Rostrum of Asclepius Vol 10, No. 2 (2011): April - June 2011

The Delphi Technique (DT) is a research methodology that uses turns or rounds between the researcher and a group of experts, until a desired level of agreement or consensus between the members of the expert panel has been reached with regards to the question in hand. Despite its popular use in the social sciences' domain and its progressive adoption by nurse-researchers internationally, in Greece, there is a lack of its application; its comprehension, usage, and methodological merits are still in question within the Greek nursing research community. Aim: To provide a detailed presentation of the epistemological and practical value of the DT, through a series of four consecutive papers which expand on the following: i) the classical methodological approach and its main modifications, ii) the methodological reflections iii) analysis and presentation of results, and iv) the use and usefulness of the method in application to nursing research. The first of the four papers provides a description and a comparative assessment of the main variations of the DT. Results: A review of the literature elucidated three main sub-types of technique: the Classic or Conventional Delphi, the Policy Delphi and the Decision Delphi Technique. Nevertheless, due to many variations of the basic philosophy of the method and the many differentiations in its application, it is quite difficult to classify each study that used Delphi, with precision. The main methodological differences that can challenge the researcher are discussed and finally, examples that show the advantages and the usefulness of the individual Delphi techniques are given. Conclusions: Use of the DT in research has many advantages and it can become exceptionally useful once the content of the method and its practical applications are fully understood.

Keywords: Delphi technique, nursing research, research methodology

In recent years, the number of patients undergoing cardiac surgeries is steadily increasing. In Greece, approximately 10,500 patients per year are admitted to some kind of cardiac operation. Constant evolution of heart surgery techniques calls for adaptation of the perioperative nursing care given. Patient education, as an important part of the perioperative care, is directly related to the reduction of postoperative complications and stress management, thus promoting the patient's overall postoperative well-being. Aim: The aim of this review was to present the most important aspects of the patient's perioperative education and the role that the nurse has to play in it. Methods: Data from selected articles were extracted from Pubmed, Chinahl and Cohrane, as well as from non-electronically published scientific studies ranging from 1998-2010 and 2003-2008 respectively. Results: According to the literature, perioperative patient education can be implemented in various ways, such as through verbal updates, the use of audiovisual means and the provision of informative leaflets. The teaching topics can be divided into those of the preoperative and postoperative phase. Stress management prepares the patients psychologically and also enhances the therapeutic nurse-patient relationship. The teaching of breathing techniques and isometric exercises of the lower limbs, the cessation of smoking, the diet to be followed, as well as the management of medication, aim in the patients' physical preparation, in order to optimize their postoperative course. Conclusion: Perioperative patient education, regardless of how it is implemented, constitutes both an integral part of the nursing care and an independent nursing intervention per se, which strengthens the nurses' autonomy and improves the patient's postoperative course

Keywords: Patient education, nursing education, cardiac surgery, perioperative care

During recent years, it has been noticed a remarkable increase in admission of the young in Intensive Care Unit due to road accident. The aim of the present study was to explore the injuries, the special conditions of admission of young 18-40 years old that were admitted to Intensive Care Unit due to road accident. Method and material: The sample studied consisted of young individuals 18-40 years old that were admitted in the Intensive Care Unit (ICU) of public hospitals in the area of Attica for 3 years. Data were collected by the completion of a special designed questionnaire that apart from demographic variables, the record of injuries and the conditions of treatment it also included variables concerning the type of vehicle that caused the road accident as well as the outcome of patients' course. Data analysis was performed by the statistical package SPSS 13 and the method x2 and t-test. Results: The sample studied consisted of 555 young individuals, of the 13,1% of total admissions in ICU. Of the participants 82,2% were men and 17,8% women, with mean age 26,5 years. Regarding the frequency of various types of injuries, 24,7% of the participants had injuries of upper limbs and 26,4% of lower. 30,2% of the sample had more than 3 fractures, while the 6,9% more than 5. 75,7% of the participants had head injury. Moreover, it was found that the frequency of head injuries was statistical significant lower among those wearing helmet (64,5%) compared to those not wearing (82,5%), p<0,05. Intubation had the 17,9% of he sample, while in coma was the 11,6%. Finally, it was found that patients admitted in ICU from operation room (36,2%) were more likely with statistical significant more to die compared to those admitted by Emergency department (17,8%) by hospital of other town (16,7%) by other hospital (14,3%), or other clinic department (12,5%). Conclusions: Road accidents consist the main reason for admission of the young in ICU. The majority of individuals were multi-injured. Due to the increased incidence of admission, it is judged necessary the institution of ICU in every big hospital.

