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Given the current rate of burnout and attrition among nurses and midwives globally, there is a need to understand the effectiveness of supportive strategies to help retain this workforce. Clinical supervision can help to ensure that nurses and midwives are supported and have the capacity to cope with their job demands. Yet there are no metasyntheses that provide a collective understanding of their experiences with clinical supervision. To synthesise the experiences of nurses and midwives who have accessed clinical supervision. A metasynthesis was conducted by systematically searching academic databases for relevant publications; assessing their quality using an established checklist; extracting and analysing qualitative content; and synthesising key findings about the experiences of nurses and midwives regarding clinical supervision. Themes and subthemes were identified from 12 papers, including: optimal logistics; support; safety and confidentiality; improving practice through reflection; and trust in the group. For clinicians to feel comfortable discussing their practice and workplace with the facilitator and colleagues, nurses and midwives needed to feel safe during clinical supervision and trust the process and their peers. Despite common difficulties of finding time for the sessions, clinical supervision can enhance collaboration and communication in the workplace. Clinical supervision that adheres to group rules can provide professional support within a safe, confidential space. Having trust in peers and facilitators at the sessions can help staff develop confidence, provide personal development and professional sustenance. [ABSTRACT FROM AUTHOR]

We conducted a qualitative metasynthesis of research focused on prompts used to elicit noticing following video observations within mathematics education. Forty-nine, peer-reviewed articles were selected based on specific criteria and analyzed using a defined approach to better understand the variations in the prompts mathematics teacher educators used as they supported teacher noticing. We also focused on research findings from articles with different types of prompts. Forty-five percent of articles included a general prompt and 55% a specific prompt. Findings based on articles in which authors used specific prompts reported the following: (a) video is a helpful tool to support the learning of noticing, (b) noticing is a skill that can be developed, (c) noticing ability differs between novice and expert teachers. Findings from articles with general prompts indicate the following: (a) teachers experienced a shift in noticing, (b) how teachers' noticed changed, (c) video selection is critical for influencing teacher noticing. [ABSTRACT FROM AUTHOR]

We conducted a qualitative metasynthesis of research focused on prompts used to elicit noticing following video observations within mathematics education. Forty-nine, peer-reviewed articles were selected based on specific criteria and analyzed using a defined approach to better understand the variations in the prompts mathematics teacher educators used as they supported teacher noticing. We also focused on research findings from articles with different types of prompts. Forty-five percent of articles included a general prompt and 55% a specific prompt. Findings based on articles in which authors used specific prompts reported the following: (a) video is a helpful tool to support the learning of noticing, (b) noticing is a skill that can be developed, (c) noticing ability differs between novice and expert teachers. Findings from articles with general prompts indicate the following: (a) teachers experienced a shift in noticing, (b) how teachers' noticed changed, (c) video selection is critical for influencing teacher noticing. [ABSTRACT FROM AUTHOR]

The experiences of women in low and middle-income countries following perinatal death remains difficult and challenging, thereby increasing their susceptibility to negative psychological impact particularly with insufficient bereavement care and support. Perinatal death invariably brings intense grief which significantly impacts women, and requires adequate bereavement care to limit negative outcomes in the short and long-term. To develop deeper understanding of women's experience of care and support following perinatal death in high burden settings. Six electronic databases were searched with relevant terms established using the SPIDER tool, supplemented by hand search of reference lists. Studies were independently screened for inclusion by all authors. Meta-ethnography (Noblit and Hare,1988) was used to synthesise existing qualitative studies. Eight studies conducted in Sub-Saharan African and South Asian countries namely South Africa, Uganda, Ghana, Kenya, India and Malawi were included, and three main themes were identified; mothers' reaction to their baby's death, care and support after perinatal death, and coping strategies in the absence of care and support. Perinatal death was not appropriately acknowledged therefore care and support was inadequate and, in some cases, non-existent. Consequently, mothers resorted to adopting coping strategies as they were unable to express their grief. There is insufficient care and support for women following perinatal death in high burden settings. Further research is required into the care and support being given by healthcare professionals and families in high burden settings, thereby ultimately aiding the development of guidance on perinatal bereavement care. [ABSTRACT FROM AUTHOR]

