Qualitative meta-synthesis: a question of dialoguing with texts

Understanding how organizational culture shapes the experiences of direct support professionals: A qualitative meta-synthesis from an organizational justice perspective

Direct support professionals (DSPs) are critical to the quality of life of people with intellectual and developmental disabilities, yet high turnover rates significantly affect the quality and consistency of their services. A qualitative meta-synthesis could help understand how organizational culture shapes the experiences of DSPs. A systematic search found six articles that met all inclusion criteria. The initial findings show that although DSPs perceived their work as worthy and rewarding, they did not feel valued or supported by management either monetarily or professionally. The analysis revealed an overarching theme with elements congruent with the organizational justice literature. Findings suggest that cultivating a culture of justice and fairness is vital to retaining quality DSPs, promoting organizational outcomes, and improving the quality of life of people with intellectual and developmental disabilities.

Exploring the experiences of ableism among Asian children and youth with disabilities and their families: a systematic review of qualitative studies

PURPOSE

Asian children and youth with disabilities often experience multiple barriers, stigmas and discrimination within and outside their families; yet less is understood about their lived experiences. This systematic review explored the experiences of ableism among Asian children and youth with disabilities and their families.

METHODS

We conducted a systematic review of qualitative studies and a qualitative meta-synthesis. We searched six databases including Ovid Medline, Embase, PsychInfo, Healthstar, Web of Science, and Scopus.

RESULTS

Forty-two articles met our inclusion criteria involving 17 countries and regions over a 22-year period. The findings were synthesized into four themes: (1) individual- and family-level ableism (i.e., stigma, fears, concerns, stress and anxieties, physical abuse, bullying, reduced engagement in community activities); (2) institutional-level ableism (i.e., barriers to accessing and navigating supports, ableist attitudes among service providers, unavailable services); (3) societal-level ableism (i.e., cultural and religious stigma, social rejection, discrimination, environmental and policy barriers); and (4) coping strategies (i.e., self-care activities, supports from family, friends and people with similar conditions, religious beliefs).

CONCLUSIONS

Our results highlight the ableist experiences that Asian children and youth with disabilities and their caregivers often encounter and the strong need for further supports to address ableism using culturally responsive strategies.

Public health nurses' experiences of ethical responsibility: A meta-ethnography

Public health nursing is grounded in public health ideologies and fundamental nursing values. Researchers have argued that ethical responsibility from the perspective of the nurse is an understudied phenomenon. This meta-ethnography provides in-depth knowledge of how public health nurses (PHNs) experience ethical responsibility when working to prevent injury and disease, and promote health and well-being in children, young people and their families. There are reciprocal findings across the 10 included studies. The findings reveal that these nurses often feel alone, have worries and uncertainties and are afraid of doing wrong. They describe unclear boundaries in their work, creating a heightened sense of responsibility. PHNs fight lonely battles. Yet they show courage and commitment and are ready to stand up and fight for children and families who do not receive adequate care. A line of argument is developed and the metaphorical phrase Chivalrous knights in moral armour is used to express the authors' overall interpretations of the findings. Reflection on the findings shows how the different dimensions of ethical responsibility are interconnected. The nurses' ethical sensitivity enables them to feel compassion for others and they show indignation when vulnerable others are not treated with dignity and respect. Indignation and compassion are interrelated, and when human life and dignity are threatened, the ethical demand to respond emerges. Indignation is a precursor to moral courage, and the nurses' moral sensitivity and respect for their clients emboldens them to stand up for vulnerable others. The findings also illustrate the paradoxical nature of freedom. Freedom of choice due to unclear boundaries heightens the nurses' sense of responsibility. This research is an important step in theory development and has implications for further research, education and practice.

Survivorship Experiences of Allogeneic Hematopoietic Stem Cell Transplantation Survivors: A Qualitative Systematic Review

BACKGROUND

The number of allogeneic hematopoietic stem cell transplantation (allo-HSCT) survivors is increasing globally. Although qualitative studies in this population are reported, clear understanding of how allo-HSCT survivors experience survivorship is lacking.

OBJECTIVE

This study aimed to identify, appraise, and synthesize evidence from qualitative research on survivorship experience among allo-HSCT survivors.

METHODS

A qualitative systematic review was conducted. A literature search of 9 databases and OpenGrey, Google Scholar, and Google was performed from inception to February 2023. Two reviewers independently screened and assessed the eligibility of each study. Descriptive information was extracted from the studies by one reviewer and checked by another. Findings were extracted and analyzed using thematic synthesis.

RESULTS

Seventeen articles were included. Four themes and 12 subthemes regarding allo-HSCT survivors' experiences emerged: (1) recovery as being a longer process than they thought (influenced by long-term physical symptoms, disturbed by survivorship uncertainty); (2) experiencing a restricted survivorship life (shrunken social world, forced dietary limitations, centered around hospitals); (3) suffering from stigma and discrimination (perceived as a burden, seen differently by others, difficulties establishing and maintaining romantic relationships and marriage, limited opportunities in work); and (4) realizing something positive obtained during survivorship (enriched survivorship self-management skills, enhanced personal growth, developed positive relationships).

CONCLUSIONS

The findings reveal the challenges, needs, and growth that allo-HSCT survivors experienced during survivorship. Some understudied areas were identified, which warrant further exploration.

IMPLICATIONS FOR PRACTICE

Targeted survivor-centered care should be provided to allo-HSCT survivors, and interventions to resolve issues experienced during survivorship should be developed.

Cancer patients' perceptions of the meaning in life: a protocol for a meta-synthesis of qualitative research

INTRODUCTION

The onset of cancer compels patients to grapple with existential questions. Enabling individuals with cancer, irrespective of the disease stage, to experience meaningful lives is of utmost importance in enhancing their overall quality of life. This study will synthesise qualitative research evidence to understand cancer patients' perceptions and perspectives regarding their meaning in life. Such insights ultimately contribute to enhancing the profound experience of meaning throughout the life course of cancer patients.

METHODS AND ANALYSIS

The English and Chinese databases we will search include the Cochrane Library, PubMed, MEDLINE, Web of Science, EMbase, CINAHL, PsycINFO, China National Knowledge Infrastructure, Wan Fang Data, Chinese Biomedical Literature Database and VIP Database for Chinese Technical Periodicals. Two independent reviewers will assess the quality of the included studies using the standard JBI Critical Appraisal Checklist for Qualitative Research and extract data using the standard JBI Data Extraction Tool for Qualitative Research. The JBI meta-aggregation approach will be employed to compare, analyse and summarise the original results. To enhance confidence in the synthesised results of the qualitative study, the final synthesised study results will be graded using the JBI ConQual approach.

ETHICS AND DISSEMINATION

External ethical approval is not necessary for this review since it involves a retrospective analysis of publicly available primary data through secondary analysis. The findings of the review will be disseminated by publishing them in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42023447664.

Effectiveness and Acceptability of Interventions Offered for Those Bereaved by Parental Loss to Suicide in Childhood: A Mixed Methods Systematic Review

OBJECTIVES

Identify interventions offered for children bereaved by parental suicide, investigate reported effectiveness and explore the acceptability of identified interventions.

METHOD

Six electronic databases were systematically searched for primary studies investigating intervention effectiveness and acceptability, (August 2011 to June 2023). Eligibility required inclusion of participants bereaved by parental suicide during childhood among sample populations. Methodological quality was evaluated applying JBI critical appraisal tools. Narrative synthesis was conducted using parallel-results convergent design.

