study highlights the variation in ability to nurse-initiate analgesia, level of acute pain knowledge, education and training, and use of validated pain assessment instruments to guide pain management in critically ill intubated patients.

Significant influencing factors and practical solutions in improvement of clinical nursing services: a Delphi study

Background

Clinical services evaluation with specific indicators are very helpful to identify improvable points. This study was conducted to analyze the factors affecting the quality of clinical nursing services and offer practical solutions for accreditation of clinical nursing services.

Methods

The present study was conducted using Delphi method with two rounds. At the beginning of the study a questionnaire was prepared using results of another project (clinical nursing services audit). This questionnaire was sent to 47 nursing and accreditation professionals. After the first round, causes and solutions were categorized. Then participants were asked to comment on the significance of each strategy on the prepared questionnaire.

Results

In the first round of Delphi in response to the question about the main causes and solutions of low quality of nursing clinical services, 394 causes and 212 solutions were mentioned by the participants. In the second round, considering moralists and specialization in the selection of nursing managers, staffing according to workload and attendance in comprehensive exam after graduation and before entering clinical fields attained the most importance.

Conclusion

Mismatch of human resources with workload and lack of clarity with regard to duties have maximum correlation with poor quality of care. Organizational structure and communication program categories gained the highest and lowest importance respectively. This information could be used by nursing managers and policy makers to plan programs in order to improve the quality of clinical nursing services.

Comparison of scenario based triage education by lecture and role playing on knowledge and practice of nursing students

INTRODUCTION

Quick and accurate triage of patients in the emergency department is a key factor for successful management of the emergency situations and ensuring the quality of care. Moreover, triage skills education is one of the important aspects of preparedness of nurses for different emergency situations. The objective of this study was to compare the effect of educating emergency severity index (ESI) triage using lecture and role-playing on the knowledge and practice of nursing students.

METHODS

This experimental study was conducted in the School of Nursing and Midwifery, Tabriz, Iran, in 2016. In this study, 56 nursing students were selected by convenience sampling method and were randomly divided into two groups. Triage scenarios were taught and presented in two ways by using lecture or role-playing method. One month later, the post-test was taken. Data were collected using a questionnaire assessing the knowledge and practice of ESI and were analysed using SPSS (version 21).

RESULTS

The mean knowledge and practice scores in both groups improved significantly (p < 0.05). The post-test score showed a significant difference between the two groups, and the mean score was higher in the role-playing group compared with that of the lecture group (p < 0.05).

DISCUSSION

The results showed the effectiveness of both educational methods on students' learning. However, the role-playing method was more effective than the lecture method and is recommended for triage education. In addition, according to the importance of triage, developing the theoretical and practical education courses for nursing students is recommended.

Interprofessional Teamwork Education: Moving Toward the Patient-Centered Approach

HOW TO OBTAIN CONTACT HOURS BY READING THIS ISSUE Instructions: 1.3 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded after you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. In order to obtain contact hours you must: 1. Read the article, "Interprofessional Teamwork Education: Moving Toward the Patient-Centered Approach," found on pages 449-460, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website to register for contact hour credit. You will be asked to provide your name, contact information, and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until September 30, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. OBJECTIVES Explain the recommended framework in teaching and implementing interprofessional competencies. Identify suggested core competencies to implement interprofessional collaborative practice. DISCLOSURE STATEMENT Neither the planners nor the author have any conflicts of interest to disclose.

BACKGROUND

The aim of this study is to develop and contextualize a competency framework for interprofessional teamwork in Iran.

METHOD

The study was conducted in three phases. First, the competencies of interprofessional teamwork were extracted from the literature. In the second phase, the content validity of the initial framework was assessed by the experts through the Delphi rounds. Content validity ratio (CVR) and item-level content validity index (I-CVI) were used for quantitative analysis. Finally, in the third phase, the importance and utility of interprofessional teamwork competencies were assessed by the experts.

RESULTS

Initial framework was constructed with 28 competencies. Quantitative analysis by CVR indicated a score of less than .49 for three items. These items were excluded from the framework. The I-CVI for all items in the framework was higher than .78. The final framework was developed and validated with 16 competencies.

DISCUSSION

The developed framework is recommended for teaching and assessment of interprofessional teamwork competencies. J Contin Educ Nurs. 2016;47(10):449-460.

An educational framework for triage nursing based on gatekeeping, timekeeping and decision-making processes

INTRODUCTION

The role of the triage nurse has emerged in response to growing community demand for a more accessible and efficient emergency department (ED) service. The focus of triage research has been on measuring outcomes and improving the delivery of emergency care. This has meant that the context of care, and triage processes and practices have remained concealed. Thus, little evidence about the role and ways to prepare nurses for this role is available. The aim of this study was to provide insight and understanding needed to educate and support the triage nursing role in Australian EDs.

METHODS

A 12-month ethnographic study of triage nursing practice was conducted in Sydney metropolitan EDs. Data were then collected from participant observation in four EDs and interviews with 10 triage nurses. Analysis used standard content and thematic analysis techniques.

FINDINGS

Findings reveal that notions of timeliness, efficiency and equity are embedded in a culture of ED care. This sustains a particular cadence of care to which triage nurses are culturally oriented. Triage nurses maintain, negotiate and restore this cadence of emergency care by using gatekeeping, timekeeping and decision-making processes.

CONCLUSION

The comprehensive study of triage nursing has led to the development of an educational framework based on the processes of gatekeeping, timekeeping and decision-making.