A fast transition: A case study of patients' experiences during the diagnostic and surgical treatment phase of an accelerated brain cancer pathway

BACKGROUND

Patients receiving a brain cancer diagnosis may face cognitive decline and a poor prognosis. In addition, they suffer from a high symptom burden in a complex cancer pathway. The aim of this study was to investigate the early hospital experiences of brain tumour patients during the diagnostic and surgical treatment phase.

METHODS

A descriptive longitudinal single-case study design was used, and data were analysed via systematic text condensation.

RESULTS

The patients' experiences of being diagnosed with and treated for brain cancer were interpreted in terms of the central theme: a fast transition into an unknown journey. This theme consisted of the following subthemes: emotionally overwhelmed, putting life on hold and an unfamiliar dependency.

CONCLUSIONS

Patients diagnosed with brain cancer struggle with overwhelming emotions due to this sudden life-threatening diagnosis, their fear of brain surgery and their progressing dependence. Patients did not voice their feelings, fears or needs, so these may easily be overlooked and unmet. A proactive and continuous care approach throughout the diagnostic phase is needed to support these patients.

Time and change: a typology for presenting research findings in qualitative longitudinal research

BACKGROUND

Qualitative longitudinal research (QLR) is an emerging methodology used in health research. The method literature states that the change in a phenomenon through time should be the focus of any QLR study, but in empirical studies, the analysis of changes through time is often poorly described, and the emphasis on time/change in the findings varies greatly. This inconsistency might depend on limitations in the existing method literature in terms of describing how QLR studies can present findings. The aim of this study was to develop and describe a typology of alternative approaches for integrating time and/or change in QLR findings.

METHODS

In this method study, we used an adapted scoping review design. Articles were identified using EBSCOhost. In total, methods and results sections from 299 QLR articles in the field of health research were analyzed with inspiration from content analysis.

RESULTS

We constructed a typology of three types and seven subtypes. The types were based on the underlying structural principles of how time/change was presented: Type A) Findings have a low utilization of longitudinal data, Type B) Findings are structured according to chronological time, and Type C) Findings focus on changes through time. These types differed in 1) the way the main focus was on time, change or neither; 2) the level of interpretation in the findings; and 3) how theoretical understandings of time/change were articulated in the articles. Each type encompassed two or three subtypes that represented distinct approaches to the aim and results presentation of QLR findings.

CONCLUSIONS

This method study is the first to describe a coherent and comprehensive typology of alternative approaches for integrating time/change into QLR findings in health research. By providing examples of various subtypes that can be used for results presentations, it can help researchers make informed decisions suitable to their research intent.

Historiographic and biographic accounts of Faroese nurses' training and health-promoting work from 1910 to the end of the 1930s

The Nordic country Faroe Islands consists of 18 mountain islands situated in the North Atlantic Sea. In the late 1800s, nursing in the Faroe Islands was behind international standards. A transition towards organised nursing commenced when Danish deaconesses arrived in 1897; their missions were to serve as nurses and train Faroese women in nursing. The overall aim of this research is to add to the history of Faroese nurses' training and work during the first decades of the 1900s, decades when Faroese nursing became visible through the presence of deaconesses and trained nurses. With historiographic and biographic approaches and in the context of Faroese history and nursing theory and research, we present accounts about four Faroese nurses' living, training and work during the three first decades of the 1900s. These years were progressive for Faroese nursing in hospital care and public health around on the islands, and a struggle to combat tuberculosis took place. We conclude by emphasising the importance of considering the beginning of professional nursing in a small faraway country where resilient nurses worked with ingenuity and often exceeded geographic and professional boundaries to help and support sick and injured compatriots, promoting their health and well-being.

Nurses' and Doctors' Experiences of Transferring Adolescents or Young Adults With Long-Term Health Conditions From Pediatric to Adult Care: A Metasynthesis

The transfer of adolescents and young adults (AYA) with long-term health conditions from pediatric to adult care is a multidisciplinary enterprise where nurses and doctors play an important role. This review aimed to identify and synthesize evidence from qualitative primary reports on how nurses and doctors experience the transfer of AYA aged 13 to 24 years with long-term health conditions to an adult hospital setting. We systematically searched seven electronic databases for reports published between January 2005 and November 2021 and reporting nurses' and doctors' experiences. We meta-summarized data from 13 reports derived from 11 studies published worldwide. Using qualitative content analysis, we metasynthesized nurses' and doctors' experiences into the theme "being boosters." Boosting AYA's transfer was characterized by supporting AYA's and their parents' changing roles, smoothening AYA's transition from pediatric to adult care, and handling AYA's encounters with a different care culture.

Qualitative longitudinal research in health research: a method study

Background

Qualitative longitudinal research (QLR) comprises qualitative studies, with repeated data collection, that focus on the temporality (e.g., time and change) of a phenomenon. The use of QLR is increasing in health research since many topics within health involve change (e.g., progressive illness, rehabilitation). A method study can provide an insightful understanding of the use, trends and variations within this approach. The aim of this study was to map how QLR articles within the existing health research literature are designed to capture aspects of time and/or change.