RESULTS

Of the 22 eligible reports, 19 articles reported on 12 manual-based supports provided during childhood; three papers described users' experiences of various specified intervention types offered following childhood loss. Twenty-one studies reported on interventions offered for heterogeneous participant groups that included children bereaved by parental suicide. Time from loss to intervention generally included both recent (1 < 30mths) and more distant loss, with just one intervention described as solely for recently bereaved children. Eight interventions (n = 12 studies) demonstrated significant positive effects (p < 0.05), for maladaptive grief, mental health, quality of life. Only one study investigated suicide-related outcomes. Qualitative findings (n = 8 studies) facilitated development of four acceptability themes: Perceived utility, Relationships, Components and Delivery.

CONCLUSIONS

Heterogeneity in causes of loss/trauma and relationships with the deceased limit specific conclusions regarding effectiveness/acceptability of reviewed interventions for children bereaved by parental suicide. Few sub-group analyses of effects were reported, and qualitative evidence specifically from children bereaved by parental suicide was limited. Further research is recommended regarding mixed-user interventions, specifically for children bereaved by parental suicide.

Why do nurses miss nursing care? A qualitative meta-synthesis

AIM

The aim of this qualitative meta-synthesis was to discover the factors impacting on missed nursing care of nurses through systematic thinking.

BACKGROUND

Although nurses are responsible for high-quality care, missed nursing care is common, endangering patient safety. Understanding of the causes related to missed nursing care could help nursing managers improve the quality of nursing care.

DESIGN

A qualitative meta-synthesis guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA).

METHODS

As a method designed to contribute to knowledge development, meta-synthesis allows for integration of qualitative study findings using thematic synthesis. Six databases were searched up to October 2021; nine studies met the inclusion and quality assessment criteria and meta-synthesis were conducted.

RESULTS

Three themes related to the causes why nurses missed nursing care were found. The themes included intrinsic resources (professional and ethical values, ambiguous nurse role, prioritization, education system, and knowledge), system structure (staff and resources shortage, heavy workload but limited time, and organizational management failure), and social environment (communication, working relationship and skill mix, and inappropriate ward layout).

CONCLUSION

The phenomenon of missed nursing care is a global tissue, with variations in its elements but also notable similarities. Meta-synthesis provides evidence of intrinsic and extrinsic factors that contribute to missed nursing care.

RELEVANCE TO CLINICAL PRACTICE

Recognizing and understanding the causes of missed nursing care is essential for nursing managers to ensure patient safety and the provision of high-quality care.

Barriers to gene therapy, understanding the concerns people with haemophilia have: an exigency sub-study

BACKGROUND

Gene therapy has the potential to offer people with haemophilia (PwH) a life free from bleeding and the burden posed by current treatment regimens. To date, gene therapy has only been available in clinical trial settings, to PwH without pre-existing or historical factor inhibitors, significant concomitant liver damage or pre-existing neutralising antibodies to the adeno-associated viruses used to deliver the therapy. Thus, most PwH treated at centres not currently involved in gene therapy trials, either as a referral/follow-up centre or as a dosing centre, have been unable to access the therapy. This Exigency sub-study aims to gain a greater understanding of the opinions of PwH in the United Kingdom who have not had access to gene therapy: asking what they understand, what concerns they have, and whether they perceive any barriers preventing their access to gene therapy.

RESULTS

Twenty-three PwH were approached; 14 consented, and one withdrew prior to interview. The mean age of the participants was 35.7 years (range 25-74 years). Eleven had haemophilia A and two haemophilia B. Two were treated with standard half-life factor products, five with extended half-life products, five with a FVIII mimetic and one with a clinical trial product. One family member (a participant's partner) was also interviewed. The participants identified four barriers to gene therapy: concerns about the process of gene therapy (Expectations), uncertainty about the results (outcomes), (Access) to treatment, and a lack of understanding about gene therapy (education).

CONCLUSIONS

This Exigency study subgroup sees gene therapy as a positive treatment development that promises an improved quality of life. For this participant group, four issues impact their decision to undergo gene therapy. If the promise of gene therapy is to be realised, these barriers need to be acknowledged and addressed by healthcare professionals, patient organisations, and gene therapy providers.

Prostate cancer patients' experiences and preferences for web-based physical activity applications: A qualitative meta-synthesis

BACKGROUND

The incidence of prostate cancer increases with age. Physical activity can improve the prognosis and quality of life of patients. However, studies have observed lower levels of physical activity in men with prostate cancer, and most do not meet physical activity guidelines. Web-based physical activity is a promising form of exercise that will play an important role in prostate cancer patients.

AIMS

To synthesise the experiences and preferences of prostate cancer patients for web-based PA applications, thereby providing a basis for the construction of intervention programs tailored to the needs of patients.

METHODS

We systematically searched PubMed, Web of Science, Cochrane Library, EMBASE, CINAHL and three Chinese databases. This review includes qualitative empirical reports from the date of establishment of the respective databases until April 2023. Data extraction was performed by two independent reviewers and study quality was assessed.

RESULTS

A total of nine studies were included. The experiences and preferences of prostate cancer patients with web-based physical activity apps were synthesised into the following three analysis themes: (1) Pursuing individualised management strategies; (2) Perceiving and seeking social support and (3) Moving forwards in the struggle.

CONCLUSION

Our study found that men with prostate cancer experienced greater challenges in engaging in physical activity. Because of individual differences between patients, health care providers need to provide care that is tailored to each patient. Future studies should further explore the specific effects of web-based PA applications in promoting the physical function of prostate cancer patients to increase their flexibility.

RELEVANCE TO CLINICAL PRACTICE

This article synthesises prostate cancer patients' experiences with web-based physical activity applications, highlighting their specific information needs. The results suggest several implications for the application of individualised management strategies, the perception and search for social support, and health- literacy. The results of this study will inform future research and program design that recognises the importance of patient-centred efforts to better self-manage physical function.

PATIENT OR PUBLIC CONTRIBUTION

In the early stages of the study, objectives and subsequent findings were presented and discussed in a meeting with a reference group that represented patients, health professionals and the public.

Factors Influencing Participation in Physical Activity, Sports, and Exercise in Children and Adolescents with Spinal Pain or Spinal Conditions: A Systematic Review and Meta-Ethnography

BACKGROUND

Physical activity is an effective treatment for paediatric spinal pain. However, participation rates remain low and review evidence is needed to establish why. This review identifies factors influencing participation in sports, exercise, and physical activity in those aged 18 or under with spinal pain or spinal conditions. Trends or differences between discrete sub-populations are identified.

METHODS

A meta-ethnographic review was undertaken. Qualitative papers were identified and appraised using the JBI checklist. Thematic trends were mapped onto the biopsychosocial model and subthemes identified. Uniqueness was calculated and the confidence in the evidence was evaluated using the GRADE-CERQual tool.

RESULTS

Data were gathered from nine qualitative papers (384 participants). Three themes were identified: (1) biological: physical challenges and bladder and bowel care; (2) psychological: perceptions of differences to peers, struggle, anger, sadness, adjustment, and acceptance; and (3) sociological: influence of friends, social acceptance, negative attitudes from others, and the influence of their disability on family routine.

