Validation of an amended assessment tool for measuring emergency nurses preparedness for chemical/biological/radiological/nuclear (CBRN) disaster
Research proposal
Validation of an amended assessment tool for measuring emergency nurses preparedness for chemical/biological/radiological/nuclear (CBRN) disaster
The following is a proposal to undertake a research project to validate an amended competency questionnaire initially developed by ADDIN EN.CITE <EndNote><Cite AuthorYear="1"><Author>Mitchell</Author><Year>2012</Year><RecNum>146</RecNum><DisplayText>Mitchell, Kernohan, and Higginson (2012)</DisplayText><record><rec-number>146</rec-number><foreign-keys><key app="EN" db-id="wa5sppfa0rwrz5ea0f9v9ax49dx5zs5w25a5" timestamp="1399345278">146</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mitchell, Christina J.</author><author>Kernohan, W. George</author><author>Higginson, Ray</author></authors></contributors><titles><title>Are emergency care nurses prepared for chemical, biological, radiological, nuclear or explosive incidents?</title><secondary-title>International Emergency Nursing</secondary-title></titles><periodical><full-title>International Emergency Nursing</full-title></periodical><pages>151-161</pages><volume>20</volume><number>3</number><keywords><keyword>CBRNe</keyword><keyword>Emergency nursing</keyword><keyword>Major incident preparedness</keyword></keywords><dates><year>2012</year><pub-dates><date>7//</date></pub-dates></dates><isbn>1755-599X</isbn><urls><related-urls><url>http://www.sciencedirect.com/science/article/pii/S1755599X11001091</url></related-urls></urls><electronic-resource-num>http://dx.doi.org/10.1016/j.ienj.2011.10.001</electronic-resource-num></record></Cite></EndNote>Mitchell, Kernohan, and Higginson (2012) to measure emergency nurses preparedness for chemical/biological/radiological/nuclear (CBRN) disaster response. In the current global climate of increased occurrence of natural, man-made and terrorist disaster events, it is of great importance to ensure that Emergency Departments (EDs) are prepared to mount a response to all types of disaster. In the Australian setting, with the lowest occurrence of disaster incidents in the developed world ADDIN EN.CITE <EndNote><Cite><Author>Hammad</Author><Year>2012</Year><RecNum>113</RecNum><DisplayText>(Hammad, Arbon, Gebbie, & Hutton, 2012)</DisplayText><record><rec-number>113</rec-number><foreign-keys><key app="EN" db-id="wa5sppfa0rwrz5ea0f9v9ax49dx5zs5w25a5" timestamp="1397543674">113</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hammad, Karen S.</author><author>Arbon, Paul</author><author>Gebbie, Kristine</author><author>Hutton, Alison</author></authors></contributors><auth-address>School of Nursing and Midwifery, Flinders University, GPO Box 2100, Adelaide 5001, SA, Australia</auth-address><titles><title>Nursing in the emergency department (ED) during a disaster: A review of the current literature</title><secondary-title>Australasian Emergency Nursing Journal</secondary-title></titles><periodical><full-title>Australasian Emergency Nursing Journal</full-title></periodical><pages>235-244</pages><volume>15</volume><number>4</number><keywords><keyword>Emergency Nursing</keyword><keyword>Disaster Planning</keyword><keyword>Nursing Practice, Evidence-Based</keyword><keyword>Emergency Service</keyword><keyword>Emergency Patients</keyword><keyword>Systematic Review</keyword><keyword>Human</keyword><keyword>Databases, Health</keyword><keyword>Thematic Analysis</keyword><keyword>Outpatients</keyword><keyword>Clinical Competence</keyword></keywords><dates><year>2012</year></dates><isbn>1574-6267</isbn><accession-num>2011781088. Language: English. Entry Date: 20130104. Publication Type: journal article</accession-num><urls><related-urls><url>http://ezproxy.library.usyd.edu.au/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=2011781088&site=ehost-live</url></related-urls></urls><electronic-resource-num>10.1016/j.aenj.2012.10.005</electronic-resource-num><remote-database-name>cin20</remote-database-name><remote-database-provider>EBSCOhost</remote-database-provider></record></Cite></EndNote>(Hammad, Arbon, Gebbie, & Hutton, 2012), it is of value to make use of a validated assessment tool to measure preparedness.
Background and Literature review
The need for preparedness
EDs are confronted with many illnesses and injuries bearing very low, or no cost to human life. Yet because of their frequency, EDs are well prepared to respond. Staff have been trained and are skilled, equipment is available, and techniques have been perfected to maximise patient safety and optimise health outcomes. Disasters, however, are few and far between, but when they do strike, their cost on human life is devastating. Therefore, it is equally important that EDs be prepared for dealing with disasters as they are for simple fractures, foreign bodies, and dislocations.
CBRN disasters bear with them the added risk of exponential injury by toxic contamination of others and the necessary facility lockdown if contamination occurs at the receiving hospital (Barker. K, personal communication, 23 May, 2014). A poorly managed disaster victim as a patient contaminated with CBRN substances in an ED could easily lead to the complete lockdown of the entire facility.