Methods

This method study used an adapted scoping review design. Articles were eligible if they were written in English, published between 2017 and 2019, and reported results from qualitative data collected at different time points/time waves with the same sample or in the same setting. Articles were identified using EBSCOhost. Two independent reviewers performed the screening, selection and charting.

Results

A total of 299 articles were included. There was great variation among the articles in the use of methodological traditions, type of data, length of data collection, and components of longitudinal data collection. However, the majority of articles represented large studies and were based on individual interview data. Approximately half of the articles self-identified as QLR studies or as following a QLR design, although slightly less than 20% of them included QLR method literature in their method sections.

Conclusions

QLR is often used in large complex studies. Some articles were thoroughly designed to capture time/change throughout the methodology, aim and data collection, while other articles included few elements of QLR. Longitudinal data collection includes several components, such as what entities are followed across time, the tempo of data collection, and to what extent the data collection is preplanned or adapted across time. Therefore, there are several practices and possibilities researchers should consider before starting a QLR project.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12874-022-01732-4.

Being cross pressured-parents' experiences of the transfer from paediatric to adult care services for their young people with long term conditions: A systematic review and qualitative research synthesis

BACKGROUND

Family members of young people (13-24 years) with long-term conditions tend to experience multiple challenges when their children transfer from paediatric to adult care, as do the patients themselves.

OBJECTIVES

To identify, interpret and theoretically conceptualise the meaning of parents' experiences of the transfer from paediatric to adult care of their young people with long-term conditions.

DESIGN

A qualitative research synthesis.

DATA SOURCES

We obtained articles from Medline, CINAHL, PsycINFO, EMBASE, Scopus, and Web of Science. Unpublished theses and dissertations were searched for using Google Scholar, Mednar, and ProQuest Dissertations and Theses.

REVIEW METHODS

Based on a previously published protocol, we followed the guidelines from the Joanna Briggs Institute. Sandelowski and Barroso's qualitative research synthesis approach guided the metasynthesis. Articles published between 1999 and March 2019 were systematically searched for.

FINDINGS

Twenty-three reports from seven Western countries representing 454 parents including significant others such as aunts and grandparents of 462 young people with various diagnoses contributed to the review. 'Being cross-pressured' was the metasynthesis found to reflect parents' experiences of the transfer from paediatric to adult care of their young people with long-term conditions. The metasynthesis comprised four themes: 'Fluctuating between parental roles', 'Navigating contrasting healthcare contexts', 'Making decisions in the face of inner conflict', and 'Trusting their child's self-management ability'.

CONCLUSIONS

Our metasynthesis finding of parents' experiences of being cross-pressured provides a new way of thinking about the study phenomena which is supported by transitions theory holding that multiple transitions can take place simultaneously involving myriads of concurrent and conflicting demands. The cross pressure may overwhelm parents. The clinical implications are to recognise parents' experiences and distress in healthcare planning to promote safe and predicable transfers of their young people. Provision of healthcare to parents during transfer needs to be tailored to a collaborative decision-making process between parents, their young people, and involved practitioners across paediatric and adult healthcare services. Tweetable abstract: Parents experienced being cross-pressured when their young people with long-term conditions were transferred from paediatric to adult care.

Physical activity experiences of children and adolescents with asthma: a qualitative systematic review protocol

OBJECTIVE

The objective of the review is to synthesize existing knowledge about experiences of children and adolescents with asthma related to participation in, or limitation of, physical activity.

INTRODUCTION

Limitations of physical activity, expressed as a barrier of bodily movement, may relate to physiological restraints, as well as emotional and social delimitation, in children and adolescents with asthma. Participation in physical activity is related to management of asthma and is important for social inclusion. Through childhood and adolescence, physical activity enhances physical, cognitive, and social development, and a dose-response relationship between physical activity and several indicators of improved health has been established. Knowledge is needed about experiences of physical activity in children and adolescents with asthma to tailor care and implement exercise and physical activity supporting interventions into clinical practice.

INCLUSION CRITERIA

This review will consider qualitative studies that include subjective experiences related to participation in, or limitation of, physical activity in children and adolescents (six to 18 years of age) with asthma. All contexts and countries will be included.

METHODS

MEDLINE, Embase, PsycINFO, CINAHL, SPORTDiscus, SocINDEX, and Social Science Citation Index List will be searched for relevant studies. Studies published in English with no date limitation will be included. Study selection, assessment of methodological quality, data extraction, synthesis, and assessment of confidence in the findings will be conducted using the JBI meta-aggregation approach.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42020164797.

"Take good care of yourself" An integrative review of older widows' self-care for health and well-being

Take good care of yourself is a regard often said to older bereaved women. However, what does it mean? Though self-care is a well-known phenomenon within health, it is not well understood in the context of late life spousal bereavement and widowhood. We undertook an integrative review to synthesize knowledge of older women's self-care challenges, resources and activities when bereaved and in a healthy transition to widowhood. Good care refers to health-promoting self-care and can be explained as the older widows' ability to access and mobilize resources and activities that are significant for a healthy transition to widowhood.

