The Delphi technique is a research methodology which has traditionally been used to gain consensus among experts on complex issues characterised by uncertainty. Pioneered by the Rand Corporation in the 1950s for military applications, it has since been widely adopted across various fields, including nursing, health and social sciences and information systems on an array of multifaceted real-world issues. However, since its inception, the Delphi technique has undergone substantial methodological development and its use has now gone beyond its initial rationale. In the last two decades there has been a growing body of work illustrating an increasing methodological diversity of the method. While such diversity presents possibilities, it also challenges traditional application and methodological rigour. In an attempt to preserve the integrity of the method, generic and discipline specific guidelines have emerged providing general principles and standards. The aim of this paper is to present a much-needed critical reflection on the current application of the Delphi technique and its methodological development and to build on our paper from 2001 (Keeney et al., 2001). While the development of the Delphi method and its evolution are well recognised and reported in the literature, some controversies surrounding the approach remain and it is timely to revisit the method with a critical eye. Ultimately, the Delphi technique's flexibility is its significant strength, enabling the exploration of novel lines of inquiry, but it also presents a challenge. Striking the right balance between flexibility and rigour can lead to more meaningful insights and actionable outcomes from a Delphi study. Yet to achieve this, some level of consensus may need to be reached on the Delphi technique itself. In recognition of its 60th birthday, it is an opportune time to re-examine its key aspects and methodological advances and reflect on 'when is a Delphi not a Delphi?'

Background: The phenomenon of ‘failing to fail’ underperforming pre-registration nursing students in clinical placements is widely recognised. In the United Kingdom, updated Nursing and Midwifery Council guidelines aim to support registered nurses (RNs) in supervising and assessing students. The aim of the study is to explore RNs’ experiences of the phenomenon of ‘failing to fail’ underperforming pre-registration nursing students in clinical placements. Methods: This research is a qualitative descriptive study. Semi-structured one-to-one online interviews with 14 RNs enrolled in postgraduate nursing courses at a university in the United Kingdom. Data were analysed using Elo and Kyngäs’ content analysis framework. Results: Four key categories were identified: (1) The Stigma of Failure – failure perceived as stigmatised; (2) Organisational Constraints and Time Pressures – limiting effective mentoring and assessment; (3) Emotional and Relational Barriers to Failing – including personal relationships, lack of confidence and fear of repercussions and (4) Enablers – including supportive workplace culture, collaboration with universities, training and clear guidance. Conclusions: Failing to fail is a complex issue influenced by cultural, organisational and individual factors. It has significant implications for patient safety, professional standards and the future nursing workforce. Addressing these challenges requires changes in mentorship practices and institutional support.

Summary: Background: Parastomal hernia is a common complication after colostomy, especially end colostomy. It is unclear whether prophylactic placement of a three-dimensional mesh at the time of stoma formation could prevent parastomal hernia formation after surgery for rectal cancer. Methods: A systematic review was undertaken to evaluate the efficacy of prophylactic mesh placement in end colostomy construction from 2000 to 2025 using MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trails, and Clinical trials including CT.gov. The gray literature was searched, including reference lists of included studies and clinical practice guidelines. Observational studies were also included due to the scarcity of randomized controlled trials (RCTs) on this topic. The primary outcome of the study was the incidence of parastomal hernia. Results: Five observational studies and two RCTs were included, comprising 512 patients across the seven selected studies. Parastomal hernia occurred in 10.2% (32/313) of patients with mesh and 50.7% (97/191) of patients without mesh. Thematic analysis identified four overarching themes that could have influenced the efficacy of three-dimensional mesh placement: (1) follow-ups and parastomal hernia, (2) postoperative complications, (3) surgical technique, and (4) demographic make-up. Conclusion: Prophylactic placement of a three-dimensional mesh at the time of stoma formation is associated with a significant reduction in the incidence of parastomal hernia. However, findings need to be interpreted with caution due to the heterogeneity of the studies retrieved regarding clinical and non-clinical parameters. The variability in the diagnosis of parastomal hernia, surgical techniques, sample characteristics (age, gender, and medical history), and methodology (follow-up time) limits comparisons of the results.