The lack of preparedness
Poor preparedness of EDs to respond to CBRN disaster is a global issue ADDIN EN.CITE <EndNote><Cite><Author>Linney</Author><Year>2011</Year><RecNum>147</RecNum><DisplayText>(Linney, George, & Higginson, 2011)</DisplayText><record><rec-number>147</rec-number><foreign-keys><key app="EN" db-id="wa5sppfa0rwrz5ea0f9v9ax49dx5zs5w25a5" timestamp="1399351324">147</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Linney, Andrew C. S.</author><author>George, Kernohan, W.</author><author>Higginson, Ray</author></authors></contributors><titles><title>The identification of competencies for an NHS response to chemical, biological, radiological, nuclear and explosive (CBRNe) emergencies</title><secondary-title>International Emergency Nursing</secondary-title></titles><periodical><full-title>International Emergency Nursing</full-title></periodical><pages>96-105</pages><volume>19</volume><number>2</number><keywords><keyword>CBRNe</keyword><keyword>Delphi study</keyword><keyword>Emergency department</keyword><keyword>Major incident</keyword></keywords><dates><year>2011</year><pub-dates><date>4//</date></pub-dates></dates><isbn>1755-599X</isbn><urls><related-urls><url>http://www.sciencedirect.com/science/article/pii/S1755599X10000339</url></related-urls></urls><electronic-resource-num>http://dx.doi.org/10.1016/j.ienj.2010.04.001</electronic-resource-num></record></Cite></EndNote>(Linney, George, & Higginson, 2011). Due to the
The lack of ED nursing preparedness
The research is clear that ED nurses feel underprepared for CBRN disaster response. PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Db25zaWRpbmU8L0F1dGhvcj48WWVhcj4yMDA5PC9ZZWFy
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ADDIN EN.CITE.DATA (Considine & Mitchell, 2009; Hammad et al., 2012; Mitchell et al., 2012). ED nurses across the world report a lack of education and training in CBRN disaster. They express concerns regarding
The lack of standardised preparedness competencies
While there have been some attempts at developing some standardised competencies they have been either poorly validated; too locally specific to be applied to other locations or services; or too general in that they apply to all relevant agencies and not specific to Health or ED, PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MaW5uZXk8L0F1dGhvcj48WWVhcj4yMDExPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (Adini, Laor, Hornik-Lurie, Schwartz, & Aharonson-Daniel, 2012; Linney et al., 2011). However aspects of the competency standards developed by ADDIN EN.CITE <EndNote><Cite AuthorYear="1"><Author>Adini</Author><Year>2012</Year><RecNum>115</RecNum><DisplayText>Adini et al. (2012)</DisplayText><record><rec-number>115</rec-number><foreign-keys><key app="EN" db-id="wa5sppfa0rwrz5ea0f9v9ax49dx5zs5w25a5" timestamp="1397543989">115</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Adini, B.</author><author>Laor, D.</author><author>Hornik-Lurie, T.</author><author>Schwartz, D.</author><author>Aharonson-Daniel, L.</author></authors></contributors><auth-address>1Ministry of Health, Tel Aviv, Israel</auth-address><titles><title>Improving hospital mass casualty preparedness through ongoing readiness evaluation</title><secondary-title>American Journal of Medical Quality</secondary-title></titles><periodical><full-title>American Journal of Medical Quality</full-title></periodical><pages>426-433</pages><volume>27</volume><number>5</number><keywords><keyword>Civil Defense -- Standards</keyword><keyword>Disaster Planning -- Standards</keyword><keyword>Emergency Service -- Standards</keyword><keyword>Mass Casualty Incidents</keyword><keyword>Benchmarking -- Methods</keyword><keyword>Civil Defense</keyword><keyword>Emergency Service -- Administration</keyword><keyword>Human</keyword><keyword>Employee Orientation -- Administration</keyword><keyword>Israel</keyword><keyword>Trauma Centers -- Standards</keyword></keywords><dates><year>2012</year></dates><isbn>1062-8606</isbn><accession-num>2011681664. Language: English. Entry Date: 20130315. Revision Date: 20130315. Publication Type: journal article</accession-num><urls><related-urls><url>http://ezproxy.library.usyd.edu.au/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=2011681664&site=ehost-live</url></related-urls></urls><electronic-resource-num>10.1177/1062860611432303</electronic-resource-num><remote-database-name>cin20</remote-database-name><remote-database-provider>EBSCOhost</remote-database-provider></record></Cite></EndNote>Adini et al. (2012) and ADDIN EN.CITE <EndNote><Cite AuthorYear="1"><Author>Linney</Author><Year>2011</Year><RecNum>147</RecNum><DisplayText>Linney et al. (2011)</DisplayText><record><rec-number>147</rec-number><foreign-keys><key app="EN" db-id="wa5sppfa0rwrz5ea0f9v9ax49dx5zs5w25a5" timestamp="1399351324">147</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Linney, Andrew C. S.</author><author>George, Kernohan, W.</author><author>Higginson, Ray</author></authors></contributors><titles><title>The identification of competencies for an NHS response to chemical, biological, radiological, nuclear and explosive (CBRNe) emergencies</title><secondary-title>International Emergency Nursing</secondary-title></titles><periodical><full-title>International Emergency Nursing</full-title></periodical><pages>96-105</pages><volume>19</volume><number>2</number><keywords><keyword>CBRNe</keyword><keyword>Delphi study</keyword><keyword>Emergency department</keyword><keyword>Major incident</keyword></keywords><dates><year>2011</year><pub-dates><date>4//</date></pub-dates></dates><isbn>1755-599X</isbn><urls><related-urls><url>http://www.sciencedirect.com/science/article/pii/S1755599X10000339</url></related-urls></urls><electronic-resource-num>http://dx.doi.org/10.1016/j.ienj.2010.04.001</electronic-resource-num></record></Cite></EndNote>Linney et al. (2011) will be used in the process of this research project.
