Research priorities for respiratory nursing: a UK-wide Delphi study

Carol Ann Kelly; Andrew J. Kirkcaldy; Melissa Pilkington; Matthew Hodson; Lindsay Welch; Janelle Yorke; Katherine Knighting

doi:10.1183/23120541.00003-2018

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FIGURE 1
Flowchart of multiphase modified Delphi phases.
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FIGURE 2
Flowchart of literature search. RNRC: Respiratory Nurse Research Consortium.

Tables

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TABLE 1

Themes and subthemes (topics) identified from the literature review

Theme	Subthemes (topics)
Theme 1: Prevention of respiratory disease and related disability	Smoking behaviour Exercise for respiratory health Prevention and early intervention
Theme 2: Disease management	Self-management Pulmonary rehabilitation Cognitive behavioural therapy Disease-specific topics for chronic obstructive pulmonary disease, asthma, bronchiectasis, cystic fibrosis, interstitial lung disease, lung cancer and obstructive sleep apnoea syndrome
Theme 3: Organisation and delivery of care	Care pathways Clinical and cost-effectiveness of respiratory nurse intervention Role effectiveness (e.g. cost and quality outcomes for respiratory nursing care interventions) Nurse prescribing in respiratory care (impact on disease management and cost; acceptability to patients) Impact of nursing assessment, examination and intervention Nurse-led clinics (advantages, disadvantages, outcomes) Telehealth and telemedicine Economics of care delivery Primary care models of respiratory care Expert patient/patient support groups Education and training of nurses in respiratory care Infection control Models of care Outcome measures Adherence to guidelines
Theme 4: Palliative care	Decision making Style/format of communication Recognising the palliative care phase Care for carers Impact on carers Skills/training Symptom management Models of end-of-life/palliative care delivery Complimentary therapies

TABLE 2

Demographic information of respondents across the rounds

Demographics	Round 1	Round 2	Round 3
Subjects	183	95	85
Current role/job title
Advanced Nurse Practitioner	11 (6)	9 (10)	6 (7)
Asthma Nurse	4 (2)	1 (1)	1 (1)
Consultant Nurse	9 (5)	4 (4)	5 (6)
Paediatric Nurse	3 (2)	0	0
Practice Nurse	20 (11)	10 (11)	10 (12)
Research Nurse	8 (4)	5 (5)	5 (6)
Respiratory Nurse	15 (8)	11 (12)	8 (10)
Respiratory Nurse Specialist	82 (45)	34 (36)	29 (36)
Team Lead Manager	17 (9)	6 (6)	2 (3)
Other	4 (2)	7 (7)	15 (19)
No response	10 (5)	8 (8)	4 (5)
Length of time working in a respiratory specialism years
<5	17 (9)	12 (13)	9 (11)
5–10	44 (24)	22 (23)	24 (30)
11–20	82 (45)	34 (36)	28 (35)
>20	30 (16)	19 (20)	20 (25)
No response	10 (6)	8 (8)	4 (5)
Type of service currently working in
Primary care	48 (26)	34 (36)	27 (32)
Community care	37 (20)	20 (21)	20 (24)
Secondary care	77 (42)	37 (37)	34 (40)
Tertiary care	7 (4)	4 (4)	5 (6)
Intermediate care	5 (3)	4 (4)	4 (5)
Other	20 (11)	6 (6)	7 (8)
Type of patient group primarily working with
Paediatrics	4 (2)	1 (1)	3 (4)
Adults	137 (75)	70 (74)	59 (73)
Both paediatrics and adults	32 (18)	16 (17)	19 (24)
No response	10 (5)	8 (8)	4 (5)

Data are presented as n or n (%).

TABLE 3

Distribution and changes to survey items and topics between rounds

Topic		Round 1 n	Change to Round 2	Round 2 n	Change to Round 3	Round 3 n
1	Approaches to the prevention of respiratory disease	6	+1	7	−3	4
2	Self-management of chronic respiratory disease	7	+1	8	−1	7
3	Pulmonary rehabilitation	8	−3	5	−2	3
4	Psychological interventions	3	0	3	0	3
5	Management of long-term respiratory conditions	10	−4	6	0	6
6	Family and unpaid carers	3	−1	2	0	2
7	Management of chronic obstructive pulmonary disease	4	0	4	−1	3
8	Management of asthma	6	−1	5	−1	4
9	Management of bronchiectasis	3	0	3	−2	1
10	Management of cystic fibrosis^#	3	−3	0	0	0
11	Management of interstitial lung disease	2	+2	4	0	4
12	Management of obstructive sleep apnoea syndrome^#	2	−2	0	0	0
13	Organisation and delivery of care	9	−1	8	−1	7
14	Education and training of nurses	4	+3	7	−1	6
15	Telehealth and telemedicine^#	4	−4	0	0	0
16	Palliative care	4	+1	5	0	5
Total		78	−11	67	−12	55

^#: Topics 10, 12 and 15 were removed based on analysis of Round 1 data, leaving 13 topics for Rounds 2 and 3.

TABLE 4

Key research priorities ranked by mean score

Rank	Research priorities	Theme (topic)^#	Consensus %	Mean score
1	Patient understanding of asthma control^¶	2 (8)	91	4.47
2	The clinical and cost-effectiveness of respiratory nurse interventions^¶	3 (13)	90	4.45
3	The impact of nurse-led clinics on patient care	3 (13)	92	4.41
4	Inhaler technique^¶	2 (2)	83	4.40
5=	Prevention of exacerbations^¶	2 (5)	92	4.39
5=	Symptom management^¶	2 (5)	92	4.39
6	Integrated approaches to delivery of care by respiratory nurses with palliative care services^¶	4 (16)	87	4.35
7	Self-management and education related to bronchiectasis^¶	2 (9)	86	4.35
8	Smoking behaviours in teenagers and children and adults^¶	1 (1)	81	4.31
9	The impact of training on the quality of spirometry^¶	3 (14)	88	4.32
10	The psychological management of anxiety and depression^¶	2 (4)	88	4.28

^#: Theme 1: Prevention of respiratory disease and related disability; Theme 2: Disease management; Theme 3: Organisation and delivery of care; Theme 4: Palliative care; see table 3 for topic numbering; ^¶: top ranked within own topic.