Newly graduated nurses’ orientation experiences: A systematic review of qualitative studies

ObjectiveThis systematic review describes the experiences of the orientation into nursing of newly graduated nurses.DesignSystematic review.MethodsData was collected from five databases: Medic, EBSCO Cinahl, Scopus, PsycARTICLES and ERIC (ProQuest). Qualitative, peer reviewed, original studies published in English, Swedish or Finnish before February 2016 and exploring newly graduated nurses’ experiences of the nursing orientation process were included. The studies were selected by screening titles, abstracts and full texts and the quality of the studies was assessed by two researchers independently. Data was analysed using content analysis.ResultsThirteen studies were chosen for the review. Newly graduated nurses’ orientation experiences were divided into four main categories: experiences related to orientation arrangements; experiences related to the preceptor; experiencing role transition during the orientation and suggestions for changes based on orientation experiences. The findings establish that the orientation and the preceptor have a great impact on how newly graduated nurses experience the start of their career. Often, newly graduated nurses wish to continue their relationship with their preceptor after the orientation period.ConclusionsResults bring together both the positive and negative aspects that newly graduated nurses relate as regards their current orientation programmes. Attention needs to be paid to the variation and imbalance in the quality of orientation programmes and preceptors. A more formal form of mentorship needs to be developed further.     

Critical care nurses’ experiences of withdrawal of treatment: A systematic review of qualitative evidence

BackgroundDeath and dying is a reality of the clinical context of the intensive care unit. Death often follows a decision to withdraw life-sustaining treatments. Critical care nurses, are the primary care providers to patients and families at the end-of-life in the intensive care unit.ObjectiveTo synthesize qualitative evidence on the experiences of critical care nurses who have cared for patients and families throughout the process of withdrawal of life-sustaining treatment.MethodsThis was a systematic review and qualitative evidence synthesis modeled on the Joanna Briggs Methodology. Pre-defined keywords were searched for in Medline, CINAHL, PsycInfo, and Web of Science to locate studies published in the English, French, and Greek languages in any year. Two reviewers independently screened articles for congruence with eligibility criteria, engaged in data extraction, and assessed quality of the included studies. Meta-aggregation was performed to synthesize the findings. A protocol was developed by two members of the review team prior to initiation of the study.ResultsThirteen studies were included in the review, 12 qualitative and one mixed-methods. Four key themes were identified from the original research: Navigating Complexity and Conflict; Focusing on the Patient; Working with Families; and Dealing with Emotions Related to Treatment Withdrawal. Critical care nurses provide care to patients and families during the process of withdrawal of life-sustaining treatment which is described as complex and challenging. Despite the inherent challenges, nurses strive towards doing their utmost for patients and families.     

Midwives’ and health visitors’ collaborative relationships: A systematic review of qualitative and quantitative studies

ObjectivesInterprofessional collaboration between midwives and health visitors working in maternal and child health services is widely encouraged. This systematic review aimed to identify existing and potential areas for collaboration between midwives and health visitors; explore the methods through which collaboration is and can be achieved; assess the effectiveness of this relationship between these groups, and ascertain whether the identified examples of collaboration are in line with clinical guidelines and policy.DesignA narrative synthesis of qualitative and quantitative studies.Data sourcesFourteen electronic databases, research mailing lists, recommendations from key authors and reference lists and citations of included papers.Review methodsPapers were included if they explored one or a combination of: the areas of practice in which midwives and health visitors worked collaboratively; the methods that midwives and health visitors employed when communicating and collaborating with each other; the effectiveness of collaboration between midwives and health visitors; and whether collaborative practice between midwives and health visitors meet clinical guidelines. Papers were assessed for study quality.ResultsEighteen papers (sixteen studies) met the inclusion criteria. The studies found that midwives and health visitors reported valuing interprofessional collaboration, however this was rare in practice. Findings show that collaboration could be useful across the service continuum, from antenatal care, transition of care/handover, to postnatal care. Evidence for the effectiveness of collaboration between these two groups was equivocal and based on self-reported data. In relation, multiple enablers and barriers to collaboration were identified. Communication was reportedly key to interprofessional collaboration.ConclusionsInterprofessional collaboration was valuable according to both midwives and health visitors, however, this was made challenging by several barriers such as poor communication, limited resources, and poor understanding of each other’s role. Structural barriers such as physical distance also featured as a challenge to interprofessional collaboration. Although the findings are limited by variable methodological quality, these were consistent across time, geographical locations, and health settings, indicating transferability and reliability.     

