Patients' experiences with musculoskeletal spinal pain: A qualitative systematic review protocol

BACKGROUND

Musculoskeletal (MSK) spinal pain encapsulates various conditions including lumbar (low back), cervical (neck), and thoracic pain that significantly impact individual and global health. While clinical aspects of spinal pain have been well-studied, understanding patients' personal narratives and lived experiences remains essential for enhancing patient-centered care, improving treatment adherence, and informing healthcare policies. It provides deep insights into the impacts of spinal pain, guiding more effective and empathetic treatment approaches. This systematic review aims to synthesize qualitative evidence on patients' experiences with MSK spinal pain, providing insight into the challenges faced, coping strategies, daily life impacts, and healthcare interactions. The objective of this review is to synthesize the qualitative evidence regarding the lived experiences of patients with MSK spinal pain.

METHODS

This systematic review will use a meta-aggregation approach to synthesize data from qualitative studies, that will be identified through a comprehensive search of electronic databases and supplemented by grey literature searches. Two independent reviewers will screen, identify, and extract data from eligible studies. In cases of disagreement, conflicts will be resolved by consulting a third reviewer. These same reviewers will then use the Joanna Briggs Institute (JBI) qualitative quality assessment tool to evaluate the methodological quality of the identified studies, with the derived scores informing the synthesis process, that will involve extracting each study's findings along with their supporting illustrations, then grouped into categories based on similarity in meaning. These categories will then be aggregated to form synthesized findings.

IMPLICATIONS

Synthesized findings on patients' lived experiences with MSK spinal pain including key themes, patterns, and insights will be presented. By emphasizing patient narratives, the results of the review can contribute to the optimization of outcomes, and to enhance patient-provider relations and improve quality of care in MSK spinal health.

Facilitators and barriers to implementation of telemedicine in nursing homes: A qualitative systematic review and meta-aggregation

BACKGROUND

Telemedicine is an effective way to provide nursing home residents ease of access to consultations with healthcare professionals. It is safe, effective, and time- and cost-efficient, and can be used when there are movement restrictions, such as during the COVID-19 pandemic. This literature focuses only on healthcare professionals' experiences and perspectives on the use of telemedicine in long-term care facilities.

OBJECTIVES

This review concentrated on telemedicine programs that did not involve remote monitoring. It aimed to comprehensively appraise existing literature examining the facilitators and barriers in implementing telemedicine services in nursing homes.

METHODS

A systematic qualitative review was conducted with content analysis. Database searching was conducted in PubMed, Embase, Cochrane, Scopus, and CINAHL. Hand searching for gray literature and reference lists of included papers was also performed. Qualitative studies or mixed-method studies with a qualitative analysis addressing implementation of telemedicine in any long-term care facilities were included. The Critical Appraisal Skills Programme qualitative checklist was used to assess the quality of the included studies. The data were extracted and cross-checked between two reviewers. A third reviewer was consulted for any disagreements. Meta-aggregation was used to synthesize the results.

RESULTS

Eighty-one findings were extracted, which informed 16 categories and 13 synthesized findings. The synthesized findings were related to the innovation domain, infrastructure, work processes, individuals, and implementation processes.

LINKING EVIDENCE TO ACTION

This review highlighted factors that affect the successful implementation of a telemedicine service in nursing homes. These findings provide evidence to support the future utilization of this service in the nursing home setting. Further research should explore the best approach to address these barriers and facilitators.

PROTOCOL: Factors influencing the implementation of non-pharmacological interventions for behaviours and psychological symptoms of dementia in residential aged care homes: A systematic review and qualitative evidence synthesis

This is a protocol for a Cochrane Review. The objectives are as follows. This paper aims to describe a protocol for a systematic review that will synthesise the qualitative evidence regarding factors influencing the implementation of non-pharmacological interventions (NPIs) for behavioural and psychological symptoms of dementia (BPSD) management in residential aged care homes (RACHs). The planned systematic review aims to answer the research question: 'What are the factors influencing the implementation of NPIs in the management of BPSD at RACHs?'. Additionally, the planned systematic review also aims to generate recommendations to guide stakeholders (e.g., clinicians and aged care staff) and policymakers in the implementation of NPIs for managing BPSD at RACHs.

Influences affecting decision-making regarding use of pre-exposure prophylaxis among black men who have sex with men in the USA: a systematic review and meta-synthesis

AIM

To systematically identify, evaluate, and synthesise qualitative research examining positive and negative influences affecting decision-making behaviour among black men who have sex with men (BMSM) in the USA regarding use of pre-exposure prophylaxis (PrEP).

BACKGROUND

Used correctly, PrEP is highly efficacious in preventing HIV infection and is available via healthcare services throughout the USA. BMSM are a key target population for HIV prevention services, however their engagement with these services is low. With potential barriers to access ranging from systemic to personal, a phenomenological perspective on the influences affecting individuals' decision-making is essential, helping to better understand the needs of this target population and guide development and delivery of more effective future policy and intervention services.

DESIGN

Qualitative meta-synthesis with meta-aggregation.

DATA SOURCES

The electronic databases Medline, CINAHL, APA PsycInfo, Embase and Ovid Emcare were comprehensively searched from inception to 21 January 2022.

REVIEW METHODS

Systematic identification, quality assessment and synthesis of existing qualitative research according to protocols of meta-aggregation. This included identifying salient study findings and corroborating illustrations from the data, sorting like findings into descriptive themed categories and developing transformative synthesised statements from aggregate appraisal of category findings.

RESULTS

Seventeen studies met the inclusion criteria and were assessed to be of acceptable quality. Synthesis of study data yielded 30 categories grouped under five themes: Stigma, Discrimination, Mistrust, PrEP positivity and PrEP negativity. Twelve synthesised statements were produced to provide a summary of the results and suggest improvements to the delivery of future PrEP services and interventions.

CONCLUSION

A more targeted approach focused on advocacy and ambassadorship outside of clinical settings may be more influential in positive decision-making regarding use of PrEP in BMSM populations than relying on traditional outreach methods via institutions and their representatives where stigma, mistrust and structural inequalities perpetuate.

Needs for mobile and internet-based psychological intervention in patients with self-injury and suicide-related behaviors: a qualitative systematic review

BACKGROUND

In recent years, mobile psychological interventions have proven effective in reducing self-injury and suicide-related behaviors. Therefore, it is essential to continually enhance the user experience and address patients' needs to facilitate the development of mobile mental health interventions. Identifying patients with mobile mental health needs can be challenging for mental health professionals. To address this, we conducted a systematic review of qualitative research to synthesize the needs of patients engaged in self-injury and suicide-related behaviors for mobile and internet-based psychological interventions.

METHODS

This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) and the Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement (ENTREQ). We explored 11 databases and synthesized the results using thematic analysis.

