Informal caring for stroke survivors: Meta-ethnographic review of qualitative literature

Stroke is a very common cause of adult disability often leaving stroke survivors dependent on others. Much of this support comes from informal carers. Research has demonstrated the importance of these carers to survivors’ recovery but also suggests that caregiving has adverse consequences. Meta-ethnography was applied to review qualitative research looking at informal stroke carers’ experiences and responses to caring. Electronic databases from 2006 to 2009 were searched and after application of inclusion and exclusion criteria, seven studies were reviewed.     

The work undertaken by mechanically ventilated patients in Intensive Care: A qualitative meta-ethnography of survivors’ experiences

BackgroundMechanical ventilation is a routine intervention for the critically ill but patients’ experiences of this intervention are largely hidden from clinicians. A comprehensive understanding of Intensive Care Units survivors’ accounts is required to provide health professionals with evidence about the patients’ experience to deliver patient-centred care.ObjectivesTo synthesise qualitative findings from international studies to understand Intensive Care Unit survivors’ experiences of mechanical ventilation, clarify the components of patient-centred care from the patient perspective and understand what can be done by health professionals to improve care processes.DesignA meta-ethnography of qualitative evidence following ENTREQ recommendations for reporting systematic reviews.Data sourcesEight databases (MEDLINE, AMED, CINAHL, PsychINFO, Scopus, WileyOnline, PubMed Central, TRIP) were systematically searched using a piloted strategy described in a published protocol. Searches were completed on 31.8.16 and no date restrictions were placed. Searches were updated on 25.4.17.Review methodsTwo researchers independently reviewed studies against pre-determined inclusion criteria to assess their eligibility. Studies were included if they reported on the adult patient experience of mechanical ventilation and used qualitative data collection and analysis methods. All included studies were quality appraised. Participant quotes and concepts, described within the categories and themes of published studies, were extracted by one reviewer and coded by two reviewers. A process of constant comparison, which is central to meta-ethnography, facilitated the re-interpretation of data by a team of researchers to generate the final qualitative synthesis. The Enhancing Transparency in Reporting the Synthesis of Qualitative (ENTREQ) statement was used to ensure that all synthesis stages were comprehensively reported.ResultsFindings from 38 studies, with 608 participants, informed a patient-centred trajectory model; three overlapping stages; alienation, hidden work and recovery characterised the experiences of mechanical ventilation survivors. Health professionals could positively influence the patient experience by promoting ‘trust’ and being vigilant so that patients felt ‘safe’. Care provision that promoted ‘personalisation’ helped participants to retain their identity as unique human beings.ConclusionsFor the first time the pooling of qualitative findings from international studies, using meta-ethnography, has provided a patient-centred model of mechanical ventilation survivors’ experiences of their care processes. Patients may actively engage or passively endure the treatment burden associated with mechanical ventilation.     

母亲经历围产儿死亡事件体验的系统评价

目的 系统评价母亲经历围产儿死亡事件的体验。方法 计算机检索中国知网、万方、VIP、PubMed、Web of Science、Medline、Wiley、EMbase数据库从建库至2020年3月有关母亲经历死产和围产儿死亡事件体验的质性研究,对文献进行质量评价后,采用Noblit和Hare's的Meta民族志方法对研究文献进行分析归纳。结果 纳入研究文献16篇。提炼出一个核心概念"母亲在痛苦的绝望中寻求新希望",基于以下4个主题,无声痛苦：母亲承受巨大的身心压力,负性情感突出;寻找出路：母亲通过应对策略抵御内心的痛苦;重建世界：母亲生活的改变与成长;未来曙光：母亲渴望得到尊重与照顾,对未来充满希冀。结论 医务人员应充分认识到围产儿的死亡不仅仅是医学问题,更是社会问题。应关注母亲心理变化,重视对母亲的情感支持,促进母亲生活重建。     

Vaginal practices as women's agency in sub-Saharan Africa: a synthesis of meaning and motivation through meta-ethnography

This paper reports on a systematic review of qualitative research about vaginal practices in sub-Saharan Africa, which used meta-ethnographic methods to understand their origins, their meanings for the women who use them, and how they have evolved in time and place. We included published documents which were based on qualitative methods of data collection and analysis and contained information on vaginal practices. After screening, 16 texts were included which dated from 1951 to 2008. We found that practices evolve and adapt to present circumstances and that they remain an important source of power for women to negotiate challenges that they face. Recent evidence suggests that some practices may increase a woman's susceptibility to HIV and other sexually transmitted infections. The success of new female-controlled prevention technologies, such as microbicides, might be determined by whether they can and will be used by women in the course of their daily life.     