Men’s experiences after prostatectomy: A meta-synthesis

ObjectiveThe purpose of this review was to critically analyze, interpret, and synthesize the literature on men’s experiences after prostatectomy.DesignA meta-synthesis was conducted.Data sourcesSix databases (PubMed, EMBASE, CINAHL, PsycINFO, AgeLine, and Sociological Abstract) were searched from the earliest year to 2016. From initial searches with main keywords (prostatectomy and qualitative study), 642 abstracts were retrieved. Based on inclusion criteria (English-language published qualitative study focusing on the experience of men after prostatectomy), this meta-synthesis included 15 studies.Review methodsComponents of meta-study (meta-data-analysis, meta-method, and meta-theory) were employed to analyze, interpret, and synthesize the results of included studies. Three authors independently appraised the methodological quality of the included studies using a combined appraisal tool (The Critical Appraisal Skills Programme Qualitative Research Checklist and Paterson et al.’s Primary Research Appraisal Tool). The Enhancing Transparency in Reporting the Synthesis of Qualitative Research Statement was used to strengthen the completeness of reporting.ResultsFifteen studies met inclusion criteria and quality appraisal guidelines, however, most did not identify or relate their findings to theory. Through meta-synthesis, five themes emerged: facing a life-changing situation, experiencing changes and their impact, striving to manage and adjust to changes, coping with masculinity, and anticipating the future.ConclusionsAfter prostatectomy, men experienced physical, psychological, and social changes. Many men are physically and psychologically ill-prepared and suffer from lack of information and support. Health care providers need to be sensitive to men’s needs including perceptions of masculinity, realize the importance of support as an essential component of men’s adaptation post-prostatectomy, and provide comprehensive and individualized patient-centered interventions. Future studies need to use rigorous research methods, clearly identify methodological approaches, and consider employing or developing theory.     

Understanding informal carers’ experiences of caring for older people with a hip fracture: a systematic review of qualitative studies

Purpose: This systematic review aimed to reconceptualize experiences from a variety of papers to provide direction for research, policy and practice.

Method: Meta-ethnography was used to inform the review, and 21 studies were included.

Findings: The analysis identified a core theme of “engaging in care: struggling through”, as carers, who wanted to be involved in caring, learnt to live with the intense and stressful impact of caring and changes to their life. The core theme is represented through three themes (1) Helping another to live, (2) Adapting ways of living and (3) Negotiating the unknown.

Conclusions: The discussion identified a focus on carers of people suffering from a hip fracture, the willingness of informal carers to engage in caring and the intense experience of adapting to changes in relationships and dependency alongside a steep experiential learning curve. Tensions exist in negotiations with complex health care systems as carers do not feel their expertise is valued and struggle to find and understand information.

• Implications for Rehabilitation

• Including relatives/carers in the umbrella of care within a family-centred approach.

• Involving relatives/carers within shared decision-making about care requirements and rehabilitation goals.

• Utilizing forms of experiential learning to help the development of relatives/carers skills in relation to their role as carer.

• Providing opportunities for carers to explore ways of sustaining their own health through self-compassion.