This research aims to find out the current situation of the articles in terms of teacher training in gifted and talented education. The key words used are as follows: "gifted education", "teacher training", "teacher education" and limited to publications between 2000-2020. In the research, google scholar, TUBITAK ULAKBIM Dergipark, Council of Higher Education Thesis Center, ERIC were used as data base of this research. The researches which are inaccessible were left out of the scope. Each of the studies was examined according to aim, sample, methodology, and results using content analysis technique. This research is a meta-synthesis study. Four master and five doctorate dissertations, 21 articles, 30 in total, were included in the analysis. An extensive literature review was the focus of this research in order to access all the researches including the defined key words. At the end of the research, some suggestions were presented related to the conclusions. [ABSTRACT FROM AUTHOR]

In the health care setting, and especially in cancer patients nearing the end of life, administrators, medical staff, patients, and families face challenges of a social, legal, religious, and cultural nature in the process of care. The present study aimed to perform a metasynthesis of qualitative studies conducted on providing end-of-life care for cancer patients. The present metasynthesis was conducted using Sandelowski and Barroso's method. A literature search was performed in PubMed, Scopus, Web of Science, and Embase databases, from the inception to date, and a total of 21 articles were identified as eligible for inclusion in the study. Critical Appraisal Skills Programme (CASP) criteria were used for assessing the articles, and data were analyzed by the subject review. Six themes were extracted for end-of-life care including psychological support, palliative support, educational-counseling support, spiritual support, preferential support, and supportive interactions, each comprising a number of categories. The most frequently mentioned categories were high-value care (67%) and adaptive acceptance (57%). The findings of this metasynthesis support the view that nurses are moral agents who are deeply invested in the moral integrity of end-of-life care involving assisted death. The present study showed that providing high-value care and facilitating adaptive acceptance are important constituents of a holistic strategy for providing end-of-life care to cancer patients. [ABSTRACT FROM AUTHOR]

Purpose To conduct a metasynthesis of qualitative research exploring parents' psychosocial experiences during complex and traumatic life transitions related to caring for a child with a life-limiting (LLI) or life-threatening illness (LTI). Background Parents' experiences of caring for a child impacted by an LLI or LTI are not clearly understood, and holistic, comprehensive pediatric nursing care for parents who have children with LLI and LTIs continues to be developed as treatment improves and survival is extended. Review Methods Predetermined inclusion and exclusion criteria were used to review qualitative studies. Those included were appraised, classified, and synthesized using systematic procedures guided by Sandelowski and Barroso (2006). Data Sources A systematic search of qualitative research was conducted by an experienced librarian to identify and retrieve studies from 10 databases. Results Of the 3515 studies screened, 23 were included. A synthesis of the findings demonstrated that parents experience profound and pervasive uncertainty, leading to their own illness experience being described as a dual reality in which fighting for survival and recognizing the threat of their child's death were daily challenges. Three key processes emerged: the devastation of living with uncertainty, the emergence of hope, and moving forward. Conclusion The integration of findings adds to the current body of knowledge by highlighting the very complex experiences that parents undergo. These findings can support a more comprehensive pediatric nursing plan of care that accounts for the intricacies of the parental experience and the importance of hope. [ABSTRACT FROM AUTHOR]