RESULTS

Sixteen qualitative and mixed-method studies were included. The study found that the needs of patients with self-injury and suicide-related behaviors for mobile psychological intervention included therapy, technology, culture, privacy, communication, emotional support, personalization, and self-management. Consistent with the Technology Acceptance Model (TAM), the needs of patients with self-injury and suicide-related behaviors are influenced by the perceived ease of use and perceived usefulness of the mobile intervention. However, the findings also highlight the importance and unmet needs of peer support, communication, self-management, and empowerment in using mobile psychological interventions for patients with self-injury and suicide-related behaviors.

CONCLUSIONS

Studies in this area have shown that the needs of patients with self-harm and suicide-related behaviors cover multiple stages, including basic therapeutic and technical needs and advanced emotional needs. This complexity makes it challenging to address the needs of patients engaged in self-injury and suicide-related behaviors through digital interventions. In the future, mental health professionals should be encouraged to participate in multidisciplinary collaborations to expand the use of digital interventions, enhancing remote self-management for patients and providing new strategies for the ongoing care of psychiatric patients. We registered the review protocol on PROSPERO (CRD42022324958).

Psychosocial experiences in youth with Tourette syndrome: a systematic review and meta-synthesis

Suffering from Tourette syndrome (TS) disrupts the daily lives and interpersonal relationships of patients. The psychosocial experiences of young people with TS are not yet clear. The aim of the systematic review is to identify and synthesize the psychosocial experiences of young people with TS. A meta-synthesis was conducted. PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and Chinese Electronic Periodical Services databases were searched for articles published from their inception to February 2023. This review followed the Joanna Briggs Institute's Guidelines for Systematic Reviews according to a previously developed protocol. We used the confidence of synthesized qualitative findings (ConQual) approach to evaluate the credibility and dependability of the synthesized findings. This review included 12 qualitative studies from Western and Asian countries published between 2005 and 2019, representing 190 young people with TS. We identified five synthesized findings: affliction by intractable TS, TS was negatively perceived in the social and cultural context, self-adjustment in response to social interaction, response to receiving various interventions, and positivity in promoting self-acceptance. The ConQual grade for each generated synthesized finding ranged from low to moderate. The psychosocial experiences of youths living with TS are unique and are influenced by their interpersonal relationships, social context, and cultural framework. The findings recommend that healthcare providers assist young people in developing personalized symptom management strategies and provide guidance and care that meets the needs of each individual.

Students' learning in clinical practice - a scoping review of characteristics of research in the Nordic countries

RATIONALE

The complex nature of student learning in clinical practice calls for a comprehensive pedagogical framework on how to create optimal learning affordances.

PURPOSE

The purpose of this study was to describe characteristics of conducted research regarding investigated research questions, distribution of different health care student groups, and employed methodological approaches.

METHODS

A scoping review was chosen to capture the multifaceted characteristics in the field of learning in clinical practice. Funded local projects were analysed to provide significant core concepts for the literature search. A systematic search and review of articles published 2000-2019 in the Nordic countries was conducted according to PRISMA- ScR (23). The search was made in Medline (OVID), SveMed+ and CINAHL and resulted in 3126 articles. After screening of the titles and abstracts 988 articles were included for further review. The abstracts of all these articles were reviewed against established inclusion and exclusion criteria and 391 articles were included. Characteristics of purposes and research questions were analysed with a qualitative content approach resulting in identified subject areas including significant categories. Health care student groups and methodological approaches were also identified.

RESULTS

Subjects predominating the research were organisation of clinical practice, supervision, and students' experience followed by interprofessional learning and learning environment. Co-operation, university-clinical setting, and patients' role were investigated to a small extent. Sparsely occurring subjects were also specific learning outcomes and evidence-based knowledge. Nursing students were involved in 74% of the studies, medical students in 20%, and other professions around 8%. Qualitative approaches were most common.

CONCLUSION

Health care students' learning in clinical practice has been researched to a large extent within the Nordic countries and important subject areas are well represented. The research displays a great potential to extract and describe factors to create a pedagogical framework with significant meaning to support students' learning.

Effectiveness, feasibility, and acceptability of behaviour change tools used by family doctors: a global systematic review

BACKGROUND

Priority patients in primary care include people from low-income, rural, or culturally and linguistically diverse communities, and First Nations people.

AIM

To describe the effectiveness, feasibility, and acceptability of behaviour change tools that have been tested by family doctors working with priority patients.

DESIGN AND SETTING

A global systematic review.

METHOD

Five databases were searched for studies published from 2000 to 2021, of any design, that tested the effectiveness or feasibility of tangible, publicly available behaviour change tools used by family doctors working with priority patients. The methodological quality of each study was appraised using the Mixed Methods Appraisal Tool.

RESULTS

Thirteen of 4931 studies screened met the eligibility criteria, and described 12 tools. The health-related behaviours targeted included smoking, diet and/or physical activity, alcohol and/or drug use, and suicidal ideation. Six tools had an online/web/app-based focus; the remaining six utilised only printed materials and/or in-person training. The effectiveness of the tools was assessed in 11 studies, which used diverse methods, with promising results for enabling behaviour change. The nine studies that assessed feasibility found that the tools were easy to use and enhanced the perceived quality of care.

CONCLUSION

Many of the identified behaviour change tools were demonstrated to be effective at facilitating change in a target behaviour and/or feasible for use in practice. The tools varied across factors, such as the mode of delivery and the way the tool was intended to influence behaviour. There is clear opportunity to build on existing tools to enable family doctors to assist priority patients towards achieving healthier lifestyles.

Health-care leaders' experiences of the competencies required for crisis management during COVID-19: a systematic review of qualitative studies

PURPOSE

This paper aims to synthesize health-care leaders' experiences of the competencies required for crisis management.

DESIGN/METHODOLOGY/APPROACH

The systematic review followed the joanna briggs institute (JBI) guidance for systematic reviews of qualitative evidence. The search strategy included free text words and medical subject headings and peer-reviewed qualitative studies published in English, Finnish and Swedish and was not limited by year or country of publication. The databases searched in March 2022 were Scopus, PubMed, CINAHL, ABI/INFORM and the Finnish database Medic. Gray literature was searched using MedNar and EBSCO Open Dissertations. Studies were screened by title and abstract (n = 9,014) and full text (n = 43), and their quality was assessed by two independent reviewers. Eight studies were included. The data was analyzed using meta-aggregation.

FINDINGS

Fifty-one findings (themes and subthemes) were extracted, and 11 categories were created based on their similarities. Five synthesized findings were developed: the competence to comprehend the operational environment; the competence to stay resilient amidst change; the competence to adapt to and manage change; the competence to manage and take care of staff; and the competence to co-operate and communicate with diverse stakeholders.

ORIGINALITY/VALUE

This systematic review produced novel information about health-care leaders' experiences of the competencies required for crisis management during COVID-19. This study complements the field of research into crisis management in health care by introducing five original and unique competency clusters required for crisis management during the acute phase of COVID-19.

Wellbeing Conceptualizations in Family Medicine Trainees: A Hermeneutic Review

PHENOMENON

High levels of burnout have been widely reported among postgraduate medical trainees, however relatively little literature has examined what 'wellbeing' means for this group. Moreover, the literature that does exist has generally overlooked the potential role of specialty factors in influencing such conceptualizations. This is particularly true for family medicine and general practice trainees - a specialty considered to be unique due, in part, to its focus on community-based care. The present review sought to explore conceptualizations of wellbeing specifically within the context of family medicine and general practice training.