CONCLUSIONS

Sociological factors were most influential on exercise participation alongside related psychological and biological factors. Adolescents over 14 years offered greater critical insight compared to the younger children. Results are best applied to neuromuscular conditions with further robust evidence required in paediatric musculoskeletal spinal pain.

A meta-synthesis of the transitioning experiences and career progression of migrant African nurses

INTRODUCTION

With the rise in global migration, hospitals and health systems in developed countries are looking to supplement their workforces with migrant nurses who have been reported to feel devalued, underutilized with experience of deskilling and unmet expectations as they transitioned. Despite the plethora of literature reporting on the experiences of internationally trained nurses, only limited work has been done regarding understanding the experiences of Migrant African nurses. Thus, this study sought to synthesize existing qualitative studies to develop in-depth understanding of the transitioning experiences of migrant African nurses, their career progression and to highlight existing gaps to guide future studies as well as inform policies.

METHOD

A meta-synthesis was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Enhancing transparency in reporting the synthesis of qualitative research statement. A pre-planned search strategy was developed guided by the SPIDER tool for qualitative synthesis searching EMBASE via OVID, CINAHL via EBSCO, PubMed, Web of Science, and PsychINFO databases. We included published studies that 1) focused on migrant African nurses, 2) employed a qualitative design and 3) reported in English.

RESULTS

The search yielded 139 studies of which nine studies met the inclusion criteria and included in final synthesis. Three themes with corresponding subthemes emerged from data synthesis: 1) Navigating reality shock (a. Navigating a new culture, b. Survival strategies and support amidst the shock); 2) Discrimination and limited opportunities for promotion (a. Prejudices and preference for White over Black, b. Lack of recognition and limited opportunities for a workplace promotion); and 3) Finding one's feet (a. Standing up for oneself and looking beyond discrimination, b. Experiencing growth).

CONCLUSION

Transitioning to a new setting can be a challenging experience for migrant African nurses warranting the availability of a tailor-made adaptation or orientation programme. Though African nurses may experience discrimination and prejudices as part of their transition, they consider their situation to be better off compared to back home. Therefore, clear transitioning policies which focus on career pathways are required by hiring institutions, and migrant nurses should be proactive in taking active roles in pushing their career ahead, instead of maintaining a culture of silence.

Barriers and facilitators of physical function, activity, sports and exercise in children and adolescents with spinal pain: a protocol for a systematic review and meta-ethnography

INTRODUCTION

Spinal pain is one of the leading causes of disability, with the incidence of adolescent back pain estimated at 20%. Multiple barriers influence exercise participation in adolescents. However, there remains a lack of literature surrounding patients' choice to exercise, perceived barriers and facilitators of exercise, and their relationship to participant demographics. The aim of this systematic review with meta-ethnography will be to identify the barriers and facilitators of exercise participation among adolescents with thoracic or lower back pain (LBP). The secondary aim will be to identify any trends in barriers and facilitators of exercise between different demographic groups within children or adolescents under 18 years.

METHODS AND ANALYSIS

The seven-phase process identified by Noblit and Hare's meta-ethnography approach will be used. A comprehensive electronic search of databases (AMED, CINAHLplus, EMBASE, MEDLINE, SCOPUS, Nursing & Allied Health, PubMed, PsycINFO, SPORTDiscus, Social Science Database) will be completed during April 2022. Grey literature using reference lists, websites and search engines will also be searched in accordance with Peer Review of Electronic Search Strategies (PRESS) guidelines. Inclusion criteria include: (A) qualitative studies, (B) participants under 18 years experiencing thoracic or LBP, (C) identification of barriers and facilitators of exercise participation in exercise, sports or physical activity and (D) primary research. This systematic review with meta-ethnography review aims to generate theories of behaviours and interpret significance across multiple studies. This process aims to develop future physiotherapeutic behavioural interventions, inform service provision and identify possible future research questions.

ETHICS AND DISSEMINATION

No ethical approval was required due to the nature of using previously published work to form a systematic review paper. This systematic review and meta-ethnography will be disseminated through both conference presentations and journal publications. No funding was received for this review.

PROSPERO REGISTRATION NUMBER

CRD42022314796.

Post-traumatic growth among childhood cancer survivors: A qualitative meta-synthesis

PURPOSE

To conduct a meta-synthesis of qualitative studies on the post-traumatic growth experiences of childhood cancer survivors.

METHOD

Various databases, including PubMed, Cochrane Library, Web of Science, EMBASE, PsycInfo, ProQuest, Scopus, China National Knowledge Infrastructure (CNKI), Wanfang Data, China Science and Technology Journal Database (CSTJ), and China Biology Medicine (CBM) were used to retrieve qualitative studies on childhood cancer survivors who experienced post-traumatic growth.

RESULTS

Eight papers were included in this study, and similar fragments were combined to form eight categories, which were further combined into four synthesized findings: adjustment of cognitive system, enhancement of personal strength, improving relationships with others, resetting of life goals.

CONCLUSIONS

Post-traumatic growth was observed in some childhood cancer survivors. The potential resources and positive forces contributing to this growth are of great significance in the fight against cancer, in tapping into individual and social resources to help survivors grow, and in improving their survival rates and quality of life. It also provides a new perspective for healthcare providers regarding the relevant psychological interventions.

Healthcare practitioners' experiences of breaking bad news: A critical interpretative meta synthesis

OBJECTIVE

To provide an overview of healthcare practitioners' experiences of breaking bad news.

METHOD

Interpretative meta synthesis of 14 qualitative papers identified through a systematic search. Data were extracted and constructs elicited via reciprocal translational analysis.

RESULTS

Findings comprised four inter-connected themes: (1) Discomfort, particularly difficult emotional and physical responses to breaking bad news; (2) Relational distress, connected to attachment and identification with patients; (3) Inadequate clinician, indicating the fear and rumination about the possibility of getting it wrong and the subsequent self-blame; and (4) Only human, highlighting a culture of invulnerability where practitioner self-care is deprioritised.

CONCLUSIONS

Breaking bad news provokes significant distress for practitioners, particularly where they experience strong attachment to or identification with a patient. Breaking bad news was understood as an isolating experience and staff's non-disclosure of difficulties appeared to sustain a culture of invulnerability in which admission of distress was not encouraged.

PRACTICE IMPLICATIONS

Given the adverse impacts and potential for practitioner burnout, organisations should acknowledge ramifications and offer time for staff to process the delivery of bad news, promote a culture of collective care and provide space for reflective practice.

Possible paths to increase detection of child sexual abuse in child and adolescent psychiatry: a meta-synthesis of survivors’ and health professionals’ experiences of addressing child sexual abuse

Background

Efforts are directed both towards prevention and early detection of Child sexual abuse (CSA). Yet, only about 50% of CSA survivors disclose before adulthood, and health professionals rarely are the first disclosure recipients. Increasing the detection rate of CSA within the context of Child and Adolescent Psychiatry (CAP) therefore represents a significant secondary prevention strategy. However, facilitating CSA disclosure when the survivor is reluctant to tell is a highly complex and emotionally demanding clinical task. We therefore argue that efforts to increase detection rates of CSA within CAP need to rest on knowledge of how both survivors and health professionals experience addressing CSA.

Method

Using meta-ethnography as method, we present separate sub-syntheses as well an overarching joint synthesis of how survivors and health professionals experience addressing CSA.

