Nitric oxide education survey – Use of a Delphi survey to produce guidelines for training neonatal nurses to work with inhaled 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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Cited by (21)
Mixed methods and the Delphi method
2022, International Encyclopedia of Education: Fourth EditionStandards for maternity care professionals attending planned upright breech births: A Delphi study
2016, MidwiferyCitation Excerpt :The Delphi method has been applied in many areas of medical and midwifery practice, including analysis of professional characteristics and competencies, developing education programmes, exploring clinical skills, and enabling expansion of the midwifery sphere of practice to include a specialist skill set (Thompson et al., 2011; Michels et al., 2012; Eskes et al., 2014; Walker et al., 2015). The perceived expertise of the panel underpins the credibility of the Delphi method, and therefore sampling is a fundamental methodological concern that is described in detail (Cornick, 2006; Hasson and Keeney, 2011). This study prioritised experience in the niche area of practice under consideration.
Essential competencies in nursing education for prevention and care related to unintended pregnancy
2015, JOGNN - Journal of Obstetric, Gynecologic, and Neonatal NursingCitation Excerpt :Consensus was set at 75% because this level is frequently used in current Delphi studies. Further, we hypothesized that there would be strong agreement on most competency items and that the credibility of the final competencies would be strengthened by using a higher consensus level (Cornick, 2006; De Villiers, De Villiers, & Kent, 2005; Gebbie et al., 2002). The study spanned a period of 5 months from June 2013 through October 2013.
Expert Consensus Building using e-Delphi for Necrotizing Enterocolitis Risk Assessment
2013, JOGNN - Journal of Obstetric, Gynecologic, and Neonatal NursingCitation Excerpt :An e‐Delphi has the additional benefits of economy and quick feedback of responses to panelists over multiple rounds. Neonatal nurse researchers have found the Delphi useful to evaluate best practices for caring for vulnerable neonates (Mainous, 2008), develop a neonatal end‐of‐life palliative care protocol (Catlin, 2003), and adapt education for nurses using new therapies (Cornick, 2006). The extent to which experts agreed on the NEC risk elements was evaluated.
Ascertaining a hierarchy of dimensions from time-poor experts: Linking tactical vignettes to strategic scenarios
2013, Technological Forecasting and Social Change
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Sources of funding (apart from employer): Draeger Neonatal Nurse Education Scholarship.