APPROACH

The Embase, Ovid Medline, and PsycINFO databases were searched from inception to November 2019 for literature examining wellbeing in family medicine and general practice trainees. Literature was iteratively thematically analyzed through the process of a hermeneutic cycle. In total, 36 articles were reviewed over seven rounds, at which point saturation was reached.

FINDINGS

The findings confirm the complex and multifaceted nature of wellbeing as experienced by family medicine and general practice trainees. An emphasis on psychological factors - including emotional intelligence, positive mental health, self-confidence and resilience - alongside positive interpersonal relationships, rewards, and balanced interactions between trainees' personal and professional demands were deemed critical elements.

INSIGHTS

A model of wellbeing that emphasizes rich connections between trainees' personal and professional life domains is proposed. Further qualitative research will help to extend current understanding of wellbeing among medical trainees, including the individuality of each specialty's experiences, with the potential to enhance interventional efforts.

The role of resilience in higher education: A meta-ethnographic analysis of students' experiences

BACKGROUND

There is increasing evidence that being resilient negates the deleterious impacts of stress and promote academic success. To develop an insight into how important resilience is, it is vital to explore how higher education students perceive and develop resilience.

OBJECTIVES

The purpose of this review was to gather students' experiences of their resilience journey in an educational setting.

DESIGN

Systematic review and meta-ethnography of qualitative evidence REVIEW METHODS: This review was reported in accordance with the eMERGe guidelines. The data were analysed with reference to the seven steps of meta-ethnography. The Grading of Recommendations, Assessment, Development and Evaluation's Confidence in Evidence from Reviews of Qualitative research (GRADE-CERQual) was used to appraise the quality of the evidence.

RESULTS

Three themes emerged: (1) resilience associates with internal resources, (2) resilience develops through meaningful relationships and (3) resilience can be instilled by educational institutions. An individual's trait, outlook and engagement within their social network can influence resilience. The presence and availability of institution-based support services can ease students transition into higher education.

CONCLUSION

This review provides a basis for influencing further research and curriculum development in ensuring students' well-being and success in school.

Seeing the complete picture: A systematic review of mental health consumer and health professional experiences of diagnostic overshadowing

AIM

To systematically identify, explore and synthesise qualitative data related to mental health consumer and health professional experiences of diagnostic overshadowing.

BACKGROUND

Mental health consumers experience significantly high rates of physical illness, poorer health outcomes and are more likely to die prematurely of physical illnesses than the general population. Diagnostic overshadowing is a complex and life-threatening phenomenon that occurs when physical symptoms reported by mental health consumers are misattributed to mental disorders by health professionals. This typically occurs in general healthcare settings.

METHODS

Drawing on JBI methodology for systematic reviews, four scholarly databases and grey literature was searched, followed by eligibility screening and quality assessment using JBI QARI frameworks, resulting in six studies for inclusion. Findings were synthesised using meta-aggregation. The PRISMA checklist was adhered to throughout this process.

FINDINGS

Five synthesised findings emerged. Three from the health professional experience: working in ill-suited healthcare systems, missing the complete diagnostic picture, and misunderstanding the lived experience of mental illness. Two from the mental health consumer experience: not knowing if the cause is physical or mental, and surviving and ill-suited health care system.

CONCLUSIONS

Diagnostic overshadowing is a multidimensional experience of interconnecting factors including systematic healthcare system issues, health professionals limited mental health knowledge and skills, stigmatic attitudes and mental health consumers miscommunicating their physical healthcare needs. Further research is needed to make diagnostic overshadowing visible and mitigate against this phenomenon that deprives mental health consumers of equitable access to quality healthcare.

RELEVANCE TO CLINICAL PRACTICE

Those who govern healthcare systems have an obligation to recognise and address the unique needs of mental health consumers who seek help for physical illnesses to ensure they receive quality and safe care. Forming collaborative partnerships with mental health consumers in the development of knowledge translation initiatives targeting healthcare policy, practice and education are urgently required.

Factors influencing the performance of community health volunteers working within urban informal settlements in low- and middle-income countries: a qualitative meta-synthesis review

BACKGROUND

There is limited information on community health volunteer (CHV) programmes in urban informal settlements in low- and middle-income countries (LMICs). This is despite such settings accounting for a high burden of disease. Many factors intersect to influence the performance of CHVs working in urban informal settlements in LMICs. This review was conducted to identify both the programme level and contextual factors influencing performance of CHVs working in urban informal settlements in LMICs.

METHODS

Four databases were searched for qualitative and mixed method studies focusing on CHVs working in urban and peri-urban informal settlements in LMICs. We focused on CHV programme outcome measures at CHV individual level. A total of 13 studies met the inclusion criteria and were double read to extract relevant data. Thematic coding was conducted, and data synthesized across ten categories of both programme and contextual factors influencing CHV performance. Quality was assessed using both the Critical Appraisal Skills Programme (CASP) and the Mixed Methods Assessment Tool (MMAST); and certainty of evidence evaluated using the Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach.

RESULTS

Key programme-level factors reported to enhance CHV performance in urban informal settlements in LMICs included both financial and non-financial incentives, training, the availability of supplies and resources, health system linkage, family support, and supportive supervision. At the broad contextual level, factors found to negatively influence the performance of CHVs included insecurity in terms of personal safety and the demand for financial and material support by households within the community. These factors interacted to shape CHV performance and impacted on implementation of CHV programmes in urban informal settlements.

CONCLUSION

This review identified the influence of both programme-level and contextual factors on CHVs working in both urban and peri-urban informal settlements in LMICs. The findings suggest that programmes working in such settings should consider adequate remuneration for CHVs, integrated and holistic training, adequate supplies and resources, adequate health system linkages, family support and supportive supervision. In addition, programmes should also consider CHV personal safety issues and the community expectations.

Quality appraisal of existing guidelines for the management of headache disorders by the AGREE II's method

OBJECTIVE

To evaluate the quality of existing clinical practice guidelines for headache management and their main recommendations.

BACKGROUND

Evidence-based clinical practice guidelines have been developed to support the clinical decision-making. However, to achieve this goal, the quality of these guidelines must be ensured.

METHODS

A systematic search for clinical practice guidelines for headache management was conducted in the PubMed database, in websites of known guideline developers and in websites of known headache associations. The quality appraisal was performed through the Appraisal of Guidelines for Research and Evaluation II method.

RESULTS

Twelve guidelines were evaluated. The domains of rigor of development, applicability, and editorial independence, which most influence the overall quality of guidelines, had the lowest average scores and the highest standard deviation rates (61% ± 23; 37% ± 20; 53% ± 31). The main recommendations regarding medication use for acute treatment of episodic tension-type headache and migraine in adult patients consisted of paracetamol, acetylsalicylic acid, and other nonsteroidal anti-inflammatory drugs in all guidelines.

