Effectiveness of cognitive rehabilitation for people with multiple sclerosis: a meta-synthesis of patient perspectives

While previous randomised controlled trials and meta-analyses offer only limited evidence for the effectiveness of cognitive rehabilitation, qualitative studies examining patient perspectives report more positive outcomes. This meta-synthesis of qualitative studies examined patient perspectives of cognitive rehabilitation for memory, attention, and executive function problems in people with multiple sclerosis. Using set eligibility criteria, we screened electronic databases, reference lists, and academic networks for relevant papers. Seven papers (195 participants) were selected. Two independent researchers conducted quality appraisals of papers. Data analysis, guided by the thematic synthesis approach, yielded six main themes. These suggested that patients benefitted from the group environment in rehabilitation. Cognitive rehabilitation facilitated the participants’ reflection and awareness of their cognitive deficits, and was associated with increased knowledge and understanding of their illness. Increased strategy use was reported and associated with improvements in cognitive functioning and greater confidence and perseverance. Participants reported emotional and social improvements, and felt more optimistic. Overall, these changes had a positive impact on participants’ quality of life. This synthesis of qualitative studies indicates that people with multiple sclerosis who experience cognitive deficits benefit from cognitive rehabilitation programmes. This finding must, however, be viewed in light of the limitations of this meta-synthesis. The meta-synthesis was registered in the PROSPERO database under CRD42017040148.     

A systematic review and meta-synthesis of qualitative studies that investigate the emotional experiences of staff working in homeless settings

Homelessness is a pervasive issue in society, and government policies have highlighted the need to focus on the experience of front-line staff in homelessness settings. The aim of this meta-synthesis was to draw together the available research to further understanding of the experiences of staff working with homeless people. A systematic search was conducted across four electronic databases (ASSIA, PsycInfo, Sociological Abstracts and Web of Science) from the date of their inception. Qualitative research exploring the emotional experiences of staff working in homeless settings was identified. Identified studies were subject to quality assessment, and the data were synthesised using meta-ethnography. Ten studies were included in the synthesis following screening of 228 titles, 92 abstracts and 33 full texts. The concepts that were obtained from the analysis were building quality relationships, negotiating boundaries, carrying the emotional burden (self and others), accessing care and support (self-care and from others), individual advancement, advocating and contextual helplessness. An overarching theoretical construction of the internal experiences of support staff in managing the demands of the role along with their own needs was developed. This theory may provide the basis for testable hypotheses in future research and inform the development of support and training opportunities for staff working within homelessness settings.     

中国癌症患者家庭照护者照护经历的质性Meta整合

背景随着中国人口老龄化的加深与癌症发病率的不断攀升,癌症患者的照护需求也随之增加,家庭照护是其中重要的一个方面。照护行为和经历会给家庭照护者带来不同层面的影响,因此系统且全面地对中国癌症患者家庭照护者的照护经历和体验进行研究是极其必要的。目的系统整合与评价中国癌症患者家庭照护者的照护经历与体验。方法2021年1—5月,系统检索Web of Science、PubMed、EmBase、Medline、Cochrane Library、Grew Literature in the Health Sciences、中国知网（CNKI）和万方数据知识服务平台中与中国癌症患者家庭照护者经历有关的质性研究,检索时限为建库至2021-05-23。采用2016版澳大利亚乔安娜布里格斯研究所（JBI）循证卫生保健中心质性研究质量评价标准对文献质量进行评价,纳入符合标准的质性研究,并采用质性Meta整合的方法对所有纳入研究的结果进行综合分析。结果最终纳入符合要求的质性研究19篇（中文6篇和英文13篇）,共计295例研究对象（家庭照护者）。其中,9篇文献质量评价结果为A级,偏倚风险很低;10篇评价结果为B级,偏倚风险较低。通过对19篇文献的研究主题进行整合分析,归纳整合为3个一级主题和15个二级主题,3个一级主题分别为以患者为中心的照护需求、照护的负担和照护的正向积极作用。结论通过对中国癌症患者家庭照护者照护经历的质性Meta整合,深入、全面地呈现了中国癌症患者家庭照护者的经历。本研究的结果能够助力完善满足以患者为中心的照护需求的医疗体制建设;在微观、中观和宏观层面加强影响照护经历的积极因素,并且进行死亡和生命教育等干预措施来减轻文化因素对照护经历的负面影响。     

护士亲历患者自杀事件后真实体验质性研究的Meta整合

目的 系统评价护士亲身经历患者自杀事件后真实体验的质性研究,为设计有效的应对策略提供依据.方法 检索Cochrane Library、Ovid、中国知网等数据库中护士亲历患者自杀后的质性研究.采用澳大利亚JBI循证卫生保健中心质性研究质量评价标准对纳入文献的方法学进行质量评价,依据其汇集性整合方法进行结果整合.结果 共...     