The lack of practice guidelines
The latest comprehensive practice guidelines developed in Australia ADDIN EN.CITE <EndNote><Cite><Author>Emergency Management Australia</Author><Year>2000</Year><RecNum>144</RecNum><DisplayText>(Emergency Management Australia, 2000)</DisplayText><record><rec-number>144</rec-number><foreign-keys><key app="EN" db-id="wa5sppfa0rwrz5ea0f9v9ax49dx5zs5w25a5" timestamp="1399057441">144</key></foreign-keys><ref-type name="Government Document">46</ref-type><contributors><authors><author>Emergency Management Australia,</author></authors></contributors><titles><title>Manual 13: Health aspects of chemical, biological and radiological hazards</title><secondary-title>Emergency Management Practice Manuals Series</secondary-title></titles><periodical><full-title>Emergency Management Practice Manuals Series</full-title></periodical><volume>2</volume><number>3</number><dates><year>2000</year></dates><urls><related-urls><url>https://www.health.gov.au/internet/main/publishing.nsf/Content/eprs-health-aspects-chemical-haz-cnt.htm#pdf</url></related-urls></urls></record></Cite></EndNote>(Emergency Management Australia, 2000) are out dated, and lack specificity in guidelines directed to EDs.The lack of standardised education requirements ED nurses
Many training and educational programs are available especially in the US. The best of these are the collection National Disaster Life Support (NDLS) programs, one of which is CBRN specific ADDIN EN.CITE <EndNote><Cite><Author>Coule</Author><Year>2009</Year><RecNum>154</RecNum><DisplayText>(Coule & Schwarz, 2009)</DisplayText><record><rec-number>154</rec-number><foreign-keys><key app="EN" db-id="wa5sppfa0rwrz5ea0f9v9ax49dx5zs5w25a5" timestamp="1402308850">154</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Coule, P. L.</author><author>Schwarz, R. B.</author></authors></contributors><titles><title>The National Disaster Life Support Programs: A Model of Competency-Based Standardized and Loccally Relevant Training</title><secondary-title>Journal of Public Health Management Practice</secondary-title></titles><periodical><full-title>Journal of Public Health Management Practice</full-title></periodical><pages>S25-S30</pages><section>S25</section><dates><year>2009</year></dates><urls></urls></record></Cite></EndNote>(Coule & Schwarz, 2009). While this program has been carefully developed as a versatile program to be adapted for site specific training, it is only available in the US, is neither ED nor nursing specific, and it lacks validation.
Literature review: available assessment tools for measuring ED nursing preparedness for CBRN disaster
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ADDIN EN.CITE.DATA (Kaji & Lewis, 2008), others use small scale model disaster scenes and hypothetical facility simulations ADDIN EN.CITE <EndNote><Cite><Author>Paul</Author><Year>2006</Year><RecNum>125</RecNum><DisplayText>(Paul, George, Yi, & Lin, 2006)</DisplayText><record><rec-number>125</rec-number><foreign-keys><key app="EN" db-id="wa5sppfa0rwrz5ea0f9v9ax49dx5zs5w25a5" timestamp="1397566552">125</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Paul, J. A.</author><author>George, S. K.</author><author>Yi, P.</author><author>Lin, L.</author></authors></contributors><auth-address>Department of Industrial Engineering, University at Buffalo, Buffalo, New York</auth-address><titles><title>Transient modeling in simulation of hospital operations for emergency response</title><secondary-title>Prehospital & Disaster Medicine</secondary-title></titles><periodical><full-title>Prehospital & Disaster Medicine</full-title></periodical><pages>223-236</pages><volume>21</volume><number>4</number><keywords><keyword>Disaster Planning</keyword><keyword>Emergency Service -- Administration</keyword><keyword>Organizational Efficiency</keyword><keyword>Analysis of Variance</keyword><keyword>California</keyword><keyword>Case Mix</keyword><keyword>Factorial Design</keyword><keyword>Funding Source</keyword><keyword>Models, Statistical</keyword><keyword>Natural Disasters</keyword><keyword>Regression</keyword><keyword>Human</keyword></keywords><dates><year>2006</year></dates><isbn>1049-023X</isbn><accession-num>2009306194. Language: English. Entry Date: 20070803. Revision Date: 20091218. Publication Type: journal article</accession-num><urls><related-urls><url>http://ezproxy.library.usyd.edu.au/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=2009306194&site=ehost-live</url></related-urls></urls><remote-database-name>cin20</remote-database-name><remote-database-provider>EBSCOhost</remote-database-provider></record></Cite></EndNote>(Paul, George, Yi, & Lin, 2006), and other models use computer simulation PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Db2hlbjwvQXV0aG9yPjxZZWFyPjIwMTM8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (D. Cohen et al., 2013; D. C. Cohen et al., 2012; Franc-Law, Bullard, & Corte, 2008; Paul et al., 2006).
Admittedly, it is difficult to apply rigorous testing on assessment tools without enduring several real disaster responses. Furthermore it is difficult to test preparedness without a real disaster response.
Three of the articles reviewed stand out above the others in that they are both well validated and that they provided helpful insight into a standard against which facility and system preparedness can be measured.
ADDIN EN.CITE <EndNote><Cite AuthorYear="1"><Author>Adini</Author><Year>2012</Year><RecNum>115</RecNum><DisplayText>Adini et al. (2012)</DisplayText><record><rec-number>115</rec-number><foreign-keys><key app="EN" db-id="wa5sppfa0rwrz5ea0f9v9ax49dx5zs5w25a5" timestamp="1397543989">115</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Adini, B.</author><author>Laor, D.</author><author>Hornik-Lurie, T.</author><author>Schwartz, D.</author><author>Aharonson-Daniel, L.</author></authors></contributors><auth-address>1Ministry of Health, Tel Aviv, Israel</auth-address><titles><title>Improving hospital mass casualty preparedness through ongoing readiness evaluation</title><secondary-title>American Journal of Medical Quality</secondary-title></titles><periodical><full-title>American Journal of Medical Quality</full-title></periodical><pages>426-433</pages><volume>27</volume><number>5</number><keywords><keyword>Civil Defense -- Standards</keyword><keyword>Disaster Planning -- Standards</keyword><keyword>Emergency Service -- Standards</keyword><keyword>Mass Casualty Incidents</keyword><keyword>Benchmarking -- Methods</keyword><keyword>Civil Defense</keyword><keyword>Emergency Service -- Administration</keyword><keyword>Human</keyword><keyword>Employee Orientation -- Administration</keyword><keyword>Israel</keyword><keyword>Trauma Centers -- Standards</keyword></keywords><dates><year>2012</year></dates><isbn>1062-8606</isbn><accession-num>2011681664. Language: English. Entry Date: 20130315. Revision Date: 20130315. Publication Type: journal article</accession-num><urls><related-urls><url>http://ezproxy.library.usyd.edu.au/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=2011681664&site=ehost-live</url></related-urls></urls><electronic-resource-num>10.1177/1062860611432303</electronic-resource-num><remote-database-name>cin20</remote-database-name><remote-database-provider>EBSCOhost</remote-database-provider></record></Cite></EndNote>Adini et al. (2012) report on the research used to develop an assessment tool in the Israeli setting. They employed a robust research method, resulting in a well thought out, exhaustive assessment tool. Furthermore, the tool has been contextually validated through its adoption by the Israeli government as legislated preparedness competency standards to which all 26 hospitals across Israel must comply. Furthermore the assessment tool is used to test the preparedness of each Israeli hospital every second year. This tool is designed to measure whole facility preparedness, and is thereby not ED specific, and neither is it CBRN specific. Furthermore, the tool is only published in Hebrew and has not been translated into English as yet. However a detailed summary of the tool is documented in the article, outlining four major categories of disaster preparedness; 1)standard operating procedures; 2)training; 3)knowledge; and 4) equipment.