CONCLUSIONS

The statistical results indicate that the appraised guidelines have room for both individual and collective improvement. In addition, there is a well-established medication recommendation pattern among all guidelines evaluated.

Parents' experiences on the combined use of continuous subcutaneous insulin infusion and real-time continuous glucose monitoring to manage Type 1 diabetes in their children: A systematic review and meta-synthesis of qualitative studies

AIM

To explore the experiences and perspectives of the combined use of continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) on parents of children with TIDM on their daily life.

DESIGN

A systematic review and meta-synthesis of qualitative studies.

METHODS

A systematic literature search of English studies published in seven databases between 2006-2021: CINAHL, MEDLINE, EMBASE, PubMed, PsycINFO, Cochrane Library and Scopus. All included studies underwent the process of thematic interpretive integration by the author team.

RESULTS

Nine studies met the inclusion criteria. Six derived themes were generated which contained interacting with devices, interacting with glycaemic information, improving quality of life for parents of children with T1DM, burden of living with CSII therapy and CGM, impact on the parent-child relationship, requirement and expectation to advanced diabetes technology. Advanced diabetes technologies affect physical, emotional and relationship between the daily life of parents and their children with T1DM.

Social relationship experiences of transgender people and their relational partners: A meta-synthesis

RATIONALE

Social relationships are important in bolstering health and well-being for everyone in the general population. For transgender people, strong supportive social relationships may be paramount to their overall health and well-being due to their marginalised status in society.

OBJECTIVE

This review aimed to investigate what is currently known about the social relationship experiences of transgender people and their relational partners (e.g., family members, romantic partners).

METHODS

Thirty-nine qualitative papers were extracted from Web of Science, Scopus, Cochrane, and PubMed that related to social relationships of transgender people. These papers were analysed via a qualitative meta-synthesis.

RESULTS

Forty-nine second-order themes were identified, initially organised into relational partner clusters (e.g., family, friends, work colleagues) for specific phenomena, then these were synthesized into five overarching conceptual themes: (1) Development of relationships through transition and beyond, (2) Coping strategies of transgender people and their relational partners, (3) Reciprocal support in social relationships, (4) Stigma enacted and ameliorated interpersonally, and (5) Influence of stigma on social health and well-being.

DISCUSSION AND CONCLUSIONS

These overarching themes show the potential characteristics that assist in the health-buffering role of social relationships for transgender people and their relational partners. Of particular note, stigma was reported as a common negative experience by transgender people and their relational partners, and open communicative social relationships had positive effects on self-conceptualisations of identity, which were inferred to protect against the damaging effects of stigma. We discuss the various implications and applications of this meta-synthesis to future research and clinical settings as well as how it can inform healthcare policy to support transgender people.

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.

Qualitative Evidence from Studies of Interventions Aimed at Return to Work and Staying at Work for Persons with Chronic Musculoskeletal Pain

Chronic musculoskeletal pain is a significant burden for employees, employers, and society. However, more knowledge is needed about which interventions reduce sick leave. Interventions were defined as the act or an instance of intervening, provided by different stakeholders. This review synthesizes the experiences of patients, employers, and health professionals concerning the interventions that influence returning to work and staying at work for persons with chronic musculoskeletal pain. A literature search was performed using several combinations of key terms. Overall, 18 qualitative studies published between 2002 and 2018 were included. Qualitative analysis assessed how much confidence could be placed in each review finding. Moderate evidence was found for factors improving the return to work process such as collaboration between stakeholders, including the persons with chronic musculoskeletal pain and support from all involved actors in the process. Moderate evidence was found for self-management strategies and workplace adjustments needed to facilitate more persons to returning to work and staying at work despite pain. This review provides stakeholders, employers, and health professionals’ information that could be used to develop and implement interventions to increase the possibilities for persons with chronic musculoskeletal pain returning to work or staying at work.

Experiences of acute care by persons with mental health problems: An integrative literature review

WHAT IS KNOWN ON THE SUBJECT?: Understanding experiences of acute care by persons with mental health problems is vital for improving these experiences through the development of different parts of the care delivery and its facilities. Literature has extensively addressed experiences of persons with mental health problems in acute care settings. Yet, there is a paucity of studies that aggregate and organize these findings in presenting development-oriented solutions for the improvements of these experiences. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Acute care can be understood through patients' experiences of structure (such as setting, staff and resources); process (such as communication and interpersonal relations); and outcome (such as satisfaction and post-discharge well-being and health) and suggests improvements in these domains. The paper illuminates that previous literature has mainly captured negative experiences of acute care by persons with mental health problems, and suggests diverting the focus to the best practices and to seek inspiration from other fields of research. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Attending to the improvement and development of different parts of the acute care might be an important step in improving experiences of persons with mental health problems. For example, improving resource allocation systems and facilities, emphasizing professionalism in encounters with these patients and systematically assessing patient satisfaction during and after visits are important areas that require attention. ABSTRACT: Aim The provision of acute care to persons with mental health problems is challenging due to difficulties in encountering this group and the vulnerability of these persons. Understanding this group's experiences with acute care is thus an important endeavour. The purpose of this review was to critically and systematically identify and assess previous research on experiences of acute care by persons with mental health problems, guided by Donabedian's structure-process-outcome framework (Prospero ID: CRD42019116652). Method and results An integrative literature review was performed, resulting in the identification of 43 studies. The search was conducted using five electronic databases: Web of Science Core, PubMed, MEDLINE, CINAHL and PsycINFO. Discussion The review revealed that patients experienced structure components such as setting, staff and resources in a predominantly negative way. A predominately negative picture also emerged of the process components, where, for example, communication and interpersonal relations were represented by negative experiences, with limited positive experiences reported. The outcome components, related to patients' satisfaction and their well-being after discharge, were also predominantly experienced negatively. Implications for practice Using Donabedian's framework of structure, process and outcome allowed us to systematize the literature reviewed, to identify the research gaps and to suggest ways forward for the field's development.

International allied health student placements: A meta-synthesis

BACKGROUND

Increasingly universities are offering international student placements as part of the global internationalisation movement. This review sought to synthesize the findings of studies to further understand the learning outcomes described by allied health students.

AIMS/OBJECTIVES

To contribute to the understanding of the learning outcomes described by allied health students who have undertaken an international placement.

METHODS

A qualitative meta-synthesis was conducted. From six databases, twenty-one studies were identified and critically appraised. Data were meta-aggregated, integrated and interpreted to develop new themes, with the experiences of over 259 allied health students synthesized.

RESULTS

Themes include: the intertwined personal and professional development experienced by the students; confidence and independence, relationship building, insight into culture, service provision and differences in socio-economic and political contexts.

CONCLUSION

Universities offering students international placements provide their students with opportunities to achieve unique learning outcomes with significant personal and professional transformational development that cannot be replicated by local placements.

