A Delphi Study of Competencies to Perform Tracheal Suction for ALS Patients with Mechanical Ventilation at Home

Thursday, 10 July 2008: 10:50 AM
Junko Imaiso, BS, BA, RN, PHN , Department of Nursing, Ishikawa Prefectural Nursing University, Ishikawa, Japan
Kana Yamauchi, BSN, RN , School of Health Sciences, Nagoya University, Nagoya, Aichi, Japan
Utako Sasaki, RN, MSN , Home-visit Nursing Station, Kuwanomi Home-visit Nursing Station, Ena-city, Gifu, Japan
Kayoko Nozaki, CN, RN , Home-visit Nursing Station, Takayama Home-visit Nursing Station, Takayama-city, Gifu, Japan

Learning Objective 1: acquire how home- visit nurses instruct for professional caregivers in order to perform tracheal suction safely.

Learning Objective 2: acquire the way of effective collaboration between home-visit nurses and professional caregivers about providing medical care and think again what nursing is.


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.


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.


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%.


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.


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