ADDIN EN.CITE <EndNote><Cite AuthorYear="1"><Author>Linney</Author><Year>2011</Year><RecNum>147</RecNum><DisplayText>Linney et al. (2011)</DisplayText><record><rec-number>147</rec-number><foreign-keys><key app="EN" db-id="wa5sppfa0rwrz5ea0f9v9ax49dx5zs5w25a5" timestamp="1399351324">147</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Linney, Andrew C. S.</author><author>George, Kernohan, W.</author><author>Higginson, Ray</author></authors></contributors><titles><title>The identification of competencies for an NHS response to chemical, biological, radiological, nuclear and explosive (CBRNe) emergencies</title><secondary-title>International Emergency Nursing</secondary-title></titles><periodical><full-title>International Emergency Nursing</full-title></periodical><pages>96-105</pages><volume>19</volume><number>2</number><keywords><keyword>CBRNe</keyword><keyword>Delphi study</keyword><keyword>Emergency department</keyword><keyword>Major incident</keyword></keywords><dates><year>2011</year><pub-dates><date>4//</date></pub-dates></dates><isbn>1755-599X</isbn><urls><related-urls><url>http://www.sciencedirect.com/science/article/pii/S1755599X10000339</url></related-urls></urls><electronic-resource-num>http://dx.doi.org/10.1016/j.ienj.2010.04.001</electronic-resource-num></record></Cite></EndNote>Linney et al. (2011) report on the research behind the development of a set of competency standards for CBRN disaster preparedness. These competencies are not Hospital specific they are broadly applicable to all agencies involved in CBRN disaster response. Ten specific competency areas were identified for CBRN disaster preparedness; 1)local and national hazards; 2)risk assessment; 3) planning; 4)resource; 5) equipment; 6) training; 7) Response; 8) communications; 9) transport; and 10) recovery.
ADDIN EN.CITE <EndNote><Cite AuthorYear="1"><Author>Mitchell</Author><Year>2012</Year><RecNum>146</RecNum><DisplayText>Mitchell et al. (2012)</DisplayText><record><rec-number>146</rec-number><foreign-keys><key app="EN" db-id="wa5sppfa0rwrz5ea0f9v9ax49dx5zs5w25a5" timestamp="1399345278">146</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mitchell, Christina J.</author><author>Kernohan, W. George</author><author>Higginson, Ray</author></authors></contributors><titles><title>Are emergency care nurses prepared for chemical, biological, radiological, nuclear or explosive incidents?</title><secondary-title>International Emergency Nursing</secondary-title></titles><periodical><full-title>International Emergency Nursing</full-title></periodical><pages>151-161</pages><volume>20</volume><number>3</number><keywords><keyword>CBRNe</keyword><keyword>Emergency nursing</keyword><keyword>Major incident preparedness</keyword></keywords><dates><year>2012</year><pub-dates><date>7//</date></pub-dates></dates><isbn>1755-599X</isbn><urls><related-urls><url>http://www.sciencedirect.com/science/article/pii/S1755599X11001091</url></related-urls></urls><electronic-resource-num>http://dx.doi.org/10.1016/j.ienj.2011.10.001</electronic-resource-num></record></Cite></EndNote>Mitchell et al. (2012) developed a tool by which ED nurses CBRN disaster preparedness can be tested. Their tool incorporates a detailed questionnaire with questions designed to test ED nurse preparedness in six different areas; 1)contaminated waste management; 2) triage; 3)decontamination; 4) contamination personal protective equipment (PPE); 5) isolation; and 6) chain of command and communication. This tool is specifically relevant in that it is ED, CBRN and nurse specific. It is also specific to North Ireland disaster and health systems.
This research project will be focussed around the adaptation of the tool developed by ADDIN EN.CITE <EndNote><Cite AuthorYear="1"><Author>Mitchell</Author><Year>2012</Year><RecNum>146</RecNum><DisplayText>Mitchell et al. (2012)</DisplayText><record><rec-number>146</rec-number><foreign-keys><key app="EN" db-id="wa5sppfa0rwrz5ea0f9v9ax49dx5zs5w25a5" timestamp="1399345278">146</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mitchell, Christina J.</author><author>Kernohan, W. George</author><author>Higginson, Ray</author></authors></contributors><titles><title>Are emergency care nurses prepared for chemical, biological, radiological, nuclear or explosive incidents?</title><secondary-title>International Emergency Nursing</secondary-title></titles><periodical><full-title>International Emergency Nursing</full-title></periodical><pages>151-161</pages><volume>20</volume><number>3</number><keywords><keyword>CBRNe</keyword><keyword>Emergency nursing</keyword><keyword>Major incident preparedness</keyword></keywords><dates><year>2012</year><pub-dates><date>7//</date></pub-dates></dates><isbn>1755-599X</isbn><urls><related-urls><url>http://www.sciencedirect.com/science/article/pii/S1755599X11001091</url></related-urls></urls><electronic-resource-num>http://dx.doi.org/10.1016/j.ienj.2011.10.001</electronic-resource-num></record></Cite></EndNote>Mitchell et al. (2012). Due to the validity and relevance, aspects of the assessment tool developed by ADDIN EN.CITE <EndNote><Cite AuthorYear="1"><Author>Adini</Author><Year>2012</Year><RecNum>115</RecNum><DisplayText>Adini et al. (2012)</DisplayText><record><rec-number>115</rec-number><foreign-keys><key app="EN" db-id="wa5sppfa0rwrz5ea0f9v9ax49dx5zs5w25a5" timestamp="1397543989">115</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Adini, B.</author><author>Laor, D.</author><author>Hornik-Lurie, T.</author><author>Schwartz, D.</author><author>Aharonson-Daniel, L.