Purpose Preventive health care services provide an important opportunity to assist adolescents to establish and maintain a healthy lifestyle and assume an increasing independent role in their health care. National guidelines emphasize the importance of an annual wellness visit to identify and address risk-behaviors that contribute significantly to the morbidity and mortality in this population. Despite these recommendations, adolescents utilize preventive health care at declining rates throughout adolescence. The purpose of this study was to capture a more holistic view of what adolescents, as consumers of health care services, expect from their primary health care providers (HCPs). Method A metasynthesis of 12 qualitative research studies was conducted using Noblit and Hare's (1988) meta-ethnographic approach. Results Five overarching metaphors, Talk with Me- Not at Me, Accept Me, Respect My Privacy and Confidentiality, Show Me You Are a Professional, and A Trusted Relationship described adolescents' expectations of their HCPs. Conclusions This study provides a more holistic view of adolescents' expectations of their HCPs. Clinical strategies are suggested to assist HCPs to meet adolescents' expectations. [ABSTRACT FROM AUTHOR]

The adoption of social media in e-learning signals the end of distance education as we know it in higher education. However, it appears to have very little impact on the way in which open and distance learning (ODL) institutions are functioning. Earlier research suggests that a significant part of the explanation for the slow uptake of social media in e-learning lies outside of conventional factors attributed to distance learning reforms. This research used the conceptual framework for online collaborative learning (OCL) in higher education. Social media such as blogs, wikis, Skype or Google Hangout, Facebook; and even mobile apps, such as WhatsApp; could facilitate deep learning and the creation of knowledge in e-learning at higher educational institutions. This metasynthesis is an interpretative integration of peer-reviewed qualitative research findings on social media in e-learning. It includes a synthesis of data, research methods, and theories used to investigate social media in e-learning. Seven themes emerged from the data which have been recrafted into a framework for social media in e-learning as the final product. The proposed framework could be useful to instructional designers and academics who are interested in using modern learning theories and want to adopt social media in e-learning in higher education as a deep learning strategy. [ABSTRACT FROM AUTHOR]

This metasynthesis critically surveyed and evaluated the learning impacts on counselor and psychology trainees' multicultural development and intercultural competence through participating in cultural immersion (CI), based on published qualitative research evidence. Accordingly, this metasynthesis identified and assessed the characteristics, the methodological strengths and qualities, and the thematic findings of 33 qualitative and mixed-methods CI studies resulting from exhaustive database searches. Using a directed content analysis technique, a six-domain analytical framework was applied to code and analyze the themes reported in these studies. The results point to CI intervention as a multifaceted and versatile instructional apparatus that impacted and contributed to trainees' multicultural development and intercultural learning multidimensionally, across cognitive, perceptual-attitudinal, affective, and skills-behavioral domains. These learning outcomes include trainees' increased cultural awareness and knowledge (cognitive), enhanced reflexivity on their worldview, positionality, and attitude (perceptual-attitudinal), heightened emotion and growth in cultural empathy (affective), adaptation and display of new behaviors and relational skills and increased multicultural competence (skills-behavioral). Therefore, CI embodies many favorable characteristics of experientially-based learning as stipulated in the existing multicultural counseling and intercultural training literature. These findings lend nuanced empirical support for the application of CI to facilitate counselor trainees' multicultural orientation, development, and skills, and offer insights into structural facilitators for enhancing immersion training. However, a lack of structural and methodological consistency and theoretical depth among the existing CI studies were observed as major limitations. Implications and recommendations for advancing future CI and multicultural training practice and research are discussed. [ABSTRACT FROM AUTHOR]

Time perception in palliative care is modified by the prospect of death and by uncertainty about the future. Patients' perceptions of time have been explored within individual qualitative studies reporting fragmented evidence. This study aimed to synthesize available qualitative literature on patients' perception of time in palliative care using the Johanna Briggs Institute integrative approach.An extensive search was conducted within the major biomedical databases using the key words "time perception," "palliative care," and "patients ." Seven studies were included. Four main themes emerged from the metasynthesis. "The suspended time of waiting " was a central theme because of its importance in patients' accounts and also because it was susceptible to change by health professionals. The other 3 themes were "the time of the diseased body," "perspectives change with time ," and "from the end to the aim of time ." This study shows the interconnected nature of physical, social, and emotional aspects of time perception and the profound social impact of providing and receiving care. Knowledge of patients' time perceptions in palliative care can help health professionals respect them and improve their care. [ABSTRACT FROM AUTHOR]