Results

Results show how both survivors and health professionals facing CSA disclosure feel deeply isolated, they experience the consequences of addressing CSA as highly unpredictable, and they need support from others to counteract the negative impact of CSA.

Conclusion

The results indicate that adapting the organization of CAP to knowledge of how the survivors and health professionals experience addressing CSA is critical to facilitate earlier disclosure of CSA within CAP.

LGBTQ+ Loss and Grief in a Cis-Heteronormative Pandemic: A Qualitative Evidence Synthesis of the COVID-19 Literature

LGBTQ+ people are no stranger to loss and grief, particularly during times of pandemic such as the 1980s-90s HIV/AIDS pandemic and now, the COVID-19 pandemic. Current COVID-19 loss and grief research remains relatively silent on LGBTQ+ peoples' loss and grief experiences. The aim of this research was to conduct a qualitative evidence synthesis of LGBTQ+ people's COVID-19 loss and grief experiences reported in the literature. A systematic search and inclusion strategy identified 22 relevant articles for review. Inductive thematic synthesis resulted in five loss-focused themes across the articles: (1) loss of work and livelihood, (2) loss of social and kinship connection, (3) loss of LGBTQ+ community connection, (4) loss of physical and mental health supports and (5) loss of LGBTQ+ identity authenticity, affirmation and visibility. Discussion of these themes highlights the many layered and often disenfranchised nature of LGBTQ+ people's loss during the COVID-19 pandemic.

Research using hashtags: A meta-synthesis

In the last 20 years, research using hashtags has grown considerably. The changes that occurred in the digital environment have influenced their diffusion and development. Today, there is considerable research on hashtags, their use, and on hashtag activism. Likewise, there is a growing interest in their descriptive measures and their metrics. This article aimed to provide a review of this area of research and studies to outline the traits of hashtag research, which are yet nascent. To achieve this, we used a meta-study to produce a meta-synthesis capable of bringing out similarities and differences in research using hashtags and identifying spaces for the generation of new knowledge.

Health Care Providers' Views on Clinic Infrastructure and Practice Models That May Facilitate HIV Preexposure Prophylaxis (PrEP) Prescribing: A Qualitative Meta-Synthesis

HIV (human immunodeficiency virus) preexposure prophylaxis (PrEP) is an effective biomedical HIV prevention tool. Increasing PrEP use among populations disproportionately affected by HIV is one of the key efforts in the United States' Ending the HIV Epidemic (EHE) initiative and the HIV National Strategic Plan for the United States. Given that PrEP is available only through prescription, it is important to explore structural, organizational, or environmental factors that could facilitate or impede health care provider's PrEP prescribing behavior. The purpose of this systematic review (PROSPERO [CRD: 42019138889]) is to identify qualitative studies that addressed this topic and conduct meta-synthesis using the thematic synthesis method to identify major themes on the characteristics of clinic infrastructure or clinic models that providers consider as facilitators of PrEP prescribing in the United States. Eighteen citations representing 15 studies were included in this review. Five overarching themes were identified: (1) routinized HIV risk assessment; (2) interdisciplinary/coordinated PrEP teams or services; (3) clinic capacity to provide essential PrEP-related services; (4) low out-of-pocket patient costs; and (5) access to the priority populations. Some of these themes are consistent with the recommendations of CDC's PrEP clinical guidelines and the EHE initiative. More recent studies that include perspectives of diverse providers, timely analysis of these studies, and implementation research to assess strategies to address the current practice gaps are needed to further promote PrEP prescribing among providers in the United States.

'Becoming and overcoming': A qualitative meta-synthesis of the experiences of men in nursing academia

BACKGROUND

The experiences of men in nursing academia remain poorly understood globally as they remain a minority within the underrepresented male nursing populace.

PURPOSE

To develop a comparative understanding of the experiences of male nurse educators.

METHOD

We conducted a systematic review and meta-synthesis. Studies were considered eligible if they employed qualitative methodologies, contained verbatim quotes, published in a peer-reviewed journal and full-text available in English. An interpretive stance inspired by Ricoeur's hermeneutic approach was employed to undertake data analysis.

RESULTS

Five studies were retained in the study. Three themes and ten subthemes emerged. Becoming describes why male nurses enter and stay in academia. Although several factors may push them, they often experienced isolation requiring them to overcome leading to professional growth.

CONCLUSION

The space of becoming and overcoming can be a lonely and isolated journey, often with no role models to support the process. Mentorship and peer support programmes are required as male nurses' transition and remain in nursing academia.

Do people perceive benefits in the use of social prescribing to address loneliness and/or social isolation? A qualitative meta-synthesis of the literature

Social prescribing is a means by which clinical services can link individuals who have psychological, social and/or practical needs with non-clinical services within their local community. There is a lack of empirical evidence investigating whether social prescribing helps such individuals and which interventions are the most effective and accepted by them to address their loneliness. This meta-synthesis aimed to synthesise findings from qualitative studies exploring experiences of people (of any age) who participated in any social prescribing intervention aimed at loneliness and/or social isolation to ascertain whether they felt it helped address loneliness/isolation and the potential mechanisms by which this might occur. We conducted a systematic search of 5 electronic databases and 4 other databases that would yield grey literature in April 2021 to identify qualitative articles on this topic written in English or French. We assessed the quality of the included studies using recognised tools, and synthesised findings using the approach of thematic analysis. We identified 19 records analysed (e.g. journal articles) from 18 studies meeting inclusion criteria. Our analysis identified three themes: (1) increased sense of wellbeing (with six subthemes), (2) factors that engendered an ongoing desire to connect with others, and (3) perceived drawbacks of social prescribing. These themes illustrate the benefits and difficulties people perceive in social prescribing programmes addressing loneliness and social isolation, with an overall balance of more benefits than drawbacks in social prescribing participation. However, given the unhelpful aspects of social prescribing identified by some participants, greater thought should be given to potential harms. Moreover, further qualitative and quantitative research is needed to better understand mechanisms and effectiveness, and how different components of social prescribing might be best matched to individual participants.

Sustainability Accounting Studies: A Metasynthesis

This review article seeks to discuss the sustainability accounting concept by examining previously conducted studies on this topic in order to understand its thematic progress in the academic literature. This study is a metasynthesis, where, in the identification phase, 334 documents published in the Web of Science (WoS) database are selected, and in the literature review stages, 15 re-reviews are selected according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) method. The results reveal that businesses, academia, and regulatory bodies do not recognize a homogeneous terminology when it comes to sustainability accounting. There is a variety of synonyms that complicate the disclosure of activities carried out by companies in the pursuit of the sustainability development goals (SDGs), with SDGs 5, 6, 13, 14, and 15 being analyzed in the academic literature in relation to the sustainability accounting concept. For future research directions, the review articles analyzed suggest examining the concrete effects produced by practices related to sustainability performance in companies, linking the relevance of understanding the sustainability reports related to the sustainability performance of companies.

The Impact Of Patient Suicide on Doctors and Nurses: A Critical Interpretive Meta-Synthesis

OBJECTIVE

To provide a conceptual overview of how medical doctors and nurses experience patient suicide.

METHOD

A systematic search identified ten qualitative papers for this interpretive meta-synthesis. Constructs were elicited and synthesized via reciprocal translational analysis.