</author></authors></contributors><auth-address>1Ministry of Health, Tel Aviv, Israel</auth-address><titles><title>Improving hospital mass casualty preparedness through ongoing readiness evaluation</title><secondary-title>American Journal of Medical Quality</secondary-title></titles><periodical><full-title>American Journal of Medical Quality</full-title></periodical><pages>426-433</pages><volume>27</volume><number>5</number><keywords><keyword>Civil Defense -- Standards</keyword><keyword>Disaster Planning -- Standards</keyword><keyword>Emergency Service -- Standards</keyword><keyword>Mass Casualty Incidents</keyword><keyword>Benchmarking -- Methods</keyword><keyword>Civil Defense</keyword><keyword>Emergency Service -- Administration</keyword><keyword>Human</keyword><keyword>Employee Orientation -- Administration</keyword><keyword>Israel</keyword><keyword>Trauma Centers -- Standards</keyword></keywords><dates><year>2012</year></dates><isbn>1062-8606</isbn><accession-num>2011681664. Language: English. Entry Date: 20130315. Revision Date: 20130315. Publication Type: journal article</accession-num><urls><related-urls><url>http://ezproxy.library.usyd.edu.au/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=2011681664&site=ehost-live</url></related-urls></urls><electronic-resource-num>10.1177/1062860611432303</electronic-resource-num><remote-database-name>cin20</remote-database-name><remote-database-provider>EBSCOhost</remote-database-provider></record></Cite></EndNote>Adini et al. (2012) and the competency standards developed by ADDIN EN.CITE <EndNote><Cite><Author>Linney</Author><Year>2011</Year><RecNum>147</RecNum><DisplayText>(Linney et al., 2011)</DisplayText><record><rec-number>147</rec-number><foreign-keys><key app="EN" db-id="wa5sppfa0rwrz5ea0f9v9ax49dx5zs5w25a5" timestamp="1399351324">147</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Linney, Andrew C. S.</author><author>George, Kernohan, W.</author><author>Higginson, Ray</author></authors></contributors><titles><title>The identification of competencies for an NHS response to chemical, biological, radiological, nuclear and explosive (CBRNe) emergencies</title><secondary-title>International Emergency Nursing</secondary-title></titles><periodical><full-title>International Emergency Nursing</full-title></periodical><pages>96-105</pages><volume>19</volume><number>2</number><keywords><keyword>CBRNe</keyword><keyword>Delphi study</keyword><keyword>Emergency department</keyword><keyword>Major incident</keyword></keywords><dates><year>2011</year><pub-dates><date>4//</date></pub-dates></dates><isbn>1755-599X</isbn><urls><related-urls><url>http://www.sciencedirect.com/science/article/pii/S1755599X10000339</url></related-urls></urls><electronic-resource-num>http://dx.doi.org/10.1016/j.ienj.2010.04.001</electronic-resource-num></record></Cite></EndNote>(Linney et al., 2011) will be utilised to adapt the tool developed by ADDIN EN.CITE <EndNote><Cite AuthorYear="1"><Author>Mitchell</Author><Year>2012</Year><RecNum>146</RecNum><DisplayText>Mitchell et al. (2012)</DisplayText><record><rec-number>146</rec-number><foreign-keys><key app="EN" db-id="wa5sppfa0rwrz5ea0f9v9ax49dx5zs5w25a5" timestamp="1399345278">146</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mitchell, Christina J.</author><author>Kernohan, W. George</author><author>Higginson, Ray</author></authors></contributors><titles><title>Are emergency care nurses prepared for chemical, biological, radiological, nuclear or explosive incidents?</title><secondary-title>International Emergency Nursing</secondary-title></titles><periodical><full-title>International Emergency Nursing</full-title></periodical><pages>151-161</pages><volume>20</volume><number>3</number><keywords><keyword>CBRNe</keyword><keyword>Emergency nursing</keyword><keyword>Major incident preparedness</keyword></keywords><dates><year>2012</year><pub-dates><date>7//</date></pub-dates></dates><isbn>1755-599X</isbn><urls><related-urls><url>http://www.sciencedirect.com/science/article/pii/S1755599X11001091</url></related-urls></urls><electronic-resource-num>http://dx.doi.org/10.1016/j.ienj.2011.10.001</electronic-resource-num></record></Cite></EndNote>Mitchell et al. (2012).
Aims of the project
The primary aim of this project is to develop and validate an adapted version of the competency questionnaire developed by ADDIN EN.CITE <EndNote><Cite AuthorYear="1"><Author>Mitchell</Author><Year>2012</Year><RecNum>146</RecNum><DisplayText>Mitchell et al. (2012)</DisplayText><record><rec-number>146</rec-number><foreign-keys><key app="EN" db-id="wa5sppfa0rwrz5ea0f9v9ax49dx5zs5w25a5" timestamp="1399345278">146</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mitchell, Christina J.</author><author>Kernohan, W. George</author><author>Higginson, Ray</author></authors></contributors><titles><title>Are emergency care nurses prepared for chemical, biological, radiological, nuclear or explosive incidents?</title><secondary-title>International Emergency Nursing</secondary-title></titles><periodical><full-title>International Emergency Nursing</full-title></periodical><pages>151-161</pages><volume>20</volume><number>3</number><keywords><keyword>CBRNe</keyword><keyword>Emergency nursing</keyword><keyword>Major incident preparedness</keyword></keywords><dates><year>2012</year><pub-dates><date>7//</date></pub-dates></dates><isbn>1755-599X</isbn><urls><related-urls><url>http://www.sciencedirect.com/science/article/pii/S1755599X11001091</url></related-urls></urls><electronic-resource-num>http://dx.doi.org/10.1016/j.ienj.2011.10.001</electronic-resource-num></record></Cite></EndNote>Mitchell et al. (2012) for the assess emergency nurses preparedness for CBRN disaster response. Various aspects of the competency questionnaire require amendment so as to make it more specific to Australian disaster response systems and Australian ED processes.