Sharing our story individualized and triadic nurse meetings support couples adjustment to living with deep brain stimulation for Parkinson's disease

Treatment with deep brain stimulation for Parkinson’s disease, leads to a rapid improvement in mobility, which may challenge patients and spouses when adjusting to everyday life. An intervention, developed to support the adjustment to everyday life with DBS, demonstrated that individualized meetings with a specialized nurse was experienced as important and fruitful by both patient and spouses. Purpose: The aim was to gain a deeper understanding of how the meetings contributed to the adjustment process. Method: 38 audio-recorded meetings and six written summaries from eight couples participating in the intervention, were analyzed in a hermeneutic process. Results: The analysis revealed four themes: A relational triad of co-creating personal knowing. Sharing and listening in an atmosphere of trust and openness. Unveiling the couple’s everyday life, coping strategies and expectations. Supporting adjustment through knowing their personal story. Conclusion: The triadic dynamics in the meetings were quite particular. The main focus was the patients’ and spouses’ stories, individually and as a couple. The DBS nurse pursues solutions based on professional and specialized knowledge of Parkinson’s disease and the couple’s everyday life. Thus, the intervention meetings offered tailored, individualized and specialized care in supporting adjustment to DBS for PD both individually and as couples.

Relationship between physical activity level and psychosocial and socioeconomic factors and issues in children and adolescents with asthma: a scoping review protocol

REVIEW QUESTION/OBJECTIVE

The first objective of this scoping review is to identify and map information about instruments used to measure psychosocial and socioeconomic factors associated with level of physical activity (PA) in children and adolescents with asthma that have been reported in quantitative literature, and to report on the construction and validation of these instruments. The second objective is to identify and map psychosocial and socioeconomic issues related to PA level reported in qualitative literature and gaps in the evidence on the relationship between psychosocial and socioeconomic factors and PA level in children and adolescents with asthma.Specifically the review questions are as follows.

Relationship between physical activity level and psychosocial and socioeconomic factors and issues in children and adolescents with asthma: a scoping review

BACKGROUND

Asthma is a heterogeneous chronic airway disease which may reduce capability for physical activity. In healthy peers, physical activity is influenced by psychosocial and socioeconomic factors. Knowledge about the role of these factors has not been mapped in children and adolescents with asthma.

OBJECTIVE

The main objective of this scoping review was to identify psychosocial and socioeconomic factors associated with physical activity level in children and adolescents with asthma in the literature. The specific objectives were to map the instruments used to measure these factors, report on the construction and validation of these instruments, map psychosocial and socioeconomic issues related to physical activity level reported in qualitative studies, and identify gaps in knowledge about the relationship between psychosocial and socioeconomic factors and physical activity level in children and adolescents with asthma.

INCLUSION CRITERIA TYPES OF PARTICIPANTS

Children and adolescents with asthma aged six to 18 years.

CONCEPT

Psychosocial and socioeconomic factors related to physical activity level and participation.

CONTEXT

All physical activity contexts.

TYPES OF SOURCES

Quantitative and qualitative primary studies in English, with no date limit.

SEARCH STRATEGY

The databases searched included nine major databases for health and sports science, and five databases for unpublished studies. After screening and identification of studies, the reference lists of all identified reports were searched, and forward citation searches were conducted using four databases.

EXTRACTION OF THE RESULTS

The following data were extracted: (a) relevant study characteristics and assessment of physical activity level, (b) instruments used to assess psychosocial and socioeconomic factors, (c) association between physical activity level and these factors, (d) construction and validation of instruments, and (e) psychosocial and socioeconomic issues related to physical activity participation.

PRESENTATION OF THE RESULTS

Twenty-one quantitative and 13 qualitative studies were included. In cross-sectional studies, enjoyment, physical self-concept, self-efficacy, attitudes and beliefs about physical activity and health, psychological distress, health-related quality of life, and social support were more often reported as being correlated with physical activity level. In three studies, the construct validity was assessed by factor analysis and construct reliability tests for the study population. Qualitative studies reported 10 issues related to physical activity participation, and capability and being like peers were most commonly reported. There was no direct evidence that qualitative research informed the development or adjustment of instruments in quantitative studies.

CONCLUSIONS

Seven psychosocial factors correlated with physical activity level; capability and being like peers were the most commonly reported issues. Reports of the construction and validation of instruments were sparse.

Experiences of adults who as children lived with a parent experiencing mental illness in a small-scale society : A Qualitative study

WHAT IS KNOWN ON THE SUBJECT?: Children of parent with severe mental illness are often carrying a caring burden; they keep the illness in the family, are documented to be stigmatized, bullied and to take special attention to their mentally ill parent's health and well-being. Little is however known about these children's experiences when growing up in a small-scale society. WHAT THIS STUDY ADDS TO EXISTING KNOWLEDGE?: Children's experiences of living with a parent with severe mental illness in the small-scale society (Faroe Islands) are paradoxical, life is often unreasonable and evidently contradictory but anyway connected. The results show that "everybody knows everybody" which refers to that, in the small-scale society, it is difficult to be anonymous. The children were familiar with that people talked and had a prejudiced attitude; this resulted that the participants were constantly reminded of their mental ill parent's difference, and they were feeling less worthy than their pals. Children of parents with severe mental illness in a small-scale society need to support from the close family as well as mental healthcare professionals. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The study adds knowledge about the challenges that children of mental ill parents have to go through. Dialogue among mental healthcare colleagues not only about caring for the sick parent but also about modes of caring for the children and the family at large would deepen the staff's knowing of the need for family-centred care within mental health care.