Keywords: Road accidents, risk factors, fractures, brain injury

Intensive Care Unit (ICU) is an autonomous section which requires the cooperation of skilled health professionals and the use of advanced technology to provide intensive care in severely ill patients. The ICU nurse must be possessed of specialized clinical knowledge and experience to be able to respond effectively to their role, which appears to be adequately investigated in our country. Purpose: The investigation of the real and functional role of nurses working in ICU, on the interventions they perform. Material-Method: As for the design, it was a cross-sectional study. The studied population consisted of 222 registered nurses (response rate 74%) working in ICU, of 12 hospitals in Athens. For data collection, which lasted 5 months, it was used a special designed questionnaire. It was investigated the frequency of carrying out various nursing interventions and their relation to various socio-demographic characteristics of the nursing staff. Data analysis was performed with the statistical package STATA ™, ver.9. Results: Of the 222 registered nurses, 80% were women. The average age of nurses was 34.16 (± 6.41) years, while the average years of work in the ICU was 8.52 (± 6.19) years. Regarding the education level of respondents 20.7% was university graduates and 79.3% was technological institute graduate. Although the ICU nurses perform a series of interventions with significant variation in their frequency, however, appear to be characterized by low autonomy, since interventions without medical advice or in emergency situation is made by a small proportion of staff. The implementation of these interventions was not associated statistically significantly with age, sex, education level and years of nurse's work. The exceptions were the measurement of central venous pressure (p<0,001) and the use of external pacemaker (p = 0,002), actions most frequently performed by nurses with more years of experience in the ICU and of university education. Conclusions: The Greeks ICU nurses are characterized by low autonomy in carrying out interventions without a medical directive or in emergency situations. This autonomy was not associated with factors such as age, sex, clinical experience and level of training of nurses, in contrast to the literature. Characteristics of the Greek reality, as the problematic organization of hospitals, lack of cooperation, the shortage of nurses in clinical training, the reduced nursing staff, the increased workloads and low satisfaction with the profession could explain the findings of this study.

Keywords: Intensive care unit, nursing role, professional autonomy

Adolescents' sexual behavior is the focus of attention since increased levels of unintended pregnancy, abortions and sexually transmitted diseases are detected. Psychological, family and social factors contribute to the above mentioned situations. The aim of the present research was to examine the intention of condom use in adolescents of both sexes using the Theory of Planned Behavior. Material- Method: The study population consisted of 378 adolescents, aged 15 to 18. Data was collected by the completion of a questionnaire based on the Theory of Planned Behavior. The statistical method used was x2, t-test, one-way ANOVA. The data statistical analysis was carried out using the SPSS 13.0 program. Results: From the participants, 94.9% reported that they had sufficient knowledge on contraception issues. Friends were the main source of information (20.2%). The majority of adolescents (58.2%) had full sexual intercourse at age 15 (30%). Proportionally, adolescents with higher self-efficacy were found to have greater intention to the condom use. The more increased was the degree of the convenience in using condom with a new partner, the more positive was the adolescents' attitude towards the use of condom with a steady partner and the greater was the degree of awareness about sexual issues, the greater the behavioral intention. Conclusions: The degree of the adolescents' self-efficacy, in other words, the more confident they are in their abilities and skills of overcoming possible obstacles, the greater their intention to use condom. According to the results, the factors which strongly predict the intention, in order of importance, were: self – efficacy, degree of control, degree of awareness and the descriptive regularity. The findings are of great importance for the Hellenic science, since there is insufficient and little data on this subject.