A Delphi technique will be employed to capture and consolidate expert opinion on the topic, and expert feedback on the adaptation of the competency questionnaire. This will result in appropriate amendments being made to the questionnaire and validation of the final tool.
Significance of this project
The aim of the original competency questionnaire was to identify areas requiring further education to improve the overall preparedness of emergency nurses to respond to CBRN disaster. Likewise it is the planned that this project will result in a validated assessment tool for the purpose of:
Equipping EDs with a tool with which they can measure the individual, and ultimately the collective, preparedness of their nurses to respond to CBRN disasters
A tool with which EDs can use to inform educational programs toward the improvement of the overall preparedness of nursing staff for CBRN disaster response
A validated set of standardised preparedness competencies to submit to the NSW Health Department for adopted and rolled out across the state for the purpose if improving overall CBRN disaster preparedness in NSW.
A validated set of standardised preparedness competencies to form the basis and structure of a CBRN disaster training program for ED nurses across NSW.
Method
A Delphi technique PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Qb3dlbGw8L0F1dGhvcj48WWVhcj4yMDAzPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (Hasson & Keeney, 2011; Hsu & Sandford, 2007; Powell, 2003) will be used to establish consensus of expert opinion on how to adapt the competency questionnaire by ADDIN EN.CITE <EndNote><Cite AuthorYear="1"><Author>Mitchell</Author><Year>2012</Year><RecNum>146</RecNum><DisplayText>Mitchell et al. (2012)</DisplayText><record><rec-number>146</rec-number><foreign-keys><key app="EN" db-id="wa5sppfa0rwrz5ea0f9v9ax49dx5zs5w25a5" timestamp="1399345278">146</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mitchell, Christina J.</author><author>Kernohan, W. George</author><author>Higginson, Ray</author></authors></contributors><titles><title>Are emergency care nurses prepared for chemical, biological, radiological, nuclear or explosive incidents?</title><secondary-title>International Emergency Nursing</secondary-title></titles><periodical><full-title>International Emergency Nursing</full-title></periodical><pages>151-161</pages><volume>20</volume><number>3</number><keywords><keyword>CBRNe</keyword><keyword>Emergency nursing</keyword><keyword>Major incident preparedness</keyword></keywords><dates><year>2012</year><pub-dates><date>7//</date></pub-dates></dates><isbn>1755-599X</isbn><urls><related-urls><url>http://www.sciencedirect.com/science/article/pii/S1755599X11001091</url></related-urls></urls><electronic-resource-num>http://dx.doi.org/10.1016/j.ienj.2011.10.001</electronic-resource-num></record></Cite></EndNote>Mitchell et al. (2012). The Delphi method will be modified according to the accepted use of literature review findings as a basis for guided discussion.
Panel selection
A panel of experts will be selected according to their expertise on the topic. A heterogeneous group of individuals ADDIN EN.CITE <EndNote><Cite><Author>Powell</Author><Year>2003</Year><RecNum>161</RecNum><DisplayText>(Powell, 2003)</DisplayText><record><rec-number>161</rec-number><foreign-keys><key app="EN" db-id="wa5sppfa0rwrz5ea0f9v9ax49dx5zs5w25a5" timestamp="1403459654">161</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Powell, Catherine</author></authors></contributors><titles><title>The Delphi technique: myths and realities</title><secondary-title>Journal of Advanced Nursing</secondary-title></titles><periodical><full-title>Journal of Advanced Nursing</full-title></periodical><pages>376-382</pages><volume>41</volume><number>4</number><keywords><keyword>Delphi</keyword><keyword>critique</keyword><keyword>consensus</keyword><keyword>expert panel</keyword><keyword>data analysis</keyword><keyword>goodness criteria</keyword><keyword>nursing research</keyword></keywords><dates><year>2003</year></dates><publisher>Blackwell Science Ltd</publisher><isbn>1365-2648</isbn><urls><related-urls><url>http://dx.doi.org/10.1046/j.1365-2648.2003.02537.x</url></related-urls></urls><electronic-resource-num>10.1046/j.1365-2648.2003.02537.x</electronic-resource-num></record></Cite></EndNote>(Powell, 2003) will therefore be selected according to their expertise in one or more of the following key areas:
-CBRN incident management (isolation, decontamination, PPE, contaminated waste management)
-Clinical emergency nursing practice
-Acute medical management of CBRN toxicology
-Disaster triage systems & reverse triage
-Disaster chain of command and communication
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ADDIN EN.CITE.DATA (Adini, Laor, Hornik-Lurie, Schwartz, & Aharonson-Daniel; Mitchell et al., 2012); practice guidelines ADDIN EN.CITE <EndNote><Cite><Author>Emergency Management Australia</Author><Year>2000</Year><RecNum>144</RecNum><DisplayText>(Emergency Management Australia, 2000)</DisplayText><record><rec-number>144</rec-number><foreign-keys><key app="EN" db-id="wa5sppfa0rwrz5ea0f9v9ax49dx5zs5w25a5" timestamp="1399057441">144</key></foreign-keys><ref-type name="Government Document">46</ref-type><contributors><authors><author>Emergency Management Australia,</author></authors></contributors><titles><title>Manual 13: Health aspects of chemical, biological and radiological hazards</title><secondary-title>Emergency Management Practice Manuals Series</secondary-title></titles><periodical><full-title>Emergency Management Practice Manuals Series</full-title></periodical><volume>2</volume><number>3</number><dates><year>2000</year></dates><urls><related-urls><url>https://www.health.gov.au/internet/main/publishing.nsf/Content/eprs-health-aspects-chemical-haz-cnt.htm#pdf</url></related-urls></urls></record></Cite></EndNote>(Emergency Management Australia, 2000); and areas that ED nurses feel are either their responsibility or that they feel underprepared for PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5XaGV0emVsPC9BdXRob3I+PFllYXI+MjAxMzwvWWVhcj48
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ADDIN EN.CITE.DATA (Considine & Mitchell, 2009; Hammad et al., 2012; Whetzel, Walker-Cillo, Chan, & Trivett, 2013) .