RESULTS

Findings comprised four inter-related themes: (1) Intrinsic but taboo: patient suicide perceived as inevitable yet difficult to discuss. (2) Significant emotional impact: clinicians deeply affected, with resilience important for mitigating impact. (3) Failure and accountability: intense self-scrutiny, guilt and shame, with blame attributed differently across professions. (4) Legacy of patient suicide: opportunities for growth but lack of postvention guidance.

CONCLUSIONS

Patient suicide affects clinicians profoundly. Further research should evaluate postvention procedures to inform effective guidance and support, acknowledging professional differences.HighlightsPatient suicide profoundly affects doctors and nurses as "suicide survivors."Despite common themes, professions differed in blame attributions.Organizations must develop postvention responses to meet clinicians' pastoral needs.

Current State and Challenges of the Global Outcomes of Dental Caries Research in the Meta-Omics Era

Despite significant healthcare advances in the 21st century, the exact etiology of dental caries remains unsolved. The past two decades have witnessed a tremendous growth in our understanding of dental caries amid the advent of revolutionary omics technologies. Accordingly, a consensus has been reached that dental caries is a community-scale metabolic disorder, and its etiology is beyond a single causative organism. This conclusion was based on a variety of microbiome studies following the flow of information along the central dogma of biology from genomic data to the end products of metabolism. These studies were facilitated by the unprecedented growth of the next- generation sequencing tools and omics techniques, such as metagenomics and metatranscriptomics, to estimate the community composition of oral microbiome and its functional potential. Furthermore, the rapidly evolving proteomics and metabolomics platforms, including nuclear magnetic resonance spectroscopy and/or mass spectrometry coupled with chromatography, have enabled precise quantification of the translational outcomes. Although the majority supports 'conserved functional changes' as indicators of dysbiosis, it remains unclear how caries dynamics impact the microbiota functions and vice versa, over the course of disease onset and progression. What compounds the situation is the host-microbiota crosstalk. Genome-wide association studies have been undertaken to elucidate the interaction of host genetic variation with the microbiome. However, these studies are challenged by the complex interaction of host genetics and environmental factors. All these complementary approaches need to be orchestrated to capture the key players in this multifactorial disease. Herein, we critically review the milestones in caries research focusing on the state-of-art singular and integrative omics studies, supplemented with a bibliographic network analysis to address the oral microbiome, the host factors, and their interactions. Additionally, we highlight gaps in the dental literature and shed light on critical future research questions and study designs that could unravel the complexities of dental caries, the most globally widespread disease.

Building community resilience in a context of climate change: The role of social capital

Social capital is considered important for resilience across social levels, including communities, yet insights are scattered across disciplines. This meta-synthesis of 187 studies examines conceptual and empirical understandings of how social capital relates to resilience, identifying implications for community resilience and climate change practice. Different conceptualisations are highlighted, yet also limited focus on underlying dimensions of social capital and proactive types of resilience for engaging with the complex climate change challenge. Empirical insights show that structural and socio-cultural aspects of social capital, multiple other factors and formal actors are all important for shaping the role of social capital for guiding resilience outcomes. Thus, finding ways to work with these different elements is important. Greater attention on how and why outcomes emerge, interactions between factors, approaches of formal actors and different socio-cultural dimensions will advance understandings about how to nurture social capital for resilience in the context of climate change.

Posttraumatic growth experiences of refugees: A metasynthesis of qualitative studies

Although forced displacement may lead to many adverse psychological problems, this experience may also result in positive psychological consequences. Given the increasing disturbance in countries, many people are forcibly displaced, a comprehensive understanding of the posttraumatic growth (PTG) experiences of refugees is warranted. In this study, we examined 12 primary studies exploring PTG among refugees using the qualitative metasynthesis method. Our analysis of the primary studies consisting of 319 adults revealed four themes: (a) improved psychologic functioning; (b) enhanced interpersonal relationships; (c) reconstruction of the meaning of life; and (d) positive future direction. These findings indicate that no matter how traumatic experiences are painful, people can hold on to life, build a new life, and grow from adversity.

The Lived Experiences of Fathers in Mealtimes: A Thematic Synthesis of Qualitative Literature

The paternal experience of family mealtimes is an emerging field within qualitative literature. Previous quantitative studies suggest that differences exist between fathers’ and mothers’ mealtime behaviours, particularly in response to fussy eating. However, qualitative research has not yet focused exclusively on fathers’ fussy eating experiences. This metasynthesis aimed to provide insights into the general paternal experience, inclusive of their fussy eating responses. Thematic synthesis methodology was adopted to achieve this process and consisted of a systematic search resulting in the inclusion of 16 studies (18 papers). The direct quotations presented within each study were subjected to three stages of analysis to produce three analytical themes, supported by eight descriptive themes. The analytical themes presented were: (1) environmental influences on fathers’ mealtime experiences; (2) attitudes and emotions of fathers during mealtimes; and (3) observable behaviours of fathers during mealtimes. These themes highlighted the complexity of the mealtime experience from a paternal perspective. Multidirectional relationships were identified between each mealtime component (i.e., the environment, attitudes, emotions and behaviours) as evidenced by the paternal commentary presented. The findings also provided insights into fathers’ fussy eating experiences, recognising that fathers should be considered as individuals in the presence of mealtime intervention.

Ergonomics indicators: A proposal for sustainable process performance measurement in ergonomics

Process performance measurement (PPM) has become a challenging task for organisations, which have many various processes, in today's globalised world. This challenging task is also remarkable in ergonomics, and combining sustainability with ergonomics can provide beneficial solutions for assessing risks and providing ergonomically favourable conditions for human well-being. In this paper, new ergonomics indicators (EIs) are proposed, classified, and described in detail to overcome this challenge through a systematic literature review that integrates ergonomics and sustainability. By considering sustainability indicators (SIs) selected from the review, the proposed EIs are presented within a three-dimensional structure. This structure enables measuring the performance on various issues in an organisation such as occupational health and safety, decent work, technology, working conditions, employee empowerment and development, charities, innovations, and recycling. Through systematic measurements using these indicators, more traceable and manageable processes can be achieved. Hence, ergonomists or managers can identify and prevent risky conditions practically. Practitioner Summary: This paper proposes ergonomics indicators and detailed descriptions for ensuring sustainable process performance measurement in ergonomics. The sustainability indicators presented as references for these proposals are utilised through selection and consolidation from literature. The ergonomics indicators are structured within a sustainability framework that considers six sustainability sub-dimensions proposed for ergonomics.

Rehabilitation Needs of Head and Neck Cancer Patients and Stakeholders: Case Study

Background

The incidents of Head and Neck Cancer (HNC) are rising worldwide, suggesting that this type of cancer is becoming more common. The foreseen growth of incidents signifies that future rehabilitation services will have to meet the needs of a wider population.

Objective

The aim of this paper is to explore the needs of patients, caregivers and healthcare professionals during HNC rehabilitation.

Methods

This paper reports the empirical findings from a case study that was conducted in a cancer rehabilitation center in Copenhagen to elicit the needs of HNC cancer patients, informal caregivers and healthcare professionals.

Results

Four areas of needs during the rehabilitation process were identified: service delivery, emotional, social and physical needs. Service delivery needs and emotional needs have been identified as the most prevalent.