ABSTRACT

Introduction An estimated 23% of children worldwide live with a parent experiencing mental illness. These children are exposed to emotional and psychosocial challenges. Little is known about these children when living in small-scale societies. Aim To explore how adults, who as children lived with parents experiencing mental illness in a small-scale society, recalled their childhood life. Method Individual interviews with 11 adults were analysed using content analysis. Results Living as a child with a parent experiencing mental illness in a small-scale society was described as "living in a paradox" which emerged from three categories: "intergenerational help and caring," "barriers understanding parental illness" and "everybody knows everybody". The children received little or no support from family members, nor from health and education professionals. Discussion In a small-scale society, stigma surrounding mental illness is notable. Families often attempt to conceal mental illness from outsiders with negative or adverse effects on children. Implications for practice Mental healthcare professionals need to consider the needs of children who have parents experiencing mental illness. It is imperative for the well-being of the patients' children to support them in understanding what is happening, turn gossiping in a positive direction and address stigma in the communities.

Parents' experiences of neonatal transfer. A meta-study of qualitative research 2000-2017

Transfers of critically ill neonates are frequent phenomena. Even though parents' participation is regarded as crucial in neonatal care, a transfer often means that parents and neonates are separated. A systematic review of the parents' experiences of neonatal transfer is lacking. This paper describes a meta-study addressing qualitative research about parents' experiences of neonatal transfer. Through deconstruction and reflections of theories, methods, and empirical data, the aim was to achieve a deeper understanding of theoretical, empirical, contextual, historical, and methodological issues of qualitative studies concerning parents' experiences of neonatal transfer over the course of this meta-study (2000-2017). Meta-theory and meta-method analyses showed that caring, transition, and family-centered care were main theoretical frames applied and that interviewing with a small number of participants was the preferred data collection method. The meta-data-analysis showed that transfer was a scary, unfamiliar, and threatening experience for the parents; they were losing familiar context, were separated from their neonate, and could feel their parenthood disrupted. We identified 'wavering and wandering' as a metaphoric representation of the parents' experiences. The findings add knowledge about meta-study as an approach for comprehensive qualitative research and point at the value of meta-theory and meta-method analyses.

The existential experience of everyday life with systemic lupus erythematosus

AIM

To explore from the perspective of women the nature of basic existential conditions while living with systemic lupus erythematosus.

BACKGROUND

Systemic lupus erythematosus has an unpredictable disease course and is documented to cause an existential rearrangement of life. The significance of changes in existential conditions and related experiences are unclear in the context of nursing and women with systemic lupus erythematosus.

DESIGN

A qualitative design guided by Van Manen's hermeneutic-phenomenological methodology.

METHOD

Individual in-depth interviews with 15 women diagnosed with systemic lupus erythematosus and of various ages, disease durations and severities were undertaken from September 2013 - October 2015. Data were analysed following van Manen's phenomenological approach and using drawing as an interpretive tool.

FINDINGS

The main existential experience was interpreted as a person "moving with the waves of systemic lupus erythematosus" constituted by the themes "oscillating between presence and absence of systemic lupus erythematosus," "recognizing space and bodily possibilities and limitations" and "being enriched through relationships and activities." When systemic lupus erythematosus was flaring, well-being was threatened and a laborious time to escape the feeling of a setback-in-life persisted long after the disease was medically under control.

CONCLUSION

Daily life with systemic lupus erythematosus is conditioned by a prominent need to be in existential motion, related to the absence and presence of systemic lupus erythematosus. The experience of a setback-in-life by illness might challenge well-being and indicates that periods of disease flares or disturbing symptoms are critical time points to provide support.

Clinical Wisdom Among Proficient Nurses

This article examines clinical wisdom, which has emerged from a broader study about nurse managers' influence on proficient registered nurse turnover and retention. The purpose of the study was to increase understanding of proficient nurses' experience and clinical practice by giving voice to the nurses themselves, and to look for differences in their practice. This was a qualitative study based on semistructured interviews followed by analysis founded on Gadamerian hermeneutics. The article describes how proficient nurses experience their practice. Proficient practice constitutes clinical wisdom based on responsibility, thinking and ethical discernment, and a drive for action. The study showed that poor working conditions cause proficient nurses to regress to non-proficient performance. Further studies are recommended to allow deeper searching into the area of working conditions and their relationship to lack of nurse proficiency.

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.