     

Comparison of remicade to curcumin for the treatment of Crohn’s disease: A systematic review

ObjectiveThe aim of this study was to review the literature to assess if there is evidence to support the use of Curcumin as a safe complementary therapy in treating Crohn’s Disease (CD) in conjunction with Remicade.DesignSystematic searches were performed by three researchers using electronic databases (ProQuest Medical Library, CINAHL Complete, and PUBMED) to locate and identify articles to meet a predetermined set of inclusion criteria. Specifically full text, peer-reviewed articles published after 2007 were included if they studied human participants 18 years or older.ResultsTumor necrosis factor-alpha (TNF-a) and Interleukin-1 (IL-1) levels increase in CD patients. Remicade reduces TNF-a in adults with CD. The issues are eventual loss of response (LOR) once IL-1 increases, and severe risks such as malignancy. CD patients using Curcumin saw a 55 point mean reduction in the Crohn’s Disease Activity Index, reducing IL-1 and Crp. Plus it reduced TNF-a and PPMTase which improved colorectal cancer outcomes.ConclusionsLOR of Remicade occurs when IL-1 increases, and it can cause malignancy. Research shows Curcumin reduces IL-1 and improves cancer outcomes. Future research, using both Remicade and Curcumin, would have to be done, but preliminary data would suggest using both would reduce LOR. Curcumin, even by itself, was found to be a cheap and safe way to reduce CD symptoms and inflammatory markers.     

Nurses’ experiences of working in organizations undergoing restructuring: A metasynthesis of qualitative research studies

BackgroundHealth care organizations worldwide undergo continual reconfiguration and structural changes in order to optimize the use of resources, reduce costs, and improve the quality of treatment.ObjectiveThe objective of this study was to synthesize qualitative studies of how nurses experience working in organizations undergoing structural changes.DesignThe review is designed as a metasynthesis and follows the guidelines put forth by Sandelowski and Barroso for synthesizing qualitative research.Data sourcesFrom January to April 2015, literature searches were conducted in the CINAHL, PubMed, ProQuest, and Web of Science databases for the period from 1994 to 2014.Review methodsA total of 762 articles were found and screened, 12 of which were included in the review after being appraised using a specially designed reading guide. The inclusion criteria were qualitative studies in English, German, Norwegian, Swedish, or Danish on nurses’ experiences with being employed in organizations undergoing structural changes. The data were then analyzed in a metasummary and metasynthesis.ResultsFour overall categories that illustrate how nurses experience working in organizations undergoing structural changes were identified: nursing management, emotional responses, nursing work, and colleagues. Generally, nurses seemed to describe their experiences working in organizations undergoing structural changes in a negative way, as all of the included articles reported that nurses experience an increased workload due to restructuring. However, some of the articles reported that nurses also experience a certain joy associated with the nursing work despite the negative consequences of the structural changes.ConclusionsThe findings can be seen as a paradox because former research has shown that an increased workload reduces the pleasure in working. Further research on this topic is needed to ensure a better working environment for nurses.     

Effects of yoga on eating disorders—A systematic review

BackgroundThe question of whether yoga practice ameliorates or even aggravates eating disorders is currently under debate. The aim of this review was to systematically assess and the effectiveness and safety of yoga in patients with eating disorders.MethodsMedline/PubMed, PsycINFO, and the Psychological and Behavioral Science Collection were screened through July 2018 for randomized controlled trials, non-randomized controlled trials and longitudinal observational studies on yoga for patients with eating disorders and other individuals with disordered eating and/or body dissatisfaction. Risk of bias was assessed using the Cochrane risk of bias tool and the Newcastle-Ottawa Quality Assessment Scale.ResultsEight randomized trials and four uncontrolled trials involving a total of 495 participants were included. Risk of bias was mixed. Comparing yoga to untreated control groups, effect sizes ranged from negligible effects of d = 0.02 to very large effects of d = 2.15. However, most effects were small to moderately sized and in most cases not significant. No safety-related data were reported.ConclusionsThere is limited evidence on the effectiveness and safety of yoga in patients with eating disorders. Yoga can be preliminarily considered as an additional treatment option in multimodal psychiatric treatment programs.     