Keywords: Adolescents, condom use, behavioral intention, the theory of planned behaviour

The term 'first aid' refers to the preliminary care that is given to patients or injured individuals. The main objective of first aid is to offer effective assistance to victims until a more qualified professional becomes available to provide for further care. Purpose: The purpose of this study was to investigate whether specific populations possess the basic knowledge and skills that are necessary to offer this initial phase of treatment. Material-Method: The studied population consisted of 1387 individuals, of which 57.9% (N = 803) were male. Data was collected through the creation and administration of a questionnaire composed of 28 questions. The data analysis was performed using the statistical program SPSS (version 16) (SPSS Inc., Chicago, IL). Results: Almost half of the sample, 764 individuals (55.1%) never attended a 'first aid' seminar, while 623 (44.9%) did. The latter group could be further divided in accordance to the duration of the seminars that they partook in. 405 (29.2%) attended for 12 to 24 hours, 88 (6.3%) for 2-3 weeks, 50 (3.6%) for one month, and 81 (5.8%) for more than a month. Health professionals were 3.1 times more likely to have attended a seminar than the other respondents (N: 1.144, OR: 3.138, 95% CI: 1.508-6.528, p: 0.002). 67.6% of the studied sample would react correctly in a situation where an unconscious child would be carried out from sea, while 63.7% would do the Heimlich maneuver on a person who felt breathlessness while choking during a meal. Nine hundred and six people (65.3%) would give an unconscious diabetic something sweet to eat. People who had graduated from an institute were 1.4 times more likely to properly deal with a diabetic who was in a critical condition (OR: 1.401, 95% CI: 1.060-1.853, p: 0.018) Conclusions: First aid training is a vital asset for all population groups. It is therefore all the more important to make such education programs accessible to the wider population. Furthermore the implementation of such programs should be systematic and should not only cover theoretical foundations but practical ones as well.

Keywords: First aid, education, bystanders, seminar

Laryngeal cancer is responsible for various physical and psychosocial problems for the patients who often exhibit high levels of anxiety and depression. Aim: The aim of this study was to explore anxiety and depression levels of laryngeal cancer patients after total or partial laryngectomy, comparing three groups with different clinical traits. Material-method: This study follows a cross-sectional survey design. The population of the study included 168 hospitalized patients from two large urban hospitals from Athens and Thessaloniki. Sixty five patients (38.7%) had total laryngectomy as part of their treatment (group A), 63 patients (37.5%) had partial laryngectomy or other treatment (radiation or chemotherapy) with voice maintenance (group B) and 40 patients (23.8%) had also total laryngectomy but they participated additionally in a self care training program (group C). This survey used the following instruments: a) a demographic data and clinical traits questionnaire, b) the Self Rated Depression Scale (SRDS-Zung) and c) the Self Rated Anxiety Scale (SRAS-Zung). Statistical analysis included Mann-Whitney U test, Kruskal-Wallis test and Chi-square test, using SPSS 15 statistical package. Results: Overall 9.6% and 19% of patients exhibited symptoms of anxiety and depression respectively, while patients after laryngectomy (group A) presented the higher percentages. Both group B and C had lower anxiety and depression levels compared with group A (p<0.05). However, no significant difference was found between group B and C for anxiety (p=0.222) and depression (p=0.198). Conclusion: Patients after laryngectomy exhibit high anxiety and depression levels. It is suggested that training programs promoting self care may help anxiety management and prevent depression after the traumatizing experience of laryngectomy.

Keywords: Anxiety, depression, laryngeal cancer, laryngectomy, self care program