Navigating in an unpredictable daily life: a metasynthesis on children's experiences living with a parent with severe mental illness

A large group of individuals suffering from mental illness are parents living with their children. These children are invisible in the health care even though at risk for illhealth. The aim of this metasynthesis was to advance knowledge of how children of parents with mental illness experience their lives, thus contributing to the evidence of this phenomenon. The metasynthesis is following Sandelowski and Barroso's guidelines. Literature searches covering the years 2000 to 2013 resulted in 22 reports which were synthesised into the theme 'navigating in an unpredictable everyday life' and the metaphor compass. Children of parents with mental illness irrespective of age are responsible, loving and worrying children who want to do everything to help and support. Children feel shame when the parent behaves differently, and they conceal their family life being afraid of stigmatisation and bullying. When their parent becomes ill, they distance to protect themselves. The children cope through information, knowledge, frankness and trustful relationships. These children need support from healthcare services because they subjugate own needs in favour of the parental needs, they should be encouraged to talk about their family situation, and especially, young children should to be child-like, playing and seeing friends.

First time mothers' experiences of breastfeeding their newborn

OBJECTIVE

Despite efforts to improve continued breastfeeding, the percentages of exclusively breastfeeding remain low. To help the breastfeeding mother and reshape professional practice, we need more knowledge of maternal experiences of breastfeeding in the first months. The objective was to explore mothers' early breastfeeding experiences.

METHOD

Qualitative content analysis was used to analyse data from 108 Danish first time mothers who had answered an open-ended question 6 months after birth.

RESULTS

All the mothers started breastfeeding. We identified three overlapping phases presented as dominant themes: (1) on shaky ground, characterised by breastfeeding interwoven with mothering, painful breastfeeding, and conflicting advice, (2) searching for a foothold, characterised by reading the baby's cues, concerns about milk production, for or against breastfeeding, and looking for professional support, and (3) at ease with choice of feeding, characterised by a thriving baby, trust in breastfeeding capability, and approval of feeding preference. Together these themes and subthemes constituted the overall theme: being on a breastfeeding-bonding trajectory.

CONCLUSION

Supporting the new breastfeeding mother should include facilitation of the transition to motherhood, learning to read the baby's cues, developing a sense of the right attachment at the breast, and building up the mother's confidence in her capability to care for the baby and produce a sufficient milk supply.

Ethical challenges in everyday work with adults with learning disabilities

BACKGROUND

Healthcare providers caring for learning-disabled individuals in institutions face challenges of what is right or wrong in their daily work. Serving this group, it is of utmost importance for the healthcare staff to raise awareness and to understand how ethical values are at stake.

RESEARCH QUESTION

What ethical challenges are discussed among healthcare providers working with adults with learning disabilities?

RESEARCH DESIGN

The study had a qualitative and investigative design.

PARTICIPANTS AND RESEARCH CONTEXT

The study was conducted in a community institution for adults with learning disabilities. Participants were healthcare providers joining regular focused group discussions. Two groups participated and each group consisted of six participants. The conversations were taped and transcribed.

ETHICAL CONSIDERATIONS

The study was reported to Norwegian Social Science Data Services and was approved by the regional ethics committee.

FINDINGS

Findings are presented in four themes: (a) feeling squeezed between conflicting actions, (b) being the client's spokesman, (c) searching shared responsibility, and (d) expecting immediate and fixed solutions. The healthcare providers wanted to be the clients' advocates. They felt obliged to speak up for the clients, however, seeking for someone with whom to share the heavily experienced responsibility. Data likewise revealed that the group discussions created expectations among the healthcare providers; they expected smart and final solutions to the problems they discussed.

DISCUSSION

The discussion focuses on everyday ethical challenges, the meaning of being in-between and share responsibility, and the meaning of ethical sensitivity.

CONCLUSION

Ethical challenges can be demanding for the staff; they might feel squeezed in-between contradictory attitudes or feel alone in decision-making. Frequent conversations about ethical challenges do not solve the ethical problems here-and-now, but they do visualize them. This also visualizes the staff's need for support.

Adolescents' and young adults' transition experiences when transferring from paediatric to adult care: a qualitative metasynthesis

OBJECTIVES

The objective of this study was to synthesize qualitative studies of how adolescents and young adults with chronic diseases experience the transition from paediatric to adult hospital care.

DESIGN

The review is designed as a qualitative metasynthesis and is following Sandelowski and Barroso's guidelines for synthesizing qualitative research.

DATA SOURCES

Literature searches were conducted in the databases PubMed, Ovid, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), ISI Web of Science, and Nordic and German databases covering the period from 1999 to November 2010. In addition, forward citation snowball searching was conducted in the databases Ovid, CINAHL, ISI Web of Science, Scopus and Google Scholar.

REVIEW METHODS

Of the 1143 records screened, 18 studies were included. Inclusion criteria were qualitative studies in English, German or Nordic languages on adolescents' and young adults' transition experiences when transferring from paediatric to adult care. There was no age limit, provided the focus was on the actual transfer process and participants had a chronic somatic disease. The studies were appraised as suitable for inclusion using a published appraisal tool. Data were analyzed into metasummaries and a metasynthesis according to established guidelines for synthesis of qualitative research.