Indigenous peoples’ experiences and perceptions of hospitalisation for acute care: A metasynthesis of qualitative studies

ObjectiveThe objective of this study was to explore Indigenous people’s experiences and perceptions of hospitalisation and acute care.MethodsSystematic procedures were used for the literature search covering the period from 2000 to 2016. Final search was conducted in early September 2016. Quality of the selected studies was assessed using the Critical Appraisal Skills Program. Data extraction was conducted using the data extraction tool from the Joanna Briggs Institute. A thematic approach to synthesis was taken. Statements were assembled to produce aggregated data of the findings, which were then categorised based on similarity of meaning, and the categories were used to produce comprehensive synthesised findings.Data sourcesThe literature search was conducted in the following databases: Cumulative Index to Nursing and Allied Health Literature, Google scholar, Medline, Psychology and Behavioural Sciences, and PsycINFO. Manual searches of the International Journal of Indigenous Health, Menzies website and references of reviewed papers were also conducted. Inclusion criteria were qualitative articles, published in English from across the world, in peer-reviewed journals, that investigated acute health care experiences of Indigenous people.Review methodsA metasynthesis of qualitative research studies was conducted following Joanna Briggs Institute guidelines.FindingsA total of 21 primary studies met the inclusion criteria. Three themes emerged from the metasynthesis: Strangers in a strange land; Encountering dysfunctional interactions; and Suffering stereotyping and assumptions. These themes emphasised the importance of meaningful relationships for Indigenous people and highlighted their cultural marginalisation in hospital settings.ConclusionThe findings indicate that healthcare experiences of Indigenous patients and their relatives in acute settings can fall well short of their expectations and needs. It behoves healthcare professionals to firstly be aware of such discrepancies, and secondly to implement strategies that enable inclusive and individualised care.     

Lived experience of a child’s chronic illness and death: A qualitative systematic review of the parental bereavement trajectory

Abstract

To understand the lived experience of parents who have lost their child to a chronic life-limiting condition, six major databases were searched by adhering to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Articles were screened for appropriateness using the Sample, Phenomenon of Interest, Design, Evaluation, Research type tool, and relevant qualitative studies were selected for full-text data analysis using Thematic Synthesis. Findings were categorized into 13 themes that were further organized into a four-phase trajectory of parental bereavement experience of child loss, namely: Liminal Margin, Holding Space, Navigating Losses, and Reconstructing Lives. The findings are discussed in the light of existing literature with practical recommendations for enhancing parental bereavement support services.     

Patients’ and healthcare professionals’ experiences and perceptions of physiotherapy services in the emergency department: a qualitative systematic review

Background

Worldwide, emergency department (ED) attendances and admissions to acute care have increased significantly. Many EDs are adding physiotherapists to their team thereby allowing doctors to see more cases that are ‘urgent’. This is a move away from the ‘traditional’ physiotherapy service whereby the ED team refers patients to an outpatient physiotherapy service sometimes resulting in significant delays. Internationally, there is no agreed consensus on the role or value of ED-based physiotherapists.

Aim

The objective of this review was to retrieve, critically appraise and synthesise the evidence from studies relating to patients’ and healthcare professionals’ experiences and/or perceptions of physiotherapy services in the ED.

Method

This is a systematic review (SR) synthesising qualitative studies, which have considered patients’ (population 1) and healthcare professionals’ (population 2) experiences and/or perceptions (outcomes) of ED physiotherapy services (exposure). A comprehensive systematic search, limited to English language articles, was undertaken on seven electronic medical databases (Medline, EMBASE, CINAHL, AMED, BNI, PubMed and PEDro) for the period January 2006 to October 2016. Grey literature was identified using Google Scholar, reference lists and website searching. The Critical Appraisal Skills Programme (CASP) qualitative checklist was used to appraise all included studies. All studies were data extracted and quality appraised by two reviewers to enhance rigour and reduce bias.

Results

A total of 2163 studies were screened, 10 received full-text review and 7 studies were included in the final review. Six of the studies originated in Australia and one from the USA. The themes that emerged were as follows:

• Patients and healthcare professionals view ED-based physiotherapists as having (1) expert clinical skills and (2) an educational role.
• There is role confusion and lack of integration of the ED-based physiotherapist within the ED team.