The current state of the center for the creation and dissemination of new Japanese nursing science: The 21st century Center of Excellence at Chiba University School of Nursing

Aim: The Center of Excellence for the Creation and Dissemination of a New Japanese Nursing Science at Chiba University School of Nursing is now in its third year of operation. This center aims to develop nursing science that is appropriate for Japanese culture and to internationally disseminate the importance of culturally based care. Our project seeks to systematically transform the art of nursing practise into a nursing science. Method: To date, multiple frameworks have been created through the qualitative meta‐synthesis of research on effective nursing care. To create a nursing science, these frameworks derived from meta‐synthesis must be verified and internalized in nursing practise. Results: After three years of research, the following findings are emerging: professional care relationships in nursing practise in Japan are characterized by the bidirectional process between the nurse and the client, in which both gradually undergo a transformation in order to establish a collaborative, therapeutic relationship; Japanese nurses emphasize the importance of understanding adolescent clients’ subjective understanding of their own life with self‐care, as well as social support; and the priority for community health nurses in Japan is to create support systems in the community, regardless of whether the intended client is an individual, a family, a specific group, or the community as a whole. Conclusions: Our future efforts will focus on verifying our findings through interdisciplinary and international comparative research and by integrating various frameworks in order to create a new Japanese nursing science.     

Role development and effective practice in specialist and advanced practice roles in acute hospital settings: systematic review and meta-synthesis

AIMS: This paper reports a study whose aim was to identify and synthesize qualitative research studies reporting barriers or facilitators to role development and/or effective practice in specialist and advanced nursing roles in acute hospital settings. BACKGROUND: The number of clinical nurse specialist, nurse practitioner, advanced nurse practitioner and consultant nurse roles has grown substantially in recent years. Research has shown that nurses working in innovative roles encounter a range of barriers and facilitators to effective practice. METHODS: Systematic literature searches were undertaken, and relevant studies identified using specific inclusion and exclusion criteria. The selected studies were appraised, and their findings synthesized using Ritchie and Spencer's 'Framework' approach. RESULTS: Fourteen relevant studies were identified, mostly from the UK. They described a range of barriers and facilitators affecting specialist and advanced nursing practice. These related to the practitioner's personal characteristics and previous experience, professional and educational issues, managerial and organizational issues, relationships with other health care professionals, and resources. The factors most widely identified as important were relationships with other key personnel, and role definitions and expectations. CONCLUSIONS: Relationships with other staff groups and role ambiguity are the most important factors which hinder or facilitate the implementation of specialist and advanced nursing roles. These factors seem interlinked, and the associated problems do not appear to resolve spontaneously when staff become familiar with the new roles. In order to reduce role ambiguity and the consequent likelihood of negative responses we recommend that, when specialist and advanced nursing roles are introduced, clear role definitions and objectives are developed and communicated to relevant staff groups; these definitions and objectives should be updated as necessary.     

Spousal experiences of coping with and adapting to caregiving for a partner who has a stroke: a meta-synthesis of qualitative research

Abstract

Purpose: This meta-synthesis was conducted to explore qualitative spousal accounts of coping and adaptation to caregiving when their partner experienced a stroke. Method: Electronic databases were searched systematically and inclusion and exclusion criteria were applied. The meta-synthesis was conducted using guidance from Sandelowski and Barroso to extract salient data relating to coping and adaptation. Results: Twelve papers were identified for inclusion and seven themes resultant themes were extracted: Seeking information; Searching for own space and well-being; Suffering in silence; Putting one’s own needs aside; Adapting to a changed role; Social support and Hope and Optimism: instilling a positive focus. Conclusions: The findings suggested spouses adopt a range of adaptive coping strategies although several barriers to these were also identified and discussed in relation to a number of clinical implications. The limitations of this meta-synthesis were discussed, together with recommendations for future research.

• Implications for Rehabilitation

• Respite care for partner-carers is important for their well-being and there is a need to improve the availability and quality of such provision.

