LIMITATION
Although the current study was only a pilot, the sample was smaller than the researchers had intended and the response rate decreased from Round 1 to Round 2, but remained same from Round 2 to Round 3. Time between rounds (i.e., 8 to 12 weeks) may have decreased the level of engagement of the participants. In addition, the sample was recruited from the Mid-Atlantic region and was unrepresentative of the United States; therefore, the findings cannot be generalized to practice settings throughout the country. Using the modified Delphi approach, participants may have felt restricted to the five subcategories of the survey. Participants were able to add qualitative data in all three rounds of the Delphi, but tion was not shared Round 3 information was not shared with participants.
A limitation to using the Delphi technique is that results could be biased because of the composition of the expert panel itself (Keeney et al., 2011) Although participants in the current study were experts managing patients with SWD or delirium in the inpatient clinical setting, simulation experts could have been included in this study. These experts could add input on the feasibility of implementing this competency checklist in a simulation setting. In addition, nurses and physieyed separately for the physicians were surveyed separately for the three Delphi rounds. The combined health care provider checklist could be further refined if nurses and physicians completed the same survey.