Conclusions

Stakeholders' needs during the rehabilitation process were found to be interrelated. All stakeholders faced service delivery challenges in the form of provision and distribution of information, including responsibilities allocation between municipalities, hospitals and rehabilitation services. Emotional and social needs have been reported by HNC patients and informal caregivers, underlining the importance of inclusion of all actors in the design of future healthcare interventions. Connected Health (CH) solutions could be valuable in provision and distribution of information.

Quality of Design Documentation in the Construction Industry: A Review Using Meta-Synthesis Approach

A meta-synthesis approach was used to identify, synthesize, and categorize appropriately factors in the literature that contribute to design documentation quality. The categories include factors on quality attributes, quality indicators, and quality-influencing factors. Findings indicate that the quality of design documentation in practice is unsatisfactory, therefore, there is a need for collaboration between the owner, designers, and end-users to improve design documentation quality. The results offer pragmatic data on design documentation quality in the construction industry between the years 1992 and 2019. However, further research on the significant impacts of poor-quality design documentation on construction projects is recommended.

The psychological effects of stillbirth on parents: A qualitative evidence synthesis of psychoanalytic literature

Objective: To review and synthesize existing psychoanalytic literature on the psychological impact of stillbirth on mothers and fathers. Method: This qualitative systematic review followed, as far as possible, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The Psychoanalytic Electronic Publishing Archive, the Single Case Archive, and PsycINFO (1999-2019) were searched to identify relevant articles published between 1999-2019 that report clinical material or theoretical considerations concerning the psychological effects of stillbirth on parents, as emerging during classical analytic or psychoanalytic therapy session/journey. A thematic synthesis was performed. Results: 46 articles were identified, providing data on the parents' experiences of grief and gender differences, the detrimental effects on the parental couple's relationship, the mother's identification with the dead baby, the importance for mothers to meet and care the stillborn baby, the mothers' drive for another pregnancy and the fear of further loss, the mothers' ambivalence toward subsequent pregnancy and child, the potential negative effects of unresolved bereavement on subsequent baby, and the replacement of a stillborn child. Conclusion: Our findings reveal there is some psychoanalytic literature providing insight into the psychological dynamics of parents after a stillbirth, with observations that could be used to improve psychological health care practices. One of the main therapeutic tasks was to facilitate parents to create a psychic space where they can bring to life, psychically, their lost and never- really-known stillborn baby, and to let him or her to be part of the on-going family narrative.

"Is My Heart Healing?" A Meta-synthesis of Patients' Experiences After Acute Myocardial Infarction

BACKGROUND

Recovery from acute myocardial infarction (AMI) has been primarily understood in a narrow medical sense. For patients who survive, secondary prevention focuses largely on enhancing clinical outcomes. As a result, there is a lack of descriptive accounts of patients' experiences after AMI and little is known about how people go about the challenge of recovering from such an event.

OBJECTIVE

We conducted a meta-synthesis of the available literature on qualitative accounts of patients' experiences after AMI.

METHODS

We searched for relevant papers that were descriptive, qualitative accounts of participants' experiences after AMI across 4 electronic databases (April 2016). Using an adapted meta-ethnography approach, we analyzed the findings by translating studies into one another and synthesizing the findings from the studies.

RESULTS

After a review of titles/abstracts, reading each article twice in full, and cross-referencing articles, this process resulted in 17 studies with 224 participants (48% women) aged 23 to 90 years. All participants provided a first-person account of an AMI within the 3-day to 25-year time frame. Two major themes emerged that characterized patients' experiences: navigating lifestyle changes and navigating the emotional reaction to the event-consisting of various subthemes.

CONCLUSION

Although AMI tends to be seen as a discrete event, participants are left with little professional guidance as to how to negotiate significant, and often discordant, psychosocial changes that have long-lasting effects on their lives, similar to persons with chronic illnesses but without research in place to figure out how to best support them.

"Navigating Between Unpredictable Icebergs": A Meta-Ethnographic Study of Employment Specialists' Contributions in Providing Job Support for People with Mental Illness

Purpose To explore and synthesize the views of Supported Employment clients, employment specialists and their supervisors on the core contributions of employment specialists to job support within the mental health field. Methods We systematically searched four databases with no time limitations and identified 16 qualitative studies published between 2006 and 2018 to be included in this meta-ethnographic study. Results The overarching metaphor of "Navigating an Unpredictable Iceberg-laden Sea" (a workplace) and seven themes were revealed: (1) "It's you and me looking," which represented the relationship between the client and ES, and (2) taking job seekers' ambitions and needs seriously, (3) mapping the route, (4) exploring the hidden, (5) being on tap, (6) avoiding crashes, and (7) bridging, which embodied the work of employments specialists. Conclusion. Our iceberg metaphor illustrates the importance of employment specialists being competent in addressing clients' work performance difficulties related not only to the individual's illness, age, gender, and cultural-related challenges, but also to psychosocial, behavioral, and environmental workplace factors. Given the effects of the specific characteristics of the working alliance developed in supported employment, we suggest that employment specialists' training and supervision be enriched by paying more attention to these important relational processes.

Physical activity in patients with rheumatoid arthritis - an agile lifelong behaviour: a qualitative meta-synthesis

Background

Physical activity (PA) in rheumatoid arthritis (RA) is considered a cornerstone in the treatment. To highlight aspects involved in supporting a positive PA behaviour, it is important to understand the patients’ perceptions of the phenomenon.

Objective

The aim of this qualitative meta-synthesis was to explore and synthesise patient perceptions of PA in RA.

Methods

A purposeful search was conducted across three online databases (PubMed, CINAHL and Web of Science). The methodological quality of the included studies was appraised, and data were extracted and analysed using an interpretive inductive thematic synthesis.

Results

Fifteen studies met the inclusion criteria and were included. PA was identified as an agile lifelong behaviour, with one main theme: The disease as a persistent catalyst for or against PA illustrating how the constant presence of the disease itself underlies the entire process of a life with or without regular PA. Seven subthemes: ‘considering aggravated symptoms’, ‘acknowledging the impact on health’, ‘becoming empowered and taking action’, ‘keeping informed to increase awareness’, ‘creating body awareness’, ‘dealing with social support’ and ‘feeling satisfied with circumstances and achievements’ were interpreted as facilitators and/or challenges.

Conclusion

This synthesis has identified PA as an agile lifelong behaviour in which the disease pervades all aspects of an individuals’ perception of PA. Placed in a theoretical context, our findings outline a model for tailoring PA support to the drivers and determinants of a certain individual, which will improve clinical practice for the benefit of both health professionals and patients with RA.

What do we know about ancillary care practices in East and Southern Africa? A systematic review and meta-synthesis

Background: Despite growing calls for the provision of ancillary care to study participants during medical research, there remains a noticeable gap in ethical guidelines for medical researchers in resource-constrained settings (RCS). We reviewed recent studies to determine the extent to which ancillary care is provided in East and Southern Africa and to examine the ethical justifications researchers provide to support their views on ancillary care obligations. Methods: A systematic search for qualitative and mixed methods studies on ancillary care was conducted across MEDLINE, Embase, African Wide Information, PubMed, CINAHL Plus, and Scopus. The National Institutes of Health (NIH) Department of Bioethics and H3 Africa websites and Google Scholar were further searched. Studies conducted in East and Southern Africa between 2004 and 2020, as well as those that reported on ancillary care provided to study participants were included. All studies included in this review were evaluated for methodological quality as well as bias risk. NVivo version 12 was used for thematic analysis. Results: Overall, 4,710 articles were identified by the initial search. After the data extraction and quality assessment, 24 articles were included. Key areas presented include ancillary care approaches and the themes of researcher motivation for providing ancillary care and expectations of participants in medical research. The review shows that while some international researchers do provide ancillary care to their study participants, approaches are not standardised without consistent guidelines for ethical practice for ancillary care. We found limited empirical studies in RCS that report on ancillary care, hence findings in this review are based on single studies rather than a collection of multiple studies. Conclusions: This paper emphasizes the value of establishing ethics guidelines for medical researchers in RCS who consider provision of ancillary care to their participants, and the need to account for these ethical guidelines in medical research.