Question: What are physiotherapists’ perceptions about identifying and managing the cognitive, psychological and social factors that may act as barriers to recovery for people with low back pain (LBP)? Design: Systematic review and qualitative metasynthesis of qualitative studies in which physiotherapists were questioned, using focus groups or semi-structured interviews, about identifying and managing cognitive, psychological and social factors in people with LBP. Participants: Qualified physiotherapists with experience in treating patients with LBP. Outcome measures: Studies were synthesised in narrative format and thematic analysis was used to provide a collective insight into the physiotherapists’ perceptions. Results: Three main themes emerged: physiotherapists only partially recognised cognitive, psychological and social factors in LBP, with most discussion around factors such as family, work and unhelpful patient expectations; some physiotherapists stigmatised patients with LBP as demanding, attention-seeking and poorly motivated when they presented with behaviours suggestive of these factors; and physiotherapists questioned the relevance of screening for these factors because they were perceived to extend beyond their scope of practice, with many feeling under-skilled in addressing them. Conclusion: Physiotherapists partially recognised cognitive, psychological and social factors in people with LBP. Physiotherapists expressed a preference for dealing with the more mechanical aspects of LBP, and some stigmatised the behaviours suggestive of cognitive, psychological and social contributions to LBP. Physiotherapists perceived that neither their initial training, nor currently available professional development training, instilled them with the requisite skills and confidence to successfully address and treat the multidimensional pain presentations seen in LBP. Registration: CRD 42014009964. [ Synnott A, O’Keeffe M, Bunzli S, Dankaerts W, O'Sullivan P, O'Sullivan K (2015) Physiotherapists may stigmatise or feel unprepared to treat people with low back pain and psychosocial factors that influence recovery: a systematic review. Journal of Physiotherapy 61: 68–76 ]. [ABSTRACT FROM AUTHOR]

Objective: to integrate findings of individual studies in order to broaden the understanding of first-time mothers' experiences of early labour. Design: the methodology was metasynthesis which is based on the interpretive meta-ethnography described by Noblit and Hare (1988). Metasynthesis is research on research which synthesises the findings of previous qualitative studies, and the focus is on interpretation and the creation of new knowledge. Setting: all included studies originated from high resource countries (USA 2, UK 4, and Scandinavia 5) and all were carried out in a context of hospital based maternity care. Participants: a total of 231 women participated in the studies. Findings: 11 articles were included. The main results are presented with the metaphor a balancing act in an unknown territory. The ‘unknown territory’ has a double meaning: as the personal experience of going into labour for the first time and as encountering the maternity care system. On both levels women have to make significant decisions: whether labour really has started and subsequently when to go to the hospital. A key challenge is to balance the arrival on the labour ward at the ‘right’ time, not too early and not too late. Arriving at the ‘right’ time leads to a positive path, while arriving ‘too soon’ might lead to a cascade of negative experiences. The results are further presented with five central themes: ‘Finding out if labour has started is absorbing’; ‘Dealing with labour at home’; ‘Trying to arrive at the labour ward at the right time’; ‘There is always a risk of being sent home’; 'Encountering health professionals arouses strong emotions'. Conclusions: the metasynthesis broadens the understanding of first-time mothers' experiences of early labour, and suggests that women's needs when planning a hospital birth are not being adequately met at this stage in the labour process. Three areas of future research are suggested: how to support and strengthen women during pregnancy in order to cope with early labour; women's experiences of early labour when planning a birth in contexts other than hospital; and to continue to investigate new ways of giving care during early labour. [ABSTRACT FROM AUTHOR]