The panel will be selected from within Australia, and a snowball/nomination sampling method will identify the most expert professionals in the field. experts will be approached according to their perceived expertise and after being briefed on the project will be asked to nominate individuals in their field who they consider to be in a better position than them to make expert contributions to this study.
A panel size of at least 15 ADDIN EN.CITE <EndNote><Cite><Author>Hsu</Author><Year>2007</Year><RecNum>150</RecNum><DisplayText>(Hsu & Sandford, 2007)</DisplayText><record><rec-number>150</rec-number><foreign-keys><key app="EN" db-id="wa5sppfa0rwrz5ea0f9v9ax49dx5zs5w25a5" timestamp="1400118351">150</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hsu, Chia-Chien.</author><author>Sandford, Brian. A.</author></authors></contributors><titles><title>The Delphi Technique: Making Sense of Consensus</title><secondary-title>Practical Assessment, Research and Evaluation</secondary-title></titles><periodical><full-title>Practical Assessment, Research and Evaluation</full-title></periodical><volume>12</volume><number>10</number><dates><year>2007</year></dates><urls></urls></record></Cite></EndNote>(Hsu & Sandford, 2007) will be required with at least 3 experts covering each key area. This will achieve a valid distribution of expert responses from each key area while maintaining a manageable panel size ADDIN EN.CITE <EndNote><Cite><Author>Powell</Author><Year>2003</Year><RecNum>161</RecNum><DisplayText>(Powell, 2003)</DisplayText><record><rec-number>161</rec-number><foreign-keys><key app="EN" db-id="wa5sppfa0rwrz5ea0f9v9ax49dx5zs5w25a5" timestamp="1403459654">161</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Powell, Catherine</author></authors></contributors><titles><title>The Delphi technique: myths and realities</title><secondary-title>Journal of Advanced Nursing</secondary-title></titles><periodical><full-title>Journal of Advanced Nursing</full-title></periodical><pages>376-382</pages><volume>41</volume><number>4</number><keywords><keyword>Delphi</keyword><keyword>critique</keyword><keyword>consensus</keyword><keyword>expert panel</keyword><keyword>data analysis</keyword><keyword>goodness criteria</keyword><keyword>nursing research</keyword></keywords><dates><year>2003</year></dates><publisher>Blackwell Science Ltd</publisher><isbn>1365-2648</isbn><urls><related-urls><url>http://dx.doi.org/10.1046/j.1365-2648.2003.02537.x</url></related-urls></urls><electronic-resource-num>10.1046/j.1365-2648.2003.02537.x</electronic-resource-num></record></Cite></EndNote>(Powell, 2003). With the appropriate participant selection, this panel size will result in a valid method leading to a robust result.
The final panel participants will be given a detailed brief detailing the topic, a copy of the competency questionnaire by ADDIN EN.CITE <EndNote><Cite AuthorYear="1"><Author>Mitchell</Author><Year>2012</Year><RecNum>146</RecNum><DisplayText>Mitchell et al. (2012)</DisplayText><record><rec-number>146</rec-number><foreign-keys><key app="EN" db-id="wa5sppfa0rwrz5ea0f9v9ax49dx5zs5w25a5" timestamp="1399345278">146</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mitchell, Christina J.</author><author>Kernohan, W. George</author><author>Higginson, Ray</author></authors></contributors><titles><title>Are emergency care nurses prepared for chemical, biological, radiological, nuclear or explosive incidents?</title><secondary-title>International Emergency Nursing</secondary-title></titles><periodical><full-title>International Emergency Nursing</full-title></periodical><pages>151-161</pages><volume>20</volume><number>3</number><keywords><keyword>CBRNe</keyword><keyword>Emergency nursing</keyword><keyword>Major incident preparedness</keyword></keywords><dates><year>2012</year><pub-dates><date>7//</date></pub-dates></dates><isbn>1755-599X</isbn><urls><related-urls><url>http://www.sciencedirect.com/science/article/pii/S1755599X11001091</url></related-urls></urls><electronic-resource-num>http://dx.doi.org/10.1016/j.ienj.2011.10.001</electronic-resource-num></record></Cite></EndNote>Mitchell et al. (2012), the literature review, the Delphi technique, and the nature of the heterogeneity of the rest of the panel. They will then be invited to participate in the study, promised some remuneration for their contribution, and if they accept the invitation, they will be asked to make in informal commitment to the study and the Delphi process.
Pilot questionnaire
A pilot questionnaire will be distributed to five of the experts who were involved in identifying the final panel; one individual from each key area. This will be to identify ambiguities in the questionnaire ADDIN EN.CITE <EndNote><Cite><Author>Powell</Author><Year>2003</Year><RecNum>161</RecNum><DisplayText>(Powell, 2003)</DisplayText><record><rec-number>161</rec-number><foreign-keys><key app="EN" db-id="wa5sppfa0rwrz5ea0f9v9ax49dx5zs5w25a5" timestamp="1403459654">161</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Powell, Catherine</author></authors></contributors><titles><title>The Delphi technique: myths and realities</title><secondary-title>Journal of Advanced Nursing</secondary-title></titles><periodical><full-title>Journal of Advanced Nursing</full-title></periodical><pages>376-382</pages><volume>41</volume><number>4</number><keywords><keyword>Delphi</keyword><keyword>critique</keyword><keyword>consensus</keyword><keyword>expert panel</keyword><keyword>data analysis</keyword><keyword>goodness criteria</keyword><keyword>nursing research</keyword></keywords><dates><year>2003</year></dates><publisher>Blackwell Science Ltd</publisher><isbn>1365-2648</isbn><urls><related-urls><url>http://dx.doi.org/10.1046/j.1365-2648.2003.02537.x</url></related-urls></urls><electronic-resource-num>10.1046/j.1365-2648.2003.02537.x</electronic-resource-num></record></Cite></EndNote>(Powell, 2003).
