Nitric oxide education survey – Use of a Delphi survey to produce guidelines for training neonatal nurses to work with inhaled nitric oxide

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Abstract

The pulmonary vasodilator nitric oxide is potentially dangerous for both patients and staff. There is however little published guidance about appropriate training for staff. This study used the Delphi survey technique to identify consensus opinion, amongst a group of experts, on how best to train neonatal nurses to work safely and effectively with nitric oxide. The consensus was used to formulate generic training guidelines which can be used to guide staff who are running or setting up nitric oxide training programmes. An internet site was established to publicise the survey and resulting guidelines and to act as a resource for neonatal staff seeking information about nitric oxide.

Section snippets

Background

Administered in the form of a gas added to ventilator circuits, the pulmonary vasodilator inhaled Nitric Oxide (iNO) was introduced to clinical practice in the early nineteen nineties (Glynn, 1999) and is now used on many neonatal units worldwide. Though much has been written about the clinical benefits of iNO there is little information available about how to prepare nurses to work safely with this potentially hazardous substance. Anecdotal reports, and personal experience gained working as

Aims

The main aim of this study was to use the Delphi survey technique to obtain, from a group of neonatal nurses, consultants and technicians, an expert consensus on iNO training that could be used to produce generic training guidelines. Secondary aims were to publicise the survey and set up a general resource for information about iNO. A website www.nitric-oxide-survey.com was established for this purpose.

The Delphi technique

The Delphi survey technique is a qualitative approach developed in the 1950s as a way to allow a group of experts to generate discussion and make policy decisions without face to face meetings (Goodman, 1987). It derives its name from the oracle at Delphi in ancient Greece where skills of interpretation and foresight were used to predict future events (Jones and Hunter, 1995). Serial rounds of questionnaires, which canvass opinion from a panel of experts, are used to identify consensus opinion

Participants, sample size and consensus

There is no definitive guide to the ideal sample size for a Delphi survey (Beretta, 1996) but there must be reasonable representation of potentially available expert opinion. To recruit expert participants for this survey all UK neonatal units with eight or more intensive cots (thirty three in total) were identified and approached (except the base unit of the author). The rationale for selection was that units undertaking a large amount of intensive care work would be likely to have staff very

Trustworthiness

For qualitative methods such as Delphi the term ‘trustworthiness’ may be more appropriate than reliability and validity when examining how effective and appropriate a study is (Holloway and Wheeler, 1996). The four aspects of trustworthiness are dependability, credibility, confirmability and transferability (Polit et al., 2001). It has been suggested that dependability and credibility are to qualitative work what reliability and validity are to quantitative work (Polit et al., 2001).

Data collection

Data was collected, over a period of eight months ending in July 2005, via three rounds of postal questionnaires. The first round questionnaire of a Delphi survey usually has a simple format (Beech, 1999) and is intended to gain broad responses about a subject (Beretta, 1996). The investigator collates responses and compiles a second questionnaire covering issues identified by the first round (Williams and Webb, 1994). This is done in a way that allows participants to score agreement or

Results

There was little change in opinion between the second and third rounds – participants were generally consistent in how they scored questions. Consensus was reached in eighty four of one hundred and nineteen items that emerged from the first round and were then scored in the second and third rounds. Whilst this was not complete agreement there was sufficient consensus to allow production of some generic guidelines (Appendix 2) related to the training of neonatal nurses to use iNO. The main aim

Discussion

The Delphi survey technique has been used to identify consensus opinion amongst a group of medical, nursing and technical staff expert in iNO therapy. Whilst this method can at times be justifiably criticised the use of an expert panel, recruited from several professional disciplines and almost two thirds of the targeted neonatal units, gives the results of this survey sufficient trustworthiness for use as the basis for consensus derived training guidelines. Several independent personnel

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    Sources of funding (apart from employer): Draeger Neonatal Nurse Education Scholarship.

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