Apr 29, 2019, By: Tracie Risling
Cleverley, K., Bartha, C., Strudwick, G,. Chakraborty, R., & Srivastav, R. (2018).
The development of a client care needs assessment tool for mental health and addictions settings using a modified Delphi approach. Nursing Leadership, 31(2), 52-65. doi:10.12927/cjnl.2018.25603
The primary aim of this Canadian nursing-led research study was the creation of the Client Care Needs Assessment (CCNA) tool. Results from the use of the tool can help nurses in mental health and addictions settings review critical elements of care delivery such as team composition and staff skill mix. The research was done using an approach called the Delphi method. If it is not familiar to you, it is worthwhile to take a look at this methodology. The Delphi is practical and interactive and could be used to advance nursing research in many areas.
Meet the methodology
The Delphi method offers an engaging way to collect data or solve a research problem by working with people who have expertise in the subject you are interested in studying. Typically, a Delphi includes focused group discussions during which members of the research team hope to achieve consensus among the participants on the most critical points of whatever topic or process is being examined. Often after the participants have identified key elements, the research team will engage other experts to review these findings, make any needed changes and then once again give a group of participants a chance to agree or disagree with the final findings. There are several ways this method can be used, ranging from short, simple applications to more complex and time-consuming versions. This adaptability and the fact that the method is highly participatory makes it a great choice for those who want to gather existing nursing expertise to create strong evidence-based results for future interventions, policies or practice.
In this study, experts worked through three rounds of discussion in the Delphi, to adapt a previously developed Canadian tool to the specific needs of mental health and addictions settings. The tool had previously been validated in a study on informing decision-making regarding acute care RN and registered practical nurse staffing. By using the Synergy Model to guide the work, and with the help of experts in the Delphi process, this team was able to produce a new tool tailored to the needs of their practice areas.
One of the things that really stuck with me in reading this article is that assessing individual patients is critical in determining the overall health of the unit on that day. I see the use of this tool as a way to create a set of “vitals” for an entire care environment.
The authors provide a strong foundation regarding the value of real-time assessment to determine appropriate models of care and staff skill mix to maximize safety and quality of care. This article can also be used to demonstrate the importance of ensuring the best staff mix possible is in place and of decision-making based on data-driven and evidence-based approaches, in all care settings.
So what comes next in terms of this work? Where could you apply it today?
Research: The research team state they would like to see more work done to examine the validity and reliability of the CCNA. Practitioners or researchers in other mental health or addictions settings across the country can trial this tool and continue to advance this research, including using it with diverse client populations.
Practice: This study produced a tool to be used directly in the practice setting. Wider uptake of the CCNA is needed to further test and develop the tool, and this will provide opportunities for additional nursing expertise to inform this research over time.
Leadership: This type of research is a valuable addition to the administrative toolkit. In this article, the complexities of providing safe and effective care in demanding clinical environments are highlighted. The researchers have noted the potential of this tool to provide a concrete way to assess and act in real-time to provide the best staff complement in response to current client needs.
Teaching: Nursing research of all types can find a home in classrooms across the country; this work is no exception. As a teaching tool, this study highlights the value of participatory approaches such as the Delphi method and how this type of research can deliver an evidence-based solution to complex health-care problems today.
Tracie Risling, RN, PhD, is an associate professor in the college of nursing at the University of Saskatchewan.