The synthesis of scientific shreds of evidence: a critical appraisal on systematic review and meta-analysis methodology

Synthesising results across studies to recognise the causes of variation in outcomes and to reach an overall understanding of a problem is a crucial part of the scientific method. Until in recent times, the results of scientific findings have been summarised in narrative reviews where the summary of transparent and objective results have become increasingly difficult. Systematic reviews and meta-analyses, conducted by subsequent strict protocols to guarantee reproducibility and decrease bias, have become more common in the synthesis of evidence.

Oral health needs of older migrants with culturally and linguistically diverse backgrounds in developed countries: A systematic review

OBJECTIVES

To identify and synthesise the available evidence regarding the oral health needs of and the oral health promotion provided for older, cultural and linguistically diverse (CALD) migrants in developed countries.

METHOD

Databases were searched using search terms to identify all relevant English-language research studies published between 2000 and January 2018.

RESULTS

Thirty-nine articles met the review criteria. Thirty-three papers reported on the oral health needs of CALD older migrants and 6 on oral health programs provided for older migrants.

CONCLUSIONS

Cultural and linguistically diverse older migrants have high oral health needs and poor oral status and face a variety of barriers in accessing oral health care in their host countries. Recommendations to improve their access to oral health programs include building transcultural dental training into the educational requirements of dental students and developing oral health promotion programs that include culturally and linguistically customised information.

A meta-synthesis of how parents of children with autism describe their experience of advocating for their children during the process of diagnosis

The diagnostic process for children with autism can be complex for parents to navigate as they advocate for their child in order to obtain answers to their concerns, and receive the subsequent support they need. Gaining an understanding of parents' experiences during this process, will assist service providers in supporting families adequately. This systematic review was undertaken to consolidate in-depth qualitative data from parents of their experience of advocating for their child with autism, during the process of diagnosis. A qualitative meta-synthesis was conducted, whereby fifteen databases were systematically searched. Twenty-two studies were identified and appraised using an adapted version of the Critical Appraisal Skills Programme tool. Data were synthesised into themes through the steps of review, meta-aggregation, integration, and interpretation. The date range of the included studies spans 1999-2016. The voices of 1,178 parents are presented in this review describing their experiences in two overarching themes: "Pathway to diagnosis-Confusion and not feeling heard"; and "Pursuing diagnosis-Resilience and commitment." Each one of these main themes had sub-themes. Our findings highlight the intense emotional journey for parents during identification of their initial concerns and the formal process of diagnosis, and their perceptions of not being supported by others on this journey. This review illustrates the significant impact that positive experiences with first-line professionals have during the process of diagnosis, and how these experiences lay the foundation for all future relationships with other service providers. As a result, awareness of parents' experiences will assist service providers to reconsider their communication style, information sharing, provision of support and to incorporate parents' contributions in facilitating a more streamlined and more supportive process of diagnosis.

Redeveloping the JBI Model of Evidence Based Healthcare

BACKGROUND

In 2005, Pearson et al. presented a developmental framework of evidence-based practice that sought to situate healthcare evidence and its role and use within the complexity of practice settings globally. A decade later, it was deemed timely to re-examine the Model and its component parts to determine whether they remain relevant and a true and accurate reflection of where the evidence-based movement is today.

METHODS

A two-phase process was employed for this project. Phase 1 involved a citation analysis, conducted using the index citation of the original source article on the Joanna Briggs Institute (JBI) Model by Pearson et al. The databases searched were Web of Science and Google Scholar from year of publication (2005) to July 2015. Duplicates and articles in languages other than English were removed, and all results were imported and combined in an Excel spreadsheet for review, coding and interpretation. Phase 2 (model revision) occurred in two parts. Part 1 involved revision of the Model by an internal working group. This revised version of the Model was then subjected to a process of focus group discussion (Part 2) that engaged staff of the Joanna Briggs Collaboration during the 2015 annual general meeting. These data were recorded then transcribed for review and consideration.

RESULTS

The citation analysis revealed that the Model was primarily utilized to conceptualize evidence and evidence-based healthcare, but that language used in relation to concepts within the Model was variable. Equally, the working group and focus group feedback confirmed that there was a need to ensure the language utilized in the Model was internationally appropriate and in line with current international trends. This feedback and analysis informed the revised version of the JBI Model.

CONCLUSION

Based on the citation analysis, working group and focus group feedback the new JBI Model for Evidence Based Healthcare attempts to utilize more internationally appropriate language to detail the intricacies of the relationships between systems and individuals across different settings and the need for contextual localization to enable policy makers and practitioners to make evidence-based decisions at the point of care.

Women's help-seeking behaviours within the first twelve months after childbirth: A systematic qualitative meta-aggregation review✰

INTRODUCTION

Women within the first 12 months after birth often do not seek professional help for post-childbirth morbidities. This systematic review uses the Behavioural Model of Health Services Use (BMSHU) to assess the barriers and facilitators to women's help-seeking from health professionals during the first twelve months after childbirth.

METHOD

A qualitative meta-aggregation was used for the review. Systematic searching of Medline via Ovid, CINAHL, EMBASE and Web of Science revealed an initial 691 papers, of which 48 were reviewed. Nine qualitative papers, peer-reviewed, English papers and published from 2000 to 2017, were identified. Studies selected according to the pre-defined protocol were assessed using The Joanna Briggs Institute Critical Appraisal Tools (JBIQARI).

RESULTS

Seventy-five findings were identified from the approved articles and aggregated into seven categories. Key themes that emerged were that women did not seek help because they accepted problems as a part of the motherhood role or because they feared being judged negatively. Women shared their issues with family and friends as trusted people. Low health literacy was a barrier to seeking help, as was lack of access to proper care and poor advice from families. The women's cultural context was an essential influence in whether or not they sought help. According to BMSHU, a model of key influences on women's help-seeking for maternal morbidities introduced.

Sources of Distress in First-Episode Psychosis: A Systematic Review and Qualitative Metasynthesis

In this study, we aim to increase our understanding of the self-reported sources of distress among people who have experienced first-episode psychosis. Following a systematic literature search, 33 relevant studies containing first-person accounts of first-episode psychosis were identified, which were synthesized using thematic analysis. Two interrelated superordinate themes were identified: intrapersonal distress and interpersonal distress. Participants reported multiple, diverse, and multifaceted sources of distress across both themes. These were substantially different from those routinely recognized and targeted in clinical practice. This review suggests that practitioners who maintain a stance of genuine curiosity about the potential sources of distress for this population will be perceived as more helpful. The findings also highlight the importance of being service user-led when planning and delivering mental health care. Additional clinical and research implications are discussed.

Systematic reviews of clinical practice guidelines: a methodological guide

OBJECTIVES

Systematic reviews (SRs) of clinical practice guidelines (CPGs) are unique knowledge syntheses that require tailored approaches to, and greater subjectivity in, design and execution compared with other SRs in clinical epidemiology. We provide review authors structured direction on how to design and conduct methodologically rigorous SRs of CPGs.

STUDY DESIGN AND SETTING

A guidance paper outlining suggested methodology for conducting all stages of an SR of CPGs. We present concrete examples of approaches used by published reviews, including a case exemplar demonstrating how this methodology was applied to our own SR of CPGs.