First Round
The first round if iterations will involve open ended questions pertaining to the experts opinion and recommendations for change according to; 1) the overall structure of the competency questionnaire by ADDIN EN.CITE <EndNote><Cite AuthorYear="1"><Author>Mitchell</Author><Year>2012</Year><RecNum>146</RecNum><DisplayText>Mitchell et al. (2012)</DisplayText><record><rec-number>146</rec-number><foreign-keys><key app="EN" db-id="wa5sppfa0rwrz5ea0f9v9ax49dx5zs5w25a5" timestamp="1399345278">146</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mitchell, Christina J.</author><author>Kernohan, W. George</author><author>Higginson, Ray</author></authors></contributors><titles><title>Are emergency care nurses prepared for chemical, biological, radiological, nuclear or explosive incidents?</title><secondary-title>International Emergency Nursing</secondary-title></titles><periodical><full-title>International Emergency Nursing</full-title></periodical><pages>151-161</pages><volume>20</volume><number>3</number><keywords><keyword>CBRNe</keyword><keyword>Emergency nursing</keyword><keyword>Major incident preparedness</keyword></keywords><dates><year>2012</year><pub-dates><date>7//</date></pub-dates></dates><isbn>1755-599X</isbn><urls><related-urls><url>http://www.sciencedirect.com/science/article/pii/S1755599X11001091</url></related-urls></urls><electronic-resource-num>http://dx.doi.org/10.1016/j.ienj.2011.10.001</electronic-resource-num></record></Cite></EndNote>Mitchell et al. (2012); 2) the questions contained within the tool. The participants will be asked to make specific recommendations to delete, re-word, or add individual questionnaire questions. Where additional questions are recommended, the participants will be asked to nominate the wording of the desired questions; and 3) the participants will be asked to rank each question as to its importance pertaining to CBRN disaster preparedness.
While maintaining anonymity, the responses from each of the panel members will be coded according to common themes, and collated into one document and redistributed to the panel members for their reconsideration.
Second Round
A questionnaire will be developed using a variety of survey techniques (ranking, prioritising, Likert scale, etc,) selected according to the nature and distribution of the responses from the first round.
The results will be statistically analysed by measures of central tendency and levels of dispersion. Statistical consensus will be determined at 80% agreement ADDIN EN.CITE <EndNote><Cite><Author>Hsu</Author><Year>2007</Year><RecNum>150</RecNum><DisplayText>(Hsu & Sandford, 2007)</DisplayText><record><rec-number>150</rec-number><foreign-keys><key app="EN" db-id="wa5sppfa0rwrz5ea0f9v9ax49dx5zs5w25a5" timestamp="1400118351">150</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hsu, Chia-Chien.</author><author>Sandford, Brian. A.</author></authors></contributors><titles><title>The Delphi Technique: Making Sense of Consensus</title><secondary-title>Practical Assessment, Research and Evaluation</secondary-title></titles><periodical><full-title>Practical Assessment, Research and Evaluation</full-title></periodical><volume>12</volume><number>10</number><dates><year>2007</year></dates><urls></urls></record></Cite></EndNote>(Hsu & Sandford, 2007).
Furthermore for each
Third Round
The results of the statistical analysis will then be distributed to the participants. They will then have an opportunity to alter their expert opinion according to consensus, or provide rationale for why their opinion is deviant from the general consensus of the rest of the panel.
Fourth round
The results from fourth round will be distributed to participants. They will be given opportunity to alter their expert opinion according to the rationale given by the participants whose opinion is deviant to the consensus opinion.
Fifth Round
A fifth round of iteration will only be undertaken if there are considerable, ongoing changes in expert opinion within the panel.
Ethical considerations
The main risk pertaining to this study is that of consuming time from the busy and important work that the experts are already doing in the field of disaster preparedness. Each round of investigation needs to be carefully designed so as to maximise the efficiency of the experts time spent in contributing to this study.
Budget
It is estimated that this study will cost $16800 according to the budget itemised below
Research investigators
It is estimated that a total of 100 hours work is required by the researchers. This will mostly be done by the primary researcher shared 70/30 with the supervising researcher.
Primary researcher70hrs X $60/hr=$4200
Supervising researcher30hrs X $110/hr=$3300
Panel participants
It is estimated that each expert panel member will spend a total of 16 hours contributing to this study
16hrs X $80/hr X 15participants=$19440
This will not be paid in full to the participants but rather each will be given $500 worth of fine dining gift voucher
$500 X 15 participants=$7500
Statistical analyst
It is estimated that the statistical analyst will spend 10 hours analysing the second round results
10hrs X $80/hr=$800
Pilot participants
It is estimated that the pilot experts will spend 2 hours proof reading the first round questionnaire
2hrs X $80/hr X 5participants=$800
This will not be paid in full to the participants but rather each will be given $200 worth of fine dining gift voucher
$200 X 5participants=$1000
TOTAL= $16800
Timeline
One of the challenges to the Delphi technique is the time and effort required to achieve the final result. This project will take an estimated 8 months to complete.
Week 0Begin snowball/nomination sampling (5 weeks)
Begin drafting the first round questionnaire
Week 5Submit the invitation package to the preferred final experts for the panelWeek 7Finalise the panel of experts and send out pilot questionnaire for first round (2 weeks)
Week 9Receive the responses from pilot questionnaire, and alter questionnaire accordingly
Week 10Distribute first round questionnaire for participants to complete (4 Weeks)
Week 14Receive the responses from first round
Commence coding and collation of first round responses (2 week)
Week 16Distribute second round questionnaire for participants to complete (2 weeks)
Week 18Receive the results of Second round questionnaire
Perform statistical analysis and prepare third round questionnaire (2 Weeks)
Week 20Distribute third round questionnaire for participants to complete (2 weeks)
Week 22 Receive the results of third round questionnaire
Prepare fourth round questionnaire (1 Weeks)
Week 23Distribute fourth round questionnaire for participants to complete (2 weeks)
Week 25Receive the results of fourth round questionnaire
Finalise the competency questionnaire tool according to the results and distribute final product with remunerative gift to the participants
Commence write up of study report (5 weeks)
Week 30Submit final competency questionnaire document with study report to NSW Health with proposal for the tool to be rolled out across the state for preparedness assessment
Submit study report article and final competency questionnaire document for academic publication
References
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