RESULTS

Four themes illustrating experiences of loss of familiar surroundings and relationships combined with insecurity and a feeling of being unprepared for what was ahead were identified: facing changes in significant relationships, moving from a familiar to an unknown ward culture, being prepared for transfer and achieving responsibility.

CONCLUSIONS

Young adults' transition experiences seem to be comparable across diagnoses. Feelings of not belonging and of being redundant during the transfer process are striking. Health care professionals' appreciation of young adults' need to be acknowledged and valued as competent collaborators in their own transfer is crucial, and may protect them from additional health problems during a vulnerable phase. Further research including participants across various cultures and health care systems is needed.

The challenge of integrating justice and care in neonatal nursing

The aim of this study was to explore neonatal nurses’and mothers of preterm infants’experiences of daily challenges. Interviews took place asking for good, bad and challenging experiences. Data were analysed using qualitative content analysis and findings were clustered in two categories: good and challenging experiences, each containing three themes. The good experiences were: managing with success as a nurse, small things matter for mothers, and a good day anyhow for mothers and nurses. The challenging experiences were: mothering in public, being pulled between responsibilities, and adverse things stick under the nurses’skin. The study shows that small daily clinical matters become big issues and could lead to moral distress, and that nurses integrate ethics of justice and ethics of care while mothers are concerned about health and well-being of their specific infant only. The challenge for nursing to integrate fairness and sensitive care in family-oriented neonatal care is discussed.

Re-establishing dignity: nurses' experiences of caring for older hospital patients

In western countries, the older population is increasing and with age follows a risk of un-health. Every fifth hospital patient is above 65 years of age. As a consequence, nursing care to older patients is a significant but tacit nursing issue. The aim of this study was to explore Danish clinical nurses' experiences of caring for older hospital patients. The study was based on Benner and Wrubel's phenomenological notion that caring as a special kind of involvement, a grasp of a situation in terms of its meaning, is primary in nursing. A qualitative secondary analysis of data from an interview study with 29 nurses and nurse assistants was performed following Van Manen's hermeneutic phenomenology. Findings show that caring mainly concerns 're-establishing dignity' especially through 'seeing the patient as a unique person', 'assisting in getting rid of the bed' and 'supporting patient appearance'. The study documents that caring for older people is about creating small everyday circumstances in which patient dignity can flourish. Shortcomings of a secondary analysis are discussed and suggestions for future research, such as how older hospital patients experience caring and dignity in relation to nursing care received, are suggested.

The perceived and predicted implications of psychiatric genetic knowledge among persons with multiple cases of depression in the family

OBJECTIVE

Psychiatric genetic research raises hope regarding better treatment and prevention, but also regarding a possible de-stigmatizing effect of attributing mental illness to genetics. This study explores i) the impact on family relations of participating in a genetic study; ii) the impact of biogenetic attributions on perceptions of depression and stigma and iii) the perceived benefits and concerns regarding psychiatric genetic testing.

METHOD

Focus groups were conducted with 17 participants suffering from depression, with multiple cases of depression in the family, and previously participating in a genetic study.

RESULTS

Participating in a genetic study caused more openness about depression in most families. A biogenetic explanation of depression was perceived as having the potential of diminishing self stigma. Testing of self and children was widely accepted, whereas prenatal testing raised concern.

CONCLUSION

Persons suffering from depression may benefit from endorsing a biogenetic explanation, especially in relation to self-understanding and self-stigma.

Living with advanced Parkinson's disease: a constant struggle with unpredictability

AIM

This paper is a report of an exploration of patients' lifeworld and way of managing life with advanced Parkinson's disease prior to Deep Brain Stimulation and what they expect from life following this treatment.

BACKGROUND

Parkinson's disease is a progressive neurodegenerative disease, which is initially well-treated with L-dopa. Living with Parkinson's disease means living with the experience of continuous loss of independence and self-esteem and unpredictable ON/OFF phenomena. Thus, in the advanced stage of the disease, treatment with Deep Brain Stimulation may become relevant.

METHOD

Eleven patients eligible for Deep Brain Stimulation were interviewed prior to treatment. Data were collected in 2007 and analysed according to the hermeneutic phenomenological methodology of van Manen, using the four existentials as analytic tools.

FINDINGS

Living with advanced Parkinson's disease can be described as the experience of living with and managing unpredictability. The disease gradually took over, and participants had to struggle with unpredictability on a daily basis. Themes in relation to this were: The body - setting the agenda, Always a struggle to be on time, Living in dependence and compromise - being a burden, and Living with restrained space and changes in social life.

CONCLUSION

Parkinson's disease leads to profound bodily restrictions. Living with an unpredictable body affects all aspects of life, and nurses need to be aware of the impact the disease has on the entire lifeworld, and how this may affect the way treatment is perceived.

Hope as experienced in women newly diagnosed with gynaecological cancer

AIM

This article presents findings from a hermeneutic-phenomenological study with the aim to investigate the meaning of the lived experience of hope in women newly diagnosed with gynaecological cancer.

METHOD

Fifteen women were interviewed the day they were receiving the diagnosis at a gynaecological department of a Danish university hospital. The women, aged 24-87 (median 52 yrs), were diagnosed with ovarian, endometrial, cervical and vulvar cancer.