RESULTS

Review context and the unique characteristics of CPGs as research syntheses or clinical guidance statements must be considered in all aspects of review design and conduct. Researchers should develop a "PICAR" statement to help form and focus on the research question(s) and eligibility criteria, assess CPG quality using a validated appraisal tool, and extract, analyze, and summarize data in a way that is cogent and transparent.

CONCLUSION

SRs of CPGs can be used to systematically identify, assess, and summarize the current state of guidance on a clinical topic. These types of reviews often require methodological tailoring to ensure that their objectives and timelines are effectively and efficiently addressed; however, they should all meet the criteria for an SR, follow a rigorous methodological approach, and adhere to transparent reporting practices.

Determinants of patient satisfaction in outpatient musculoskeletal physiotherapy: a systematic, qualitative meta-summary, and meta-synthesis

Purpose: To identify and synthesise patient-identified factors that influence satisfaction with outpatient musculoskeletal physiotherapy (O-MSK).Methods: A systematic, qualitative meta-summary and meta-synthesis was conducted by accessing six electronic databases: CINAHL, Embase, MEDLINE, Scopus, Web of Science, and Wiley Online Library, from inception to March 2017. Additional studies were identified by using a "berry-picking" method. Search limits were: primary studies; English language; and involving human subjects. Qualitative peer-reviewed articles describing patient satisfaction in O-MSK were eligible for inclusion. Two reviewers critically appraised eligible studies independently using the critical appraisal of skills programme tool for qualitative studies. Extracted verbatim data of included studies were synthesised using the meta-summary and meta-synthesis by using a purpose-designed form.Results: Eleven studies were included in the article. Factors influencing patient satisfaction were grouped into six broad themes: 1) clinical outcomes; 2) physiotherapist features; 3) patient features; 4) physiotherapist-patient relationship; 5) treatment features, and 6) healthcare setting features.Conclusions: These findings suggest that patient satisfaction in O-MSK is a multidimensional construct influenced by individual patient/provider, clinical, and contextual factors. Future reviews should include a synthesis of findings from both qualitative and quantitative studies to establish a fully comprehensive understanding of this complex health phenomenon.Implications for rehabilitationPatient satisfaction in outpatient musculoskeletal physiotherapy is affected by different factors, thus reflecting a multidimensional construct;Single determinants are not sufficient to affect patient satisfaction;Patient satisfaction is influenced individual patient/provider, clinical outcomes, and contextual factors;Further studies should be designed to investigate the relationships among these factors.

Work Participation Among Employees with Common Mental Disorders: A Meta-synthesis

Purpose The aim was to aggregate knowledge about the opportunities, challenges and need for support employees with common mental disorders experience in relation to work participation in order to develop recommendations for practice. Methods A meta-synthesis was conducted using a meta-aggregative approach to accurately and reliably present findings that could be used to meet our aim. Qualitative inductive content analysis was used to analyze and synthesize the findings. Results In all, 252 findings were extracted from 16 papers, and six categories were generated and aggregated into two synthesized findings. One synthesized finding indicates that a strong work identity and negative perceptions regarding mental disorders can impede work participation, creating an essential need for a supportive work environment. The other reveals that the diffuse nature of the symptoms of mental disorders causes instability in life and loss of control, but through the use of internal motivation and external support, employees may be able to regain control of their lives. However, external support is hampered by insufficient cooperation and coordination between vocational stakeholders. Conclusions Based on the synthesized findings, we recommended that the employer is involved in the rehabilitation process, and that rehabilitation professionals seek to strengthen the employee's ability to manage work-related stress. In addition, rehabilitation professionals should provide individualized and active support and ensure meaningful cooperation across the multidisciplinary disciplines involved in the rehabilitation process.

Parents' voices: "Our process of advocating for our child with autism." A meta-synthesis of parents' perspectives

BACKGROUND

Advocacy has been described by parents of children with autism as an important coping strategy, enabling them to move forward by redirecting emotions into actions. A key factor in the development of collaborative and constructive partnerships between service providers and parents is having an understanding of how parents engage in advocacy and the support needed to do so. This meta-synthesis was undertaken to consolidate in-depth qualitative data from parents' perspectives of the process that they use to advocate for their children with autism.

METHODS

A qualitative meta-synthesis was conducted, whereby 15 databases were systematically searched. Thirty-one studies were identified and appraised using an adapted version of the Critical Appraisal Skills Programme tool. Data were synthesized into themes through the steps of review, meta-aggregation, integration, and interpretation.

RESULTS

The voices of 1,662 parents are presented describing the process of advocacy in the stages of seeking a diagnosis, seeking self-education, and taking action. Taking action includes 2 subthemes: seeking, access, and use of support services and community engagement and educating others.

CONCLUSIONS

Results highlight the significant impact that positive experiences with first-line professionals have during the diagnosis process and how these experiences lay the foundation for all future relationships with other service providers. Important implications arise from this meta-synthesis for service providers in supporting parents' advocacy and hence building constructive relationships with families with a child with autism.

A systematic review and meta-synthesis of the qualitative literature exploring the experiences and quality of life of survivors of a cardiac arrest

BACKGROUND

Survival following cardiac arrest and subsequent cardiopulmonary resuscitation (CPR) is increasing worldwide, mainly due to greater awareness of the symptoms of cardiac events and an increased attention to CPR training. Although patient outcomes remain unpredictable and quantitative studies suggest that the overall quality of life (QOL) is acceptable, it is valuable to synthesise qualitative studies exploring these phenomena in depth, providing a deeper knowledge of survivors' experiences and QOL.

AIMS

To critically appraise and synthesise the qualitative literature on survivors' experiences of a cardiac arrest and CPR with the aim of identifying common themes that can inform clinical pathways and thereby improve survivor outcomes and QOL.

METHODS

A systematic review and meta-synthesis of the qualitative literature, using Thomas and Harden's framework, and confined to peer-reviewed papers published from 2000 to 2015, which were identified through database searches of EBSCO, OVID and ProQuest.

RESULTS

The search produced 204 papers, and of these, seven relevant papers were identified for review. Data extraction included setting, participants, research design, data collection, analysis and themes. Five qualitative themes were identified and were the subject of this meta-synthesis: multitude of contrasting feelings; disruption in the continuum of time; new reality and psychological challenges; changed body with new limitations; and confrontation with death.

CONCLUSION

This review provides insights into the experiences of survivors' QOL after CPR. Increased knowledge can improve person-centred care in the immediate and forthcoming care after the event, both in terms of planning for discharge and in the future care of people who survive a cardiac arrest.

Compassion fatigue in nurses: A metasynthesis

AIMS AND OBJECTIVES

To interpret the body of qualitative work focusing on compassion fatigue to distil a common understanding that could then be applied to nursing care.

BACKGROUND

Complex demands place extraordinary stress on nurses struggling to work in overburdened healthcare systems. The result can be the inability to care well for others, leading to compassion fatigue, burnout and increased numbers leaving the profession. Metasynthesis offers a means of more fully illuminating compassion fatigue and further understanding of practices which might reduce its negative consequences.

