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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
ERJ Open Research 2018 4: 00003-2018; DOI: 10.1183/23120541.00003-2018
Carol Ann Kelly
1Postgraduate Medical Institute, Edge Hill University, Ormskirk, UK
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Andrew J. Kirkcaldy
2Evidence-based Practice Research Centre, Edge Hill University, Ormskirk, UK
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Melissa Pilkington
2Evidence-based Practice Research Centre, Edge Hill University, Ormskirk, UK
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Matthew Hodson
3Homerton University Hospital Foundation Trust and Association of Respiratory Nurse Specialists, London, UK
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Lindsay Welch
4Solent NHS Trust and the University of Southampton, and Association of Respiratory Nurse Specialists, Southampton, UK
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Janelle Yorke
5Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine, Health Sciences, University of Manchester, Manchester, UK
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Katherine Knighting
2Evidence-based Practice Research Centre, Edge Hill University, Ormskirk, UK
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  • Article
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Figures

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  • FIGURE 1
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    FIGURE 1

    Flowchart of multiphase modified Delphi phases.

  • FIGURE 2
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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

    ThemeSubthemes (topics)
    Theme 1: Prevention of respiratory
    disease and related disability
    Smoking behaviour
    Exercise for respiratory health
    Prevention and early intervention
    Theme 2: Disease managementSelf-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 careCare 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 careDecision 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

    DemographicsRound 1Round 2Round 3
    Subjects1839585
    Current role/job title
     Advanced Nurse Practitioner11 (6)9 (10)6 (7)
     Asthma Nurse4 (2)1 (1)1 (1)
     Consultant Nurse9 (5)4 (4)5 (6)
     Paediatric Nurse3 (2)00
     Practice Nurse20 (11)10 (11)10 (12)
     Research Nurse8 (4)5 (5)5 (6)
     Respiratory Nurse15 (8)11 (12)8 (10)
     Respiratory Nurse Specialist82 (45)34 (36)29 (36)
     Team Lead Manager17 (9)6 (6)2 (3)
     Other4 (2)7 (7)15 (19)
     No response10 (5)8 (8)4 (5)
    Length of time working in a respiratory specialism years
     <517 (9)12 (13)9 (11)
     5–1044 (24)22 (23)24 (30)
     11–2082 (45)34 (36)28 (35)
     >2030 (16)19 (20)20 (25)
     No response10 (6)8 (8)4 (5)
    Type of service currently working in
     Primary care48 (26)34 (36)27 (32)
     Community care37 (20)20 (21)20 (24)
     Secondary care77 (42)37 (37)34 (40)
     Tertiary care7 (4)4 (4)5 (6)
     Intermediate care5 (3)4 (4)4 (5)
     Other20 (11)6 (6)7 (8)
    Type of patient group primarily working with
     Paediatrics4 (2)1 (1)3 (4)
     Adults137 (75)70 (74)59 (73)
     Both paediatrics and adults32 (18)16 (17)19 (24)
     No response10 (5)8 (8)4 (5)

    Data are presented as n or n (%).

    • TABLE 3

      Distribution and changes to survey items and topics between rounds

      TopicRound 1
      n
      Change to
      Round 2
      Round 2
      n
      Change to
      Round 3
      Round 3
      n
      1Approaches to the prevention of respiratory disease6+17−34
      2Self-management of chronic respiratory disease7+18−17
      3Pulmonary rehabilitation8−35−23
      4Psychological interventions30303
      5Management of long-term respiratory conditions10−4606
      6Family and unpaid carers3−1202
      7Management of chronic obstructive pulmonary disease404−13
      8Management of asthma6−15−14
      9Management of bronchiectasis303−21
      10Management of cystic fibrosis#3−3000
      11Management of interstitial lung disease2+2404
      12Management of obstructive sleep apnoea syndrome#2−2000
      13Organisation and delivery of care9−18−17
      14Education and training of nurses4+37−16
      15Telehealth and telemedicine#4−4000
      16Palliative care4+1505
      Total78−1167−1255

      #: 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

        RankResearch prioritiesTheme (topic)#Consensus %Mean score
        1Patient understanding of asthma control¶2 (8)914.47
        2The clinical and cost-effectiveness of respiratory nurse interventions¶3 (13)904.45
        3The impact of nurse-led clinics on patient care3 (13)924.41
        4Inhaler technique¶2 (2)834.40
        5=Prevention of exacerbations¶2 (5)924.39
        5=Symptom management¶2 (5)924.39
        6Integrated approaches to delivery of care by respiratory nurses with palliative care services¶4 (16)874.35
        7Self-management and education related to bronchiectasis¶2 (9)864.35
        8Smoking behaviours in teenagers and children and adults¶1 (1)814.31
        9The impact of training on the quality of spirometry¶3 (14)884.32
        10The psychological management of anxiety and depression¶2 (4)884.28

        #: 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.

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        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
        ERJ Open Research Apr 2018, 4 (2) 00003-2018; DOI: 10.1183/23120541.00003-2018

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        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
        ERJ Open Research Apr 2018, 4 (2) 00003-2018; DOI: 10.1183/23120541.00003-2018
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