RESULTS

Hope was found to be connected to both diagnosis, cure, family life and life itself and closely tied to hopelessness. The newly received cancer diagnosis made the women oscillate between hope and hopelessness, between positive expectations of getting cured and frightening feelings of the disease taking over. Five major interrelated themes of hope were identified: hope of being cured, cared for and getting back to normal, hope as being active and feeling well, hope as an internal power to maintain integration, hope as significant relationships and hope as fighting against hopelessness. Thus, hope was woven together with hopelessness in a mysterious way; it took command through inner strength and courage based on a trust in being cured and of being in relationship with significant others.

CONCLUSION

The findings of the close relationship between the shades of hope and hopelessness support the need for nurses to continue to practice hope-inspiring nursing. Nurses need to understand the complexity of hope and its close connection to hopelessness when newly diagnosed with a threatening disease as cancer; and the findings might help nurses assist patients in fighting hopelessness.

Shattered expectations: when mothers' confidence in breastfeeding is undermined--a metasynthesis

OBJECTIVES

Why do mothers give up breastfeeding, even though breastfeeding has great importance to them? This study examines what has affected mother's confidence in breastfeeding when she gives up breastfeeding.

METHOD

A metasynthesis of seven studies on mothers' experiences with breastfeeding was conducted using Noblit and Hare's methodological approach.

RESULTS

The metasynthesis shows that confidence in breastfeeding is shaped by shattered expectations and is affected on an immediate level by mothers' expectations, the network and the breastfeeding experts and on a discourse level by the discourses: breastfeeding as nature, the female body as a machine and the note of caution. Foucault's concept of discourse is used to discuss how these discourses affect mothers' confidence in breastfeeding by giving the right to speak about breastfeeding to the breastfeeding experts, by isolating the mothers who do not breastfeed and by organizing knowledge about breastfeeding in a certain way.

CONCLUSIONS

The individual mother is responsible for the success of breastfeeding and the discourses are hiding that general perceptions of breastfeeding undermines the mothers' confidence in breastfeeding and leads to shattered expectations.

Mothers' experiences of having a preterm infant in the neonatal care unit: a meta-synthesis

Neonatal nurses today are challenged not only to provide the best possible developmental care for a preterm infant but also to help the mother through an uncertain motherhood toward a feeling of being a real mother for her preterm baby. An increasing interest in mothers' experiences of having a preterm baby is seen. A meta-synthesis of 14 qualitative research studies on mothers' experiences of having a preterm baby in the neonatal intensive care unit, published from 2000 onward, was conducted. Noblit and Hare's methodological approach was used. The meta-synthesis revealed five metaphors that captured the mothers' experiences. These metaphors centered on reciprocal relationships that consisted of mother-baby relationship ("from their baby to my baby"), maternal development (a striving to be a real normal mother), the turbulent neonatal environment (from foreground to background), maternal caregiving and role reclaiming strategies (from silent vigilance to advocacy), and mother-nurse relationship (from continuously answering questions through chatting to sharing of knowledge). Implications of the meta-synthesis for neonatal nursing are addressed.

Self-care as a health resource of elders: an integrative review of the concept

AIM

To review the literature related to self-care and health promotion for elders and to develop an understanding of self-care as a health resource.

BACKGROUND

Self-care may improve health and prevent illness and disabilities in elders. Although studies of self-care are numerous, the significance of the concept as a health resource for elders lacks clarity. Before 1989, research focused principally on medical self-care at the expense of health care, and self-care was seen more as supplementary to professional health care rather than as a health-promoting approach in health care.

METHOD

In this integrative review from 2006, we selected theoretical and empirical articles published between 1990 and 2006, where self-care was related to elders' health promotion. Data were extracted from primary sources and included definitions of self-care, critical attributes, antecedents, goals and outcomes. We interactively compared data and display matrices to describe self-care as a health resource.

RESULTS

Fifty-seven articles addressed health self-care and were integrated into a framework of self-care as a health resource of elders. Self-care was identified as a two-dimensional construct including action capabilities and processes for health in self-care practice. The capabilities consisted of fundamental capabilities, power capabilities and performance capabilities. The action processes included a process of life experience, a learning process and an ecological process.

CONCLUSION

This review offers insight into self-care as a significant health resource of elders with different health status. It suggests that an elder's self-care ability is determined by the interaction of various sub-resources and conditions and emphasizes the constantly evolving nature of self-care. The framework may be of use in clinical practice, policy-making and research into health care of frail or robust elders.

Challenges in approaching metasynthesis research

The overall aim of this study was to contribute to the development of metasynthesis through an analysis of the challenges involved. The study grew out of the critique of qualitative metaresearch raised by current developers of metamethodologies. Different views on the application of methodologies have emerged in the literature, contributing to confusion and ambiguity concerning the challenging questions of what, why, how, and who in metasynthesis research, which might increase the risk of misunderstanding. The roots of metasynthesis research are seen as multifaceted and influencing the development of the methods in different directions. The primary worth of metasynthesis is theoretical and/or methodological development (synthesis) combined with the potential for reflection: going beyond and behind the studies (meta). Metasynthesis research has also the potential to raise questions of research collaboration, culture, and language.