Conclusion

This review adds an in-depth human perspective to the current ED physiotherapy literature, which provides insight into how ED healthcare services and physiotherapy services specifically should be developed and delivered in the future. The knowledge from this review has implications for future education programmes, as well as development of both new care pathways and physiotherapy clinical roles.Research into ED-based physiotherapy services is predominantly quantitative. Despite the newness of the ED physiotherapy role, this review reveals that the provision of physiotherapists within EDs contributes value to both patients and staff. However, the dominance of Australian research means it is uncertain how it translates to the UK or elsewhere. There needs to be further UK-based research.

     

A child’s admission to hospital: a qualitative study examining the experiences of parents

Aims To compare the experiences of parents and children during inpatient admission to either a paediatric intensive care unit (PICU) or a general paediatric ward (GPW) with a specific focus on identifying factors which may influence psychological outcome.Methods Semi-structured qualitative interviews of 20 parents whose children had been admitted to hospital. Cases were sampled purposively to ensure representation of both groups (PICU and GPW admissions). Interviews were tape recorded, transcribed and subjected to a thematic analysis.Results The experiences of parents were explored with regard to illness onset, admission to PICU or GPW and the discharge period. In the PICU group, the sources of stress differed according to the stage: at onset, they were mainly related to their childs illness; during admission, concerns were focused on their childs appearance; finally, on discharge, possible relapse of the illness, impact of the admission on the child and family and the lack of clear follow-up were the central themes. In the GPW group, parents reported similar themes but with lower levels of associated stress. Both groups identified good communication with the medical team and opportunities for participation as helpful in reducing stress.Conclusions Admission to hospital is stressful for parents particularly if the child is admitted to PICU. Hospital staff should enhance communication with parents and maximise opportunities for parental participation in the childs treatment. Such interventions may reduce parents experience of stress during the admission and have the potential to improve psychological outcome.     

Factors that influence father’s experiences of childbirth and their implications upon postnatal mental health: A narrative systematic review

AimTo explore factors that influence fathers’ experiences of childbirth and implications for their subsequent postnatal mental health.BackgroundFathers who attend the birth of their baby often have very rewarding experiences. However, those who witness a difficult birth may progress to develop subsequent mental health problems, e.g., trauma symptoms that can affect future relationships with partner and infant.MethodA narrative systematic review of literature was carried out. Two overarching themes were identified, each with 3 underpinning sub-themes: (1) Interpersonal relationships with maternity care professionals; (1b) Communication; (1b) Feeling isolated during labour; (1c) Being prepared; (2) The aftermath; (2a) Support provision; (2b) Effects on relationships; (2c) Psychological trauma.ConclusionsFindings emphasise that good communication between fathers and midwives is a fundamental part of providing excellent care before, during and post-childbirth, as it can reduce partners’ feelings of isolation, improve their relationships and limit development and impact of psychological trauma.Recommendations for practiceIt is important to develop more on-line partner sites, parenthood education programmes and support groups, which include education about how to prevent, recognise, support and treat mental health complications. Also, further in-depth qualitative studies would enhance understanding of specific aspects of labour that traumatise fathers.     

Effectiveness and safety of acupuncture in the treatment of Parkinson’s disease: A systematic review and meta-analysis of randomized controlled trials

ObjectiveThis study aimed to examine the effectiveness and safety of acupuncture in the treatment of Parkinson’s disease (PD).MethodsEnglish, Chinese, and Korean electronic databases were searched up to June 2016. Randomized controlled trials (RCTs) were eligible. The methodological quality was assessed using Cochrane’s risk of bias tool. Meta-analysis was performed using RevMan 5.3.ResultsIn total, 42 studies involving 2625 participants were systematically reviewed. Participants treated using combined acupuncture and conventional medication (CM) showed significant improvements in total Unified PD Rating Scale (UPDRS), UPDRS I, UPDRS II, UPDRS III, and the Webster scale compared to those treated using CM alone. The combination of electroacupuncture and CM was significantly superior to CM alone in total UPDRS, UPDRS I, UPDRS II, and UPDRS IV. Similarly, the combination of scalp electroacupuncture, acupuncture, and CM was significantly more effective than CM alone in total UPDRS. However, our meta-analysis showed that the combination of electroacupuncture and CM was not significantly more effective than CM alone in UPDRS III, the Webster, and the Tension Assessment Scale. The results also failed to show that acupuncture was significantly more effective than placebo acupuncture in total UPDRS. Overall, the methodological quality of the RCTs was low. No serious adverse events were reported.ConclusionsWe found that acupuncture might be a safe and useful adjunctive treatment for patients with PD. However, because of methodological flaws in the included studies, conclusive evidence is still lacking. More rigorous and well-designed placebo-controlled trials should be conducted.     