Objectives To highlight recent advances in knowledge synthesis methods and reporting guidelines. Background Knowledge synthesis is critical to advancing practice, research, and policy, but synthesizing knowledge from an often-heterogenous body of literature is challenging. Methods A review of knowledge synthesis methods and reporting guidelines for health sciences research was completed using Google Scholar, Medline, CINAHL, and PsycInfo. Relevant information was critiqued and summarized for applicability to health science and practice. Results Recent advances and guidelines pertaining to systematic reviews, meta-analysis, qualitative synthesis, mixed studies reviews, integrative reviews, scoping reviews, RE-AIM reviews, and umbrella reviews are discussed and examples of the application of each method to cardiopulmonary research are provided. Methods of quality appraisal are also presented. Conclusions Advancements in knowledge synthesis and reporting guidelines enhance the quality, scope, and applicability of results; thus improving health science and clinical practice, and advancing health policy. [ABSTRACT FROM AUTHOR]

Introduction: pregnancy, childbirth and motherhood are natural processes that bring joy to individual women and families. However, for many migrant women, becoming a mother while attempting to settle in a new country where the culture is different, can be a challenge for them. Aim: to identify and synthesise qualitative research studies that explore the perceptions of pregnancy, childbirth and motherhood, and lived experiences of migrant women in their new home country. Methods: the seven steps of Noblit and Hare's meta-ethnography was used to conduct the meta- synthesis. Searches for literature of qualitative studies were conducted in May and June 2013 using PubMed, CINAHL, Google Scholar and La Trobe University databases. Studies published in English addressing pregnancy, childbirth and motherhood experiences of women from immigrant backgrounds met the inclusion criteria. Findings: 15 studies published between 2003 and 2013 related to the pregnancy, childbirth and motherhood experiences for women from migrant backgrounds were eligible for the meta-synthesis. Four major themes were identified as common in all the qualitative studies: expectations of pregnancy and childbirth; experiences of motherhood; encountering confusion and conflict with beliefs; and dealing with migration challenges. Conclusions: migrant women's pregnancy, childbirth and motherhood experiences are influenced by societal and cultural values, and they vary depending on the adjustment process in the new home country. The provision of culturally sensitive maternal health services enhances positive outcomes of a healthy mother and healthy infant. Supportive structures that address the issue of language and cultural barriers seem to promote antenatal clinic attendance, prevent pregnancy and childbirth complications, and enhance their positive motherhood experiences. Implications: women from immigrant backgrounds have the right to receive adequate and sensitive health care during the childbearing and childrearing times regardless of their migrant status. [ABSTRACT FROM AUTHOR]