• It is important to provide stroke-related information and training in practical care tasks, preferably before their partner is discharged home from hospital, in order to avoid leaving spouses feeling vulnerable and unprepared.

• The positive adapting mechanisms identified within this review can be drawn on by clinicians to inform their interactions with stroke spousal carers and to advise them in strategies which have helped their counterparts.

     

Qualitative meta-synthesis: a question of dialoguing with texts

AIMS: This paper discusses whether useful synthesis of research reports across different qualitative methodologies is possible, and whether qualitative meta-synthesis violates the tenets of the interpretive paradigm. BACKGROUND: Qualitative meta-synthesis is a recent development in qualitative inquiry that offers a means of enhancing the contribution of qualitative findings to the development of more formalized knowledge. However, there are a number of unanswered questions and areas that require debate. DISCUSSION: A brief overview of qualitative meta-synthesis as a method of inquiry is presented. The assumptions of phenomenology, ethnography and grounded theory are explored for their amenability to meta-synthesis and the possibility of coherent synthesis of findings across these methodologies. In addition, a summary of major philosophical commitments common to the interpretive paradigm is presented. Qualitative meta-synthesis as a methodology is then explored for its fit within this paradigm. An argument is made, with some caveats, for synthesis across qualitative methodologies. Gadamer's concepts of the hermeneutic circle, the fusion of horizons, and dialogue with the text are explored for the insight they provide into the place of qualitative meta-synthesis in inquiry. CONCLUSION: It is important for researchers to bring hermeneutic skill to the process of meta-synthesis in order to develop a comprehensive understanding of the various philosophical assumptions in which qualitative approaches are based. The particular challenge of combining analysis and interpretation from studies with markedly different approaches and intentions may prompt synthesists to create new and innovative approaches to the presentation of meta-synthesis.     

Meta-synthesis of presence in nursing

AIM: This paper reports a meta-synthesis of the concept of presence. BACKGROUND: Presence is a complex concept that is vague and poorly defined. It is often confused with other concepts such as caring, empathy, therapeutic use of self, support and nurturance. Adding to this confusion is the fact that presence has been fragmented into numerous types, used indiscriminately and combined with other concepts such as caring. METHOD: The nursing literature was searched using the cinahl, Dissertation Abstracts and Missouri Bibliographic Information User System databases and the keywords presence, concept analysis, qualitative studies, grounded theory, phenomenology and ethnography. The reference lists of the sources were also scrutinized. Four linguistic concept analyses and 14 qualitative studies of presence were identified and a meta-analysis was conducting using these. FINDINGS: Presence is an interpersonal process that is characterized by sensitivity, holism, intimacy, vulnerability and adaptation to unique circumstances. It consists of a process in which patients demonstrate a need for and openness to presence. In turn, nurses must be willing to enact presence and practice within an environment that is conducive to it. Nurses must also possess personal and professional maturity and base their practice on moral principles of commitment and respect for individual differences. The process results in enhanced mental well-being for nurses and patients and improved physical well-being for patients. In keeping with the nature of a process, the consequences of presence go on to influence its future enactment. CONCLUSION: Advanced concept analysis methods should be used to further explicate presence and differentiate it from other nursing constructs. Until this is done, scholars are cautioned against parsing the term and combining it with vaguely defined nursing concepts such as caring. Researchers are urged to consider how presence can be preserved using tele-health technology and in time-sensitive healthcare settings.     

成年癌症患者生育力保存决策体验质性研究的Meta整合

目的 系统整合癌症患者生育力保存决策体验的质性研究,为辅助癌症患者做决策及改进现有决策支持体系提供循证依据。方法 计算机检索PubMed、EMbase、The Cochrane Library、CINAHL、Web of Science、PsycINFO、Scopus、中国知网、万方数据库、维普数据库关于癌症患者生育力保存决策的质性研究,检索时限为建库至2022年8月。采用JBI循证卫生保健中心质性研究质量评价标准对文献进行质量评价,采用Meta整合中汇集性整合方法对结果进行整合。结果 共纳入18篇文献,提炼出67个研究结果,将相似结果归纳成7个新的类别,并综合成3个整合结果：对生育力保存风险-收益的艰难权衡,紧迫决策下复杂的心理变化过程,决策过程的干扰。结论 医护人员及相关卫生机构应重视癌症患者生育力保存决策的心理体验和信息需求,优化决策程序、开发决策辅助方案,促进患者尽快完成决策。