Parents’ experiences of transitioning to home with a very-low-birthweight infant: A meta-ethnography

Medical-technological advances and neurodevelopmental care have improved the survival of extremely- and very-low-birthweight infants born before 32 weeks' gestation. After months in neonatal care, the infants are discharged, and parents exited but full of anxiety. This review is designed as a meta-ethnography, addressing parents' discharge experiences to comprehend the synthesised research, which includes 12 eligible studies. From the analysis, we constructed three themes: ‘approaching discharge with both uncertainty and confidence’; ‘discharge as a longed-for though disordering turning point’; and ‘facing joys, worries and multiple challenges when at home’. The overarching interpretation was ‘discharge as double-edged sword’. We conclude that bringing home very-low-birthweight infants is a joyful event, yet parents also experience discharge as never-endingly worrying, as a time filled with challenges to which parents must adapt and as necessitating continuous support from knowledgeable providers.     

Working with interpreters in health care: A systematic review and meta-ethnography of qualitative studies

Objective

To identify relational issues involved in working with interpreters in healthcare settings and to make recommendations for future research.

Methods

A systematic literature search in French and English was conducted. The matrix method and a meta-ethnographic analysis were used to organize and synthesize the data.

Results

Three themes emerged. Interpreters’ roles: Interpreters fill a wide variety of roles. Based on Habermas's concepts, these roles vary between agent of the Lifeworld and agent of the System. This diversity and oscillation are sources of both tension and relational opportunities. Difficulties: The difficulties encountered by practitioners, interpreters and patients are related to issues of trust, control and power. There is a clear need for balance between the three, and institutional recognition of interpreters’ roles is crucial. Communication characteristics: Non-literal translation appears to be a prerequisite for effective and accurate communication.

Conclusion

The recognition of community interpreting as a profession would appear to be the next step. Without this recognition, it is unlikely that communication difficulties will be resolved.

Practice implications

The healthcare (and scientific) community must pay more attention to the complex nature of interpreted interactions. Researchers need to investigate how relational issues in interpreted interactions affect patient care and health.     

Turning points,identity, and social capital: A meta-ethnography of methamphetamine recovery

BackgroundDespite the increasing prevalence and distinct nature of methamphetamine-related harms, treatment models are limited, and relapse is common. Meta-ethnography has been increasingly used to synthesise qualitative health research and develop new concepts or theories. This meta-ethnography aimed to explore methamphetamine users’ experiences of cessation, recovery, and relapse, to better understand how to tailor support for this population.MethodsA systematic review was conducted of six electronic databases, supported by hand searches of leading journals and reviews of reference lists. Reports were included that used naturalistic participant observation to examine methamphetamine cessation, recovery, and relapse with at least 50% of their sample. The life course approach to drug use was used to inform the process of data analysis and interpretation. The final sample was synthesised using Reciprocal Translation supported by open and axial coding.ResultsNineteen sources were selected, thirteen of which were conducted in the United States. Two themes were identified: methamphetamine users are exposed to a range of relapse triggers, but also triggers for recovery, and their susceptibility to these triggers is largely determined by their social environment; and the process of recovery requires changes in personal and social identity which can be a barrier to recovery for some users.ConclusionThese findings present the concept of recovery triggers and highlight the role of wider risk environments in determining methamphetamine recovery, and the negative potential of social capital. These themes also address the ongoing debate regarding the agency of drug users, and the impact of this debate on drug user’s experiences of recovery.     

Non-adherence with compression garment wear in adult burns patients: A systematic review and meta-ethnography

ObjectiveUp to 40% of adult burn-injured patients are non-adherent with prescribed compression garment wear. The aim of this paper is to systematically review the literature to understand barriers to adherence with compression garment wear.MethodPapers were included if they: investigated adults who required compression garment wear for the management of burns scars; focussed on reasons for non-adherence to compression garment wear; and were available in English. The process of meta-ethnography was then followed to synthesise the findings.ResultsThe factors impacting adherence to compression garment wear were grouped into six themes: sensory factors, psychological state, the impact of the garment on the patient’s function, the availability of social support, the degree of choice, and the education provided to patients by their therapists. A model of compression garment adherence was developed detailing how these factors fit within the continuum of treatment for a burn-injured patient.ConclusionsAdherence to compression garment wear post-burn injury is a complex, dynamic phenomenon impacted by a range of factors. Findings from this review may inform approaches to support more consistent and/or extended garment wear, potentially improving scar outcomes and quality-of-life. Further research is recommended to investigate how each of the six identified themes impact adherence.