The aim of this metasynthesis was to identify, analyze and synthesize the qualitative findings from original research studies addressing student nurses' experiences with a peer mentoring program in their clinical placements. Students' positive experiences from clinical placement studies, are often associated with quality of clinical mentoring and learning environments. However, nurse mentors struggle to find sufficient time for mentoring student nurses. Establishing a peer mentoring program, may provide additional mentoring and strengthen clinical placement as learning environment. A peer mentoring program entails, that senior student nurses at one level act as a supportive mentor and serve as role models for fellow novice student nurses at a lower level. A flexible descriptive design was applied for this metasynthesis. By using the same search strategy, systematic searches were made in the following electronic databases: CINAHL, MEDLINE OVID, Embase, ERIC, Scopus, Oria and SveMed+. Ten articles met the eligibility criteria, reporting findings from altogether 203 student mentors and 446 student mentees. Extracted information (data) from the articles were analyzed in lines with Graneheim & Lundmans' five phases of thematic analysis of data. The analysis resulted in two overarching themes characterizing students' experiences. Student mentors experienced that participating in peer mentoring had been Strengthening the road to becoming a professional nurse. Student mentees experienced that participating in peer mentoring had been Strengthening the studying and learner role in clinical placement. The themes covering student mentors experience were : Understanding and integrating nursing competence; Realizing the need to be mentored and supported as mentors; Understanding the content and complexity of clinical mentoring. The themes covering student mentees experience were : Reaching further for clinical competence and self-confidence; Taking advantage of mentoring and learning situations; Understanding the importance of learning conditions and their own learning responsibility. All themes were further characterized with sub-themes. The findings from this metasynthesis are in general positive for both student mentors and mentees and both student groups experienced to benefit from participating in the peer mentoring program. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: the active engagement of fathers in maternity care is associated with long-term health and social benefits for the mother, baby and family. The maternity care expectations and experiences of expectant and new fathers have received little attention to date. Aim: to identify and synthesise good quality qualitative research that explores the views and experiences of fathers who have encountered maternity care in high resource settings. Methods: based on a pre-determined search strategy, relevant databases were searched for papers published between January 1999 and January 2010. Backchaining of the reference lists in included papers was undertaken. Inclusion criteria: good quality qualitative research studies exploring fathers'' involvement in maternity care through pregnancy, birth, and up to 6 months postnatally, that were undertaken in high resource countries. No language restrictions were imposed. Analytic strategy: the analysis was based on the metaethnographic techniques of Noblit and Hare (1988) as amended by . Findings: from 856 hits 23 papers were included. The emerging themes were as follows: risk and uncertainty, exclusion, fear and frustration, the ideal and the reality, issues of support and experiencing transition. Synthesis: fathers feel themselves to be ‘partner and parent’ but their experience of maternity care services is as ‘not-patient and not-visitor’. This situates them in an interstitial and undefined space (both emotionally and physically) with the consequence that many feel excluded and fearful. Conclusions: fathers cannot support their partner effectively in achieving the ideal of transition to a successful pregnancy, joyful birth and positive parenthood experience unless they are themselves supported, included, and prepared for the reality of risk and uncertainty in pregnancy, labour and parenthood and for their role in this context. [Copyright &y& Elsevier]

Metasynthesis is a technique that can help establish qualitative research as a viable source of evidence. Using this approach, results from multiple qualitative research studies on the same topic are combined and synthesized to reveal the best evidence. This article addresses metasynthesis and its application to perioperative evidence-based care. Noblit and Hare's method for synthesizing qualitative research is described and illustrated using a previously published metasynthesis of postpartum depression research. [ABSTRACT FROM AUTHOR]

Introduction: Although Australian rural women appear to be coping well despite a lack of services, harsh environmental conditions and overall rural health disadvantage, there is little research into the factors which promote good health among them. The aim of this article is to document and analyse current understandings about how rural Australian women maintain health and wellbeing, by conducting a metasynthesis of peer reviewed empirical qualitative research. Methods: Searches were conducted of CINAHL, MEDLINE, Proquest, Blackwell Synergy, Informit, Infotrac, National Rural Health Alliance and Indigenous Health Infonet data bases. A definition of health and wellbeing as a positive concept emphasising social and personal resources as well as physical capacities, provided a framework for the review. Six studies published in rural health, nursing and sociology journals between 2001 and 2006 were selected. Common and recurring themes from the original studies were identified. Reciprocal translation was used to synthesise the findings among the studies, leading to interpretations beyond those identified in the original studies. Results: Four themes emerged from the metasynthesis: isolation, belonging, coping with adversity, and rural identity. The findings of this study exhibit a tension between a sense of belonging and the experience of social and geographical isolation. The study findings also reveal tension between adherence to a strong gendered rural identity which fosters a culture of stoicism and self reliance and feelings of resistance to societal expectations of coping with adversity. Conclusions: Metasynthesis enabled a deeper understanding of the health and wellbeing of rural women in Australia. The social experiences of rural women influence the way they construe their health and wellbeing. Understanding how women maintain health and wellbeing is critical in ensuring that policies and services meet the needs of rural women and do not entrench existing inequalities. [ABSTRACT FROM AUTHOR]

The article presents a study about the lived experiences of immigrant Asian nurses working in Western countries. A metasynthesis conducted on 14 studies using G. W. Noblit and R. D. Hare's procedures resulted into four themes, namely communication as a daunting language, differences in nursing practice, marginalization, discrimination, and exploitation, and cultural differences. The study also discussed the implications of this metasynthesis for nursing knowledge development, clinical practice, and policy making.

