In Japan, the number of ALS patients with mechanical ventilation at home increases. From about 2003,

possibility of providing suction by caregivers is discussed because of family caregivers' burden.

Objective:

To identify the most important items for nurses to instruct the way of performing tracheal suction at

home for ALS patients with mechanical ventilation to professional caregivers.

Methods:

Expert panels were defined 1) as an instructor; home-visit nurses who have ever experienced to

instruct the way of performing suction for caregivers or interested in the instruction 2) as a learner; caregivers

who have ever experienced to perform suction or interested in performing suction. Through a comprehensive literature review and a pre-test, the initial questionnaire was consisted of 8 skill items, 12 knowledge items and 7 attitude items, and it was given to each expert.

Subsequently, a three round Delphi study was conducted to validate the items. For each round, participants were asked to select the 5 stage importance of competencies for nurses and caregivers. The criterion for consensus was set as an agreement rate of 100%.

Results:

At Round 1, the number of participants was 25 nurses (31.3%) and 13 caregivers (59.1%). At Round 2, responses were turned 19 nurses and 9 caregivers, and at Round 3, 17 nurses and 9 caregivers. Following the experts' opinions about the initial questionnaire items, the second questionnaire was revised; 9 skill items, 11 knowledge items and 6 attitude items. At Round 3, the questionnaire wasn't revised. 3 competencies as very important item achieved a 100% agreement between nurses and caregivers. The items were as follows; 1) Way of coping with emergency situation 2) Estimated dangerous items 3) Observation of a patient's breathing.

Conclusions:

A system of educating the way of performing suction safely to caregivers by nurses in home-setting will be expected.