DESIGN

Metasynthesis.

METHOD

As a method designed to facilitate knowledge development, metasynthesis allowed for integration of qualitative study findings conducted between 1992-2016 using defined search terms. Six databases were searched for articles published in English. Nine papers met the criteria for review and metasynthesis was conducted using the meta-ethnographic approach detailed by Noblit and Hare.

RESULTS

Four themes related to compassion fatigue were found by consensus discussion. The themes included: physical ("just plain worn out") and emotional symptoms ("walking on a tightrope"), triggering factors ("an unbearable weight on shoulders" and "alone in a crowded room"), and measures to overcome/prevent ("who has my back?").

CONCLUSIONS

Compassion fatigue is a concept of documented relevance to those in nursing and represents a basic inability to nurture others and engenders a temporal component. Synthesis of studies provides evidence of the veracity of the concept for application to clinical practice and research related to nursing care.

RELEVANCE TO CLINICAL PRACTICE

Findings provide insight into the clinical milieu needed to prevent compassion fatigue. A theoretical model is presented which can be used to guide future research, as well as the creation of clinical practice policies which might mitigate the development of compassion fatigue and its potential consequences.

The experience of spirituality from the perspective of people living with dementia: A systematic review and meta-synthesis

Spirituality is an important aspect of humanity. Concerned with deriving meaning from events, and connection with others, it provides a mechanism for some to cope with illness and disability. While spiritual support is recognised as important, little is known about the spiritual needs of those people experiencing dementia. This meta-synthesis considers the experiences of spirituality from the perspective of people living with a diagnosis of dementia. Using a review protocol, key words from a preliminary scoping review were used to direct database searches in November 2013. A total of 667 papers were initially identified. However, following careful quality review assessment a final eight papers were selected. Findings demonstrated the ongoing importance of spirituality to people living with dementia and its importance as a means of finding hope, meaning and linkage with past, present and future. Expression of spirituality through faith practices, contact with faith communities, and the impact of dementia on these, were also highlighted.

Calidad de vida de los cuidadores de personas con enfermedad crónica

El alto impacto epidemiológico, social, económico y cultural de las enfermedades crónicas no transmisibles afecta el significado de calidad de vida en las personas que las padecen y en sus cuidadores familiares. Objetivo: describir la forma como se construye el significado de calidad de vida de cuidadores de personas con enfermedad crónica. Método: investigación desarrollada con la propuesta de metasíntesis cualitativa de Sandelowski y Barroso. Resultados: se presentan tres momentos en la trayectoria: 1) se afecta (destrucción celular programada); 2) se trasforma (autocontrol del desarrollo y crecimiento), y 3) se resignifica (condensación); y cuatro factores condicionantes para la construcción del significado de calidad de vida para el cuidador como son el soporte social, la espiritualidad, la habilidad para cuidar y el tiempo. Conclusiones: la calidad de vida se afecta y se reconstruye en virtud del significado que el cuidador tenga de esta.

Parents' voices: 'why and how we advocate'. A meta-synthesis of parents' experiences of advocating for their child with autism spectrum disorder

Parenting a child with autism spectrum disorder (ASD) can be stressful, and accessing services can add to this stress. Self-efficacy, agency and advocacy are important for parents when accessing and using services. To develop insight into parental advocacy, a meta-synthesis was undertaken to consolidate the literature focussing on parents' experiences of advocating for their child with ASD. A qualitative meta-synthesis was conducted. Fifteen databases were systematically searched by using key terms related to ASD, children, parents/carers, advocacy and qualitative studies. Twenty-four studies were identified and appraised using an adapted version of the Critical Appraisal Skills Programme tool. Data were synthesized into themes through the steps of review, meta-aggregation, integration and interpretation. Two overarching concepts emerged, illustrating both the challenging nature of advocacy and the associated personal and societal benefits. These two concepts are supported by eight themes: a life-long, all-encompassing challenge; advocacy as a parental coping strategy; advocacy involving working to create a future; balancing roles and needs; isolation versus support; personal impacts of advocacy; benefits of advocacy; and the barriers to advocacy. The experience of advocacy for parents with a child with ASD is complex and intensive, presenting both personal and societal benefits, as well as challenges for parents. In supporting individuals with ASD and family well-being, service providers need to have an understanding of the advocating role of parents and ensure that opportunities exist for their voices to be heard during service delivery.

Infant Co-Bedding: Practices and Teaching Strategies

PURPOSE

Studies show that co-bedding is a common cause of death in babies. The purpose of this study is to identify teaching strategies that can be used to increase safe sleep practices.

DESIGN AND METHODS

A rigorous systematic literature search identified articles that expressed ways in which to provide co-bedding teaching or provided recommended approaches to educating mothers and families about co-bedding risks. NOTARI software, from OVID Tools, was used to appraise articles, extract data, and thematically organize the findings, resulting in meta-aggregation.

RESULTS

Two major findings were synthesized from four categories. First, co-bedding occurred despite knowing risks and having received teaching. Second, families should receive co-bedding messages tailored to their specific circumstances and risks.

PRACTICE IMPLICATIONS

Findings showed that the lack of dialogue in co-bedding teaching often deters caregivers and families from seeking further education or consultation. Nurses need to ensure that safe sleep practices are taught and that the material provided pertains to the caregiver's specific cultural and familial situation.

Fall-related experiences of stroke survivors: a meta-ethnography

PURPOSE

Health professionals view falls after stroke as common adverse events with both physical and psychological consequences. Stroke survivors' experiences are less well understood. The aim of this systematic review was to explore the perception of falls-risk within the stroke recovery experience from the perspective of people with stroke.

METHODS

A systematic literature search was conducted. Papers that used qualitative methods to explore the experiences of individuals with stroke around falls, falls-risk and fear of falling were included. Two reviewers independently assessed the methodological quality of papers. Meta-ethnography was conducted. Concepts from each study were translated into each other to form theories that were combined through a "lines-of-argument" synthesis.

RESULTS

Four themes emerged from the six included qualitative studies: (i) Fall circumstances, (ii) perception of fall consequences, (iii) barriers to community participation and (iv) coping strategies. The synthesis revealed that stroke survivors' perceived consequences of falls exist on a continuum. Cognitive and emotional adjustment may be required in the successful adoption of coping strategies to overcome fall-related barriers to participation.

CONCLUSIONS

Stroke survivors' fall-related experiences appear to exist within the context of activity and community participation. Further research is warranted due to the small number of substantive studies available for synthesis. Implications for Rehabilitation Health care professionals should recognize that cognitive and emotional adjustment may berequired for stroke survivors to accept strategies for overcoming falls-risk, including dependenceon carers and assistive devices. Several factors in addition to physical interventions may be needed to minimize falls-risk whileincreasing activity participation. These factors could include increasing public awareness about the effects of stroke and falls-risk,and ensuring access to psychological services for stroke survivors. Rehabilitation professionals should reflect on whether they perceive there to be an appropriatelevel of fear of falling post-stroke. They should understand that stroke survivors might not conceptualize falls-risk in this way.