The prevalence of post traumatic stress disorder in survivors of ICU treatment: a systematic review

Objective To determine the prevalence of post traumatic stress disorder in survivors of intensive care treatment. Design Systematic literature review including Medline, Embase, CINAHL, PsycINFO and references from identified papers. Study selection Studies determining the prevalence of PTSD in adult patients who had at least 24 h treatment on an intensive care unit. Independent duplicate data extraction. Study quality was evaluated in terms of study design and method and timing of PTSD assessment. Data synthesis and results Of the 1472 citations identified, 30 studies meeting the selection criteria were reviewed. PTSD was diagnosed by standardised clinical interview alone in 2 studies. A self-report measure alone was used in 19 studies to measure PTSD symptomatology. The remaining 9 studies applied both standardised clinical interview and a self-report measure. The reported prevalence of PTSD was 0–64% when diagnosed by standardised clinical interview and 5–64% by self-report measure. PTSD assessments occurred 7 days to 8 years after intensive care discharge. Conclusion The true prevalence of PTSD and the optimum timing and method of PTSD assessment have not yet been determined in intensive care unit survivors. Deficiencies in design, methodology and reporting make interpretation and comparison of quoted prevalence rates difficult, and rigorous longitudinal studies are needed. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users. Contributors: J. G. and J. D. Y. initiated the project. J. G. and V. B. searched, extracted, and analysed the data. J. G., V. B. and G. F. cross-checked the extracted data. All authors participated in discussing the results and in writing the paper. J. G. is the guarantor for the paper.     

Nursing students’ perceptions and experiences of reflective practice: A qualitative meta-synthesis

Reflective practice is a vital component of nursing education. It allows for the integration of core theoretical knowledge and the clinical experience. Despite a small and growing body of literature exploring the nursing students’ perceptions and experiences of this process, a review of the qualitative literature has not been published. The purpose of this meta-synthesis is to examine the qualitative data of nursing students’ perceptions and experiences of reflective practice. This meta-synthesis provides a model that suggests quality reflection results in an improvement in practice. Students perceive that quality reflection occurs when all facets of this model have been met. This encompasses an understanding of knowledge including, learning and the barriers and enablers to knowledge, as well as self-discovery including, facing emotions and personal growth. Understanding these experiences and perceptions will permit further understanding of the motivations and factors that influence the quality of reflective practice.     

Future nurses’ cultural competencies: what are their learning experiences during exchange and studies abroad? A systematic literature review

kokko r. (2011) Journal of Nursing Management 19, 673–682
Future nurses’ cultural competencies: what are their learning experiences during exchange and studies abroad? A systematic literature review Aim This article describes the development of cultural competence among nursing students. The focus is on illuminating the learning experiences of nursing students during their exchange. Background As the world gets smaller, the demand for culturally competent nurses increases. Future nurses need to be open-minded towards international cooperation and willing to develop the quality of care from a cultural point of view. Nursing education in many countries provides an option for students to learn nursing in different cultures while taking part of their studies abroad. Methods A systematic literature search was conducted. Inductive content analysis was applied to the data consisting of empirical studies (n = 7) describing nursing students’ studies abroad. Results The process of developing cultural competence among nursing students on exchange was found to consist of three main themes, namely: (1) an increased cultural knowledge base, (2) personal growth and (3) the impact of exchange experiences on the nursing student’s own practice. Conclusions Studies abroad are a beneficial strategy for the development of future nurses’ cultural competence. Implications for nursing management Nursing is facing a crucial challenge to recruit culturally competent nurses, because an increasing number of patients are from different cultures. Nurses with experiences of studying abroad can offer employers a resource through their preparedness for culturally competent nursing.