Older Adults' Experiences With Using Wearable Devices: Qualitative Systematic Review and Meta-synthesis

BACKGROUND

Older adults may use wearable devices for various reasons, ranging from monitoring clinically relevant health metrics or detecting falls to monitoring physical activity. Little is known about how this population engages with wearable devices, and no qualitative synthesis exists to describe their shared experiences with long-term use.

OBJECTIVE

This study aims to synthesize qualitative studies of user experience after a multi-day trial with a wearable device to understand user experience and the factors that contribute to the acceptance and use of wearable devices.

METHODS

We conducted a systematic search in CINAHL, APA PsycINFO, PubMed, and Embase (2015-2020; English) with fixed search terms relating to older adults and wearable devices. A meta-synthesis methodology was used. We extracted themes from primary studies, identified key concepts, and applied reciprocal and refutational translation techniques; findings were synthesized into third-order interpretations, and finally, a "line-of-argument" was developed. Our overall goal was theory development, higher-level abstraction, and generalizability for making this group of qualitative findings more accessible.

RESULTS

In total, we reviewed 20 papers; 2 evaluated fall detection devices, 1 tested an ankle-worn step counter, and the remaining 17 tested activity trackers. The duration of wearing ranged from 3 days to 24 months. The views of 349 participants (age: range 51-94 years) were synthesized. Four key concepts were identified and outlined: motivation for device use, user characteristics (openness to engage and functional ability), integration into daily life, and device features. Motivation for device use is intrinsic and extrinsic, encompassing many aspects of the user experience, and appears to be as, if not more, important than the actual device features. To overcome usability barriers, an older adult must be motivated by the useful purpose of the device. A device that serves its intended purpose adds value to the user's life. The user's needs and the support structure around the device-aspects that are often overlooked-seem to play a crucial role in long-term adoption. Our "line-of-argument" model describes how motivation, ease of use, and device purpose determine whether a device is perceived to add value to the user's life, which subsequently predicts whether the device will be integrated into the user's life.

CONCLUSIONS

The added value of a wearable device is the resulting balance of motivators (or lack thereof), device features (and their accuracy), ease of use, device purpose, and user experience. The added value contributes to the successful integration of the device into the daily life of the user. Useful device features alone do not lead to continued use. A support structure should be placed around the user to foster motivation, encourage peer engagement, and adapt to the user's preferences.

When primary care providers and smokers meet: a systematic review and metasynthesis

Primary Care Providers (PCPs) often deal with patients on daily clinical practice without knowing anything about their smoking status and willingness to quit. The aim of this metasynthesis is to explore the PCPs and patients who are smokers perspectives regarding the issue of smoking cessation within primary care settings. It relies on the model of meta-ethnography and follows thematic synthesis procedures. Twenty-two studies are included, reporting on the view of 580 participants. Three main themes emerge: (i) What lacks, (ii) Some expectations but no request, and (iii) How to address the issue and induce patients' motivation. Our results reveal a global feeling of a lack of legitimacy among PCPs when it comes to addressing the issue of tobacco and smoking cessation with their patients, even though they have developed creative strategies based on what is at the core of their practice, that is proximity, continuity, long-term and trustworthy relationship.

Critically ill patients' experience of agitation: A qualitative meta-synthesis

BACKGROUND

Acute episodes of agitation are frequently experienced by patients during critical illness, yet what is not understood is the experience of agitation from the patient and family perspectives.

AIMS AND OBJECTIVES

To search existing literature, appraise it and then provide a synthesized interpretation to broaden the understanding of patients' and their families' experience of agitation during an adult critical care admission.

DESIGN

Qualitative meta-synthesis.

METHODS

A qualitative meta-synthesis based on a systematic literature search registered with PROSPERO. The search conducted between July and September 2019 was applied to ProQuest, Cumulative Index to Nursing and Allied Health, British Nursing Index, Cochrane Library, Ovid Medline, Web of Science, and PsycINFO databases. We appraised the selected literature and presented a synthesized interpretation. Analysis was based on the approach of Gadamerian hermeneutics. Due to the lack of data identified; the family experiences of agitation could not be addressed within the review.

RESULTS

In total, 8 studies were included capturing the experiences of 494 patients, aged between 18 and 92 years, with 225 (45%) women. The analysis generated three core themes: (a) What is real, what is not, (b) loss of communication and dependency, and (c) what helps, what does not. Fear of death, the emotion of anxiety, and feelings of pain alongside transient periods of fluctuating conscious levels provoked a feeling of intense vulnerability. The loss of effective communication and the feeling of dependence incite agitation and distress.

CONCLUSIONS

The patient's recollection of their critical illness can be completely or partially absent and disjointed with uncertainty around what is real and what is not. Family members observe the full effect of the patient's critical care illness and could be a wealth of untapped information.

RELEVANCE TO CLINICAL PRACTICE

Increasing awareness of the critically ill patients' experience of agitation highlights possible contributing factors to agitation development, such as staff interaction and communication skills, and the critical care environment.

Emergency Nurses' Experiences in Treating Patients With Mental Illness: A Qualitative, Interpretive Metasynthesis

INTRODUCTION

Each year, emergency departments are seeing an increase in the number of patients with mental illness. Nurses often do not feel equipped with the knowledge or skills for this patient population while caring for them. Although there is published literature about nurses caring for patients with mental illness, there is a gap in knowledge about the lived experiences of these frontline workers.

METHODS

To gain a better understanding of the experiences of emergency nurses in treating patients presenting with psychiatric issues, a qualitative interpretive metasynthesis of 5 qualitative articles was conducted.

RESULTS

Three themes emerged from the synthesis: (1) feeling unprepared and unqualified, (2) feeling anxious and hesitant, and (3) the need to keep the patient environment safe.

DISCUSSION

The overarching finding in our QIMS was the prevalent feeling of general concern regarding treating patients with mental illness despite the nurses' own preconceptions and apprehensions. It is important to understand the lived experiences of nurses treating patients with mental illness to learn be better prepared for future encounters.

Lifelong learning and nurses' continuing professional development, a metasynthesis of the literature

Background

Continuing professional development (CPD) is central to nurses’ lifelong learning and constitutes a vital aspect for keeping nurses’ knowledge and skills up-to-date. While we know about the need for nurses’ continuing professional development, less is known about how nurses experience and perceive continuing professional development. A metasynthesis of how nurses experience and view continuing professional development may provide a basis for planning future continuing professional development interventions more effectively and take advantage of examples from different contexts. The aim of this paper is to conduct such a metasynthesis, investigating the qualitative research on nurses’ experiences of continuing professional development.

Methods

A metasynthesis of the qualitative literature was conducted. A total of 25 articles fulfilled the inclusion criteria and were reviewed.