Pain is the most common and distressing symptom for children at the end of life, with management challenges causing significant distress for patients and caregivers. Patient-controlled analgesia allows self-administration of preset medication doses for breakthrough pain and has shown benefits in postoperative and chronic pain management. However, its use and effectiveness in pediatric palliative care remain unclear. To review and synthesize the evidence pertaining to patient-controlled analgesia use for children at the end of life. A scoping review used the Arksey and O'Malley Framework to identify: (1) utilization of patient-controlled analgesia, including patient groups, advantages, and proxy use; (2) implications, safety, side effects, and impact on pain; and (3) child and parental perspectives. The key finding is a lack of a clearly defined, standardized patient-controlled analgesia policy for use in children at the end of life. Much of the reviewed evidence was organization-dependent, and most related to use for children with a malignant diagnosis. Further research is required involving patient-controlled analgesia use with children with a nonmalignant diagnosis, including the perspectives of children and parents. Nurses are integral team members and well-positioned to be developers of policies related to patient-controlled analgesia use in children at the end of life. This is a call to action for nurse clinicians, leaders, researchers, and educators to collaborate to identify and implement an evidence-based, effective policy.

Background: Many people spend their last year of life at home, with most wishing to die there. Evidence suggests paramedics facilitate over half of Emergency Department visits for palliative care patients, many of which are avoidable. Objective: To explore the perceptions and experiences of providing end-of-life care amongst paramedics in one region of the United Kingdom. Design: Online descriptive cross-sectional survey design using the ParAid Questionnaire. Quantitative data analysed using descriptive statistics. Setting and Participants: 182 paramedic respondents completed the questionnaire online (34% response rate). Results: Respondents reported numerous barriers to delivering end-of-life care. Access to medicines was problematic, with 54% reporting that they ‘always’ or ‘often’ had no access to specific medicines needed for symptom control. Education gaps were also evident: 67% reported that lack of pre-registration end-of-life care education and 71% that lack of post-registration education ‘always’ or ‘often’ influenced their ability to meet patients’ needs. Only 28% felt ‘very’ or ‘extremely’ competent in supporting patients and families in the last year of life, while 47% reported experiencing a ‘fear of doing the wrong thing’ ‘always’ or ‘often’. Access to information and referral pathways also presented challenges: 88% reported that they ‘always’ or ‘often’ lacked access to existing Advance Care Planning documentation, while 62% reported that they ‘rarely’ or ‘never’ had access to a specialist palliative care team out-of-hours. Conclusions: Findings emphasise the need for improved palliative care education, support structures, and improved access to information and medicines for paramedics. Findings identify potential areas for service development, including training, communication, and referral pathways, which may better support paramedics in providing end-of-life care.

To map the available evidence on educational interventions used to teach clinical reasoning skills among student advanced nurse practitioners. As autonomous practitioners, trainee advanced nurse practitioners learn and develop effective clinical decision-making skills. Although advocated globally as core competency skills, little is known about how these skills are taught or developed in practice. A scoping review was conducted in April 2025, using CINAHL, OVIDMEDLINE, EMBASE and WEB OF SCIENCE, aligned to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA) guidelines. In addition, a search of grey literature and reference lists of included studies were conducted. Key terms were constructed based on the Population-Concept Context (PCC). The eligibility of articles was determined by three reviewers independently. In total, 457 articles were identified, of which 25 were eligible for inclusion. No standardised conceptual definition of clinical reasoning, underpinning theoretical framework or approach to teaching or measurement existed. Results showed that multiple educational interventions were used in practice. Several novel techniques were also identified. There was little statistically significant evidence of effectiveness from the identified studies. Significant variance exists in teaching method used globally. There remains a lack of evidence on the effectiveness of teaching strategies for teaching clinical reasoning to trainee advance nurse practitioners and no commonly accepted validated tool to assess these skills in practice. A commonly accepted theoretical framework for clinical reasoning is needed or to develop, deliver and assess effective educational interventions.