Using Sandelowski and Barroso's Meta-Synthesis Method in Advancing Qualitative Evidence

The purpose of this article was to iteratively account for and discuss the handling of methodological challenges in two qualitative research syntheses concerning patients' experiences of hospital transition. We applied Sandelowski and Barroso's guidelines for synthesizing qualitative research, and to our knowledge, this is the first time researchers discuss their methodological steps. In the process, we identified a need for prolonged discussions to determine mutual understandings of the methodology. We discussed how to identify the appropriate qualitative research literature and how to best conduct exhaustive literature searches on our target phenomena. Another finding concerned our status as third-order interpreters of participants' experiences and what this meant for synthesizing the primary findings. Finally, we discussed whether our studies could be classified as metasummaries or metasyntheses. Although we have some concerns regarding the applicability of the methodology, we conclude that following Sandelowski and Barroso's guidelines contributed to valid syntheses of our studies.

A Guide to Writing a Qualitative Systematic Review Protocol to Enhance Evidence-Based Practice in Nursing and Health Care

BACKGROUND

The qualitative systematic review is a rapidly developing area of nursing research. In order to present trustworthy, high-quality recommendations, such reviews should be based on a review protocol to minimize bias and enhance transparency and reproducibility. Although there are a number of resources available to guide researchers in developing a quantitative review protocol, very few resources exist for qualitative reviews.

AIMS

To guide researchers through the process of developing a qualitative systematic review protocol, using an example review question.

METHODOLOGY

The key elements required in a systematic review protocol are discussed, with a focus on application to qualitative reviews: Development of a research question; formulation of key search terms and strategies; designing a multistage review process; critical appraisal of qualitative literature; development of data extraction techniques; and data synthesis. The paper highlights important considerations during the protocol development process, and uses a previously developed review question as a working example.

IMPLICATIONS FOR RESEARCH

This paper will assist novice researchers in developing a qualitative systematic review protocol. By providing a worked example of a protocol, the paper encourages the development of review protocols, enhancing the trustworthiness and value of the completed qualitative systematic review findings.

LINKING EVIDENCE TO ACTION

Qualitative systematic reviews should be based on well planned, peer reviewed protocols to enhance the trustworthiness of results and thus their usefulness in clinical practice. Protocols should outline, in detail, the processes which will be used to undertake the review, including key search terms, inclusion and exclusion criteria, and the methods used for critical appraisal, data extraction and data analysis to facilitate transparency of the review process. Additionally, journals should encourage and support the publication of review protocols, and should require reference to a protocol prior to publication of the review results.

Evaluating the evidence on employee engagement and its potential benefits to NHS staff: a narrative synthesis of the literature

Background

Recent studies have suggested engagement is linked with beneficial outcomes for individuals and organisations. Despite growing demand for resources and advice on engagement within the NHS, there has been no systematic evaluation of how engagement strategies can be developed and operationalised within the NHS.

Objectives and research questions

To evaluate evidence and theories of employee engagement within the NHS and the general workforce to inform policy and practice. Four research questions focused on definitions and models of engagement; the evidence of links between engagement and staff morale and performance; approaches and interventions that have the greatest potential to create and embed high levels of engagement within the NHS; and the most useful tools and resources for NHS managers in order to improve engagement.

Review methods

Evidence was evaluated using a narrative synthesis approach involving a structured search of relevant academic databases and grey literature. The search yielded a final data set of 217 items, comprising 172 empirical papers, 38 theoretical articles, four meta-analyses and three books. From the grey literature, only 14 items were used in the analysis.

Main findings

There is no one agreed definition or measure of engagement. Existing approaches were grouped under three headings: a psychological state; a composite attitudinal and behavioural construct; and employment relations practice. Most fell under the first category, with the Utrecht Work Engagement Scale being the most prevalent. Most theorising around engagement used the job demands–resources framework. Thirty-five studies considered engagement and morale, and the most consistent finding was a positive link between engagement and life satisfaction, and a negative link between engagement and burnout. Some studies suggested that engagement was positively associated with organisational commitment and job satisfaction and negatively linked to turnover intentions. Of 42 studies that looked at performance and engagement, the strongest support was found for a link between engagement and individual in-role performance and a negative link between engagement and counterproductive performance outcomes. A link between engagement and higher-level performance outcomes was also found. Of 155 studies that explored approaches and interventions that promote engagement, the strongest support was found for the following: positive psychological states including resilience; job-related resources and job design features; positive leadership; perceived organisational support; team-level engagement; training and development. Only a small proportion of studies were based in health-care settings, making the application of evidence to wider contexts limited. Studies identified in the grey literature suggested that the focus of practitioner material was more on wider managerial issues than on psychological factors.

Conclusions

The synthesis highlights the complex nature of the engagement evidence base. The quality of evidence was mixed. Most studies were cross-sectional, self-report surveys, although the minority of studies that used more complex methods such as longitudinal study designs or multiple respondents were able to lend more weight to inferences of causality. The evidence from the health-care sector was relatively sparse. Only a few studies used complex methods and just two had taken place in the UK. The evidence synthesis suggests that employers might consider several factors in efforts to raise levels of engagement including development and coaching to raise levels of employee resilience, the provision of adequate job resources, and fostering positive and supportive leadership styles.

Funding

This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research (HSDR) programme.

Translating knowledge into best practice care bundles: a pragmatic strategy for EBP implementation via moving postprocedural pain management nursing guidelines into clinical practice

AIMS AND OBJECTIVES

To describe quantitative and qualitative best evidence as sources for practical interventions usable in daily care delivery in order to integrate best evidence into clinical decision-making at local practice settings. To illustrate the development, implementation and evaluation of a pain management nursing care bundle based on a clinical practice guideline via a real-world clinical exemplar.

BACKGROUND

Successful implementation of evidence-based practice requires consistent integration of best evidence into daily clinical decision-making. Best evidence comprises high-quality knowledge summarised in systematic reviews and translated into guidelines. However, consistent integration of guidelines into care delivery remains challenging, partly due to guidelines not being in a usable form for daily practice or relevant for the local context.

DESIGN

A position paper with a clinical exemplar of a nurse-led, evidence-based quality improvement project to design, implement and evaluate a pain management care bundle translated from a national nursing guideline.

METHODS

A pragmatic approach to integrating guidelines into daily practice is presented. Best evidence from a national nursing guideline was translated into a pain management care bundle and integrated into daily practice in 15 medical-surgical (med-surg) units of nine hospitals of a large university hospital system in Finland.

CONCLUSIONS

Translation of best evidence from guidelines into usable form as care bundles adapted to the local setting may increase implementation and uptake of guidelines and improve quality and consistency of care delivery.

RELEVANCE TO CLINICAL PRACTICE

A pragmatic approach to translating a nursing guideline into a pain management care bundle to incorporate best evidence into daily practice may help achieve more consistent and equitable integration of guidelines into care delivery, and better quality of pain management and patient outcomes.