Being in an alien world: Danish parents' lived experiences when a newborn or small child is critically ill

Parents of critically ill small children have received quite a lot of attention in nursing and allied health literature. However, no documented studies were found from Danish paediatric or neonatal contexts. The aim of the study therefore was to identify Danish parents' lived experiences during a newborn or small child's critical illness. The study was undertaken in a human caring perspective assuming that caring is primary and relational, and that persons are concerned when things matter to them. Thirteen parents were interviewed twice, and data were analysed following Van Manen's phenomenological methodology. The findings revealed that being a parent when a newborn or small child is critically ill resembled being in another world, alien from what they knew and had earlier experienced. The parents wanted to be close to the child, they were seeking for an understanding of what happened, and they felt inexperienced and insecure but at the same time they were attentive and vigilant. The sub-themes that were more prominent were 'a need to be there', 'What is going on?', 'being vigilant', 'being a spectator to your own life', and 'oscillating between hope and hopelessness'. The study implies that the staff needs to help the parents perceive some kind of meaning of what is going on, to instill hope despite not knowing the outcome, and to accept and respect the parents' style of coping with stress and concern for their sick child.

Danish parents' experiences when their new born or critically ill small child is transferred to the PICU-a qualitative study

The aim of this study was to describe Danish parents' experiences when their newborn or small child was critically ill. Thirteen parents were interviewed. Data were analysed using qualitative content analysis. The child's transfer to the paediatric intensive care unit (PICU) meant either help or death for the parents. The back transfer was experienced as joy and despair. The parents had confidence in most nurses, and they were kind, helpful, informative and capable. Less capable and distressed nurses made the parents feel uncomfortable and insecure. Parents need help and support during their child's transfer to and from the PICU. Critical care nurses have to discuss the policy of family-centred care.

A double concern: grandmothers' experiences when a small grandchild is critically ill

Grandmothers play an active part in family health and illness, but so far they are peripheral in both nursing and nursing research. This article addresses grandmothers' lived experiences when a small grandchild is critically ill. A convenience sample of 7 grandmothers was interviewed once. With the use of the methodology of Van Manen, (1990), the essence of the phenomenon was found to be a "double concern," a worry and loving care that encompassed both parents and grandchildren. Although the findings have limitations, they constitute a systematic and thematic description of Danish grandmothers' experiences and therefore add to a family-oriented body of knowledge in pediatric nursing.

A double concern: Danish grandfathers’ experiences when a small grandchild is critically ill

This paper addresses grandfathers' lived experiences when a new-born or small grandchild is critically ill. Grandfathers are marginal in nursing research in spite of the fact that intensive care nursing has broadened its perspective from being patient-centred to include family-oriented care. A convenience sample of seven grandfathers was interviewed once. Using Van Manen's phenomenological methodology, the essence of the phenomenon was found to be "a double concern". Main themes in this essential theme were: "Being a father and a grandfather" and "being in the midst of life and death". Six sub-themes expanded and clarified the meaning of these themes. Overall the grandfathers experienced worry and loving concern for parents and grandchildren. In life-threatening situations grandfathers were scared and felt helpless; they were prepared to console and comfort; they always hoped for the best; and they felt like being in the inner circle if the health personnel included them when informing about the infant. Information and presence generally were of importance for the wellbeing of grandfathers. The findings constitute a systematic and thematic description of Danish grandfathers' experiences and therefore add to a family-oriented body of knowledge for intensive care nursing.

Translation and restandardization of an instrument: the Early Infant Temperament Questionnaire

AIMS OF THE STUDY

To test the psychometric properties of a Danish translation of the Early Infant Temperament Questionnaire (EITQ) and to establish standards for scoring the questionnaire.

RATIONALE

The general aim was to create a translation that remained close to the original version, was meaningful for the Danish participants, and had acceptable psychometric properties.

BACKGROUND

Patterns of temperament can be discerned early in life and tend to persist over time and across situations. For the past 50 years, temperament has been studied by theorists, clinicians and nurse clinicians to predict behaviour, discover interventions that prevent serious behaviour disturbances, and help parents understand the implications of their child's temperament. Thomas and Chess's conceptualization of temperament in nine categories was the framework for the development of the English-language EITQ. Research methods. The translation followed a stepwise process of translation, back translation and consensus. A convenience sample of 204 Danish mothers with 1-4-month old infants completed the translated questionnaire and a demographic questionnaire in 1999.

RESULTS

Alpha coefficients for the nine subscales ranged from 0.59 to 0.82. All alpha coefficients were comparable to or higher than those reported on the original United States standardization study. There were statistically significant differences between reported United States mean scores and those in the Danish sample.

DISCUSSION

The psychometric properties of the Danish translation are equal to or better than those reported for the United States study. Differences in mean scores or most subscales point to the need to create Danish profiles for scoring.

CONCLUSIONS

The Danish version of the EITQ has acceptable reliability and is ready for use in Denmark.