Results

We determined five overarching themes, Organisational culture shapes the conditions, Supportive environment as a prerequisite, Attitudes and motivation reflect nurse’s professional values, Nurses’ perceptions of barriers and Perceived impact on practice as a core value. This metasynthesis highlights that nurses value continuing professional development and believe that it is fundamental to professionalism and lifelong learning. Moreover CPD is identified as important in improving patient care standards.

Conclusions

Based on the metasynthesis, we argue that access to continuing professional development could be made more attainable, realistic and relevant. Expediently, organizations should adequately fund and make continuing professional development accessible. In turn, nurses should continue to actively engage in continuing professional development to maintain high standards of nursing care through competent practice. This paper highlights the perceived benefits and challenges of continuing professional development that nurses face and offers advice and understanding in relation to continuing professional development. We believe that this metasynthesis contributes with insights and suggestions that would be valuable for nurses and policy makers and others who are involved in nurse education and continuing professional development.

Identifying the outcomes of participating in peer mentorship for adults living with spinal cord injury: a qualitative meta-synthesis

OBJECTIVE

Peer mentorship is a flagship program utilized by Canadian community-based spinal cord injury (SCI) organizations. Through connecting trained SCI peer mentors with fellow adults with SCI, these programs help adults adapt and thrive following their injury. The objective of this meta-synthesis was to work with SCI community organizations and to identify outcomes of participating in community- or rehabilitation-based peer mentorship programs using an integrated knowledge translation approach.

DESIGN

A meta-synthesis of 21 qualitative peer-reviewed studies and 66 community documents was conducted.

MAIN OUTCOME MEASURES

A total of 87 outcomes of peer mentorship were identified.

RESULTS

The outcomes of peer mentorship were grouped according to six higher-order themes: 1) Independence: enhanced self-sufficiency; 2) Personal growth: positive psychological changes; 3) Activities and participation: greater participation in activities and events; 4) Adaptation: adapting to life with disability; 5) Knowledge: obtaining new information, resources, and opportunities; and 6) Connection: developing and maintaining social relationship.

CONCLUSION

The positive nature of the identified outcomes suggests that participating in peer mentorship can promote improved health and quality of life for adults with SCI. Furthermore, the integrated knowledge translation approach helped identify outcomes that were previously not examined within SCI peer mentorship research, thus providing important insight for future research.

Developing a catch-up model of technology: a grounded theory approach

Purpose

Catch-up is a process during which the countries that are behind the technological borders try to reduce their technological gaps. For a company or country in the catch-up process, a suitable level of technological capabilities and absorption capacity is necessary as a fixed advance requirement. This paper aims to develop a catch-up model of technology.

Design/methodology/approach

This study reviewed 90 published articles in the field of business management in Q1 and Q2 journals from the very beginning to the year of 2018 so that a framework can be presented for a catch-up. This framework has been obtained according to the process of grounded theory and by combining the previous studies.

Findings

Accordingly, a framework of six categories has been presented including causal factors, main category, background factors, intervening factors, strategies and consequences. Finally, three general approaches including independence, collaboration and cooperation, are introduced and each of these categories has been described in a spectrum of this approach.

Originality/value

This is the first study to conceptualize a catch-up model of technology by grounded theory.

HIV Patient Navigation in the United States: A Qualitative Meta-Synthesis of Navigators' Experiences

Patient navigation is increasingly used to link and (re)engage persons with human immunodeficiency virus (HIV) to care. A more holistic understanding of patient navigation can be achieved by exploring the experiences of navigators, the persons who comprise half of the navigation process. We conducted a meta-synthesis of navigator experiences with HIV patient navigation using a phenomenological approach. We identified nine relevant studies. Data were analyzed using thematic synthesis. Analysis identified two overarching themes relating to (1) the breadth and depth of bidirectional relationships and functional activities that navigators undertake to connect their clients to care and (2) the inherently personal experience of delivering navigation services. From these thematic findings, we recommend that HIV patient navigators exhibit capacity and expertise in developing and maintaining interpersonal relationships with clients and health care systems/providers and develop self-care practices and emotional boundaries with clients. Our review seeks to advance public health research and practice by articulating key experiences and perspectives of HIV patient navigators, drawing findings and recommendations applicable to the development, implementation, and evaluation of HIV patient navigation.

Stigma in Healthcare? Exploring the Knowledge, Attitudes, and Behavioural Responses of Healthcare Professionals and Students toward Individuals with Mental Illnesses

Individuals with mental illnesses are often stigmatized by healthcare professionals and students, shaping the quality of care that such clients receive. This study examines the knowledge, attitudes, and behavioural responses of healthcare professionals and students toward individuals with mental illnesses. The seven-phase meta-ethnography was utilized to complete this study: getting started, deciding relevance, reading the studies, determining how the studies are related, translating the studies into one another, synthesizing translations, and expressing the synthesis. The meta-synthesis yielded five core themes. Two themes described insight into positive and negative perceptions and behaviours of healthcare professionals and students toward individuals with mental illnesses. Three themes addressed the factors, including insufficiencies in the healthcare system, contact experiences, and other biological and social influences, that impact the perceptions and behaviours. Understanding these humiliating perceptions and behaviours and the factors that shape them is the first step toward diminishing mental health stigma in the healthcare system.

Elephant in the Room: A Methodology for Case Studies Metasynthesis

The Relationships Between Categories (RBC) technique is a qualitative methodology for the metasynthesis of psychoanalytic case studies. By analyzing repetitive bilateral, trilateral, or quadrilateral relationships of transference themes, this methodology seeks to analyze case studies with existing theoretical concepts, thereby formulating a new theory. The proposed tool attempts to explore and validate hidden connections between different psychotherapy components, thus enhancing integration of various bodies of knowledge and decreasing the gap between practice and theory. This methodology is demonstrated here by research on transference case studies that connect transference to components of cognitive behavioral therapy.

Beliefs, Attitudes, and Practices of Latinas Related to Gestational Weight Gain: A Qualitative Meta-Synthesis

INTRODUCTION

Excessive and inadequate gestational weight gain (GWG) are associated with a number of negative health outcomes for mother and infant. Approximately two-thirds or more of Latinas gain outside of GWG guidelines. Acculturation plays a role in GWG-related factors, however the views of Latinas are often aggregated in overall study samples, thus trivializing the specific needs of this demographic group. The purpose of the present meta-ethnography was to better understand GWG beliefs, attitudes, and practice among Latinas by synthesizing extant qualitative findings on this topic.

METHODS

Qualitative studies offer an important window into Latinas' views and practices related to GWG. A qualitative meta-ethnography (a form of meta-synthesis) was implemented to synthesize qualitative studies about Latinas' views of GWG-related factors. An initial sample of articles was distilled based on meta-ethnography guidelines from Noblit and Hare (1988) to a final sample of six qualitative articles that included perspectives from Latinas.

RESULTS

Six concepts emerged across the studies, they included: shifts in feeling control, inconsistent/lacking information, self vs. other, applied wisdom, isolation vs. support, and everyday practicality. Studies met most quality assessment criteria (Atkins et al., BMC Medical Research Methodology 8:21, 2008).

DISCUSSION

The views of Latinas about GWG-related factors are often buried in with perspectives of other women, which hides important details that are valuable for health program interventions designed to support these women. Future research should further explore the cultural differences in experience among Latinas to produce information and resources that are culturally relevant and relatable.