This article describes the process and the product of a metasynthesis of qualitative studies focused on hospice nurses. A metaphor of body and spirit is used to present a composite snapshot of the qualities, characteristics, and challenges of hospice nurses in the United States. The foundations that support the ability of the nurse to sustain this work are revealed through the legs. The stressors and emotional turbulence embedded in the practice are centered in the belly. Gifts given and received are described through the hands. Communications of often-difficult truths are relegated to the ears and mouth. The specialized knowledge resides in the mind. The existential qualities are conceptualized within the heart and spirit. Commonalities of the highly skilled hospice nurse include strong commitments to the interdisciplinary team, to the patient families, and to the self. The nurse brings skillful, compassionate care to the patient families while working to maintain personal and professional support systems. [ABSTRACT FROM AUTHOR]

To explore facilitators and barriers to the implementation of a physiological approach to care during labour and birth in obstetric settings. To explore how facilitators and barriers located at three levels: organisation, professional groups (midwives and obstetricians) and women, interact to influence the implementation of a physiological approach. A systematic review of the literature, identified 32 eligible studies from four databases reporting relevant qualitative data. Findings from these studies were thematically synthesised in three phases: line by line coding of findings from primary studies, development of descriptive themes and analytical themes. This review is reported in line with PRISMA guidelines. At an organisational level, centralisation of care in obstetric units limited time for labouring and professional care to support a physiological labour and birth. Risk management strategies ostensibly designed to promote safety sustained a risk-based approach. At a professional level, important barriers include hierarchical decision-making led by obstetricians, midwifery acquiescence, obstetric and midwifery risk preoccupation, rationalisation of the routine use of clinical intervention and an erosion of midwifery skills and knowledge. At the level of the woman, barriers include a lack of knowledge and reliance on professional decision-making. Facilitators include collaborative working by midwives and obstetricians, a valuing of midwifery autonomy and women's questioning of inappropriate intervention use. Contrary to evidence-based guidelines that recommend a physiological approach, a risk-based approach informs practices in obstetric units. Primary research has mainly identified barriers to implementing a physiological approach at a professional level, and this has been studied largely from a midwifery perspective. To aid comprehensive investigations of facilitators and barriers and their interactive influences, this review identifies important research gaps for study across all levels: organisation, professionals (midwives and obstetricians) and women. Risk preoccupations and rationalisation, with negative influences on knowledge and skills in the use of a physiological approach, must prompt reflection and action amongst professional groups. Power imbalances between midwives and obstetricians need to be addressed, drawing on experiences in units where collaborative working and midwifery autonomy is fostered. [ABSTRACT FROM AUTHOR]

• International literature supports nurse protections against workplace violence. • This study explains the factors that influence violence in emergency settings. • Findings provide evidence to implement strategies to prevent violence. Workplace violence against nurses in the Emergency Department (ED) is a significant issue worldwide and has received increased attention. Workplace violence against nurses in the ED has increased in recent years. With such a large number of nurses having experienced violence, it is important to understand and elucidate the nurses' perspective of violence in the ED. Qualitative studies that were published between 2010 and 2019. A metasynthesis of 6 qualitative studies was conducted using Noblit and Hare's metaethnographic methodology. The Critical Appraisal Skills Program (CASP) was used to evaluate the quality of the studies. Four overarching themes emerged from the data: the inevitability of violence, invisible wounds and painful memories, post-violence repercussions, and double-sided: physical and verbal abuse. Findings provide insight into policies actions related to perpetrators and developing violence protections guidelines to support ED nurses in managing workplace violence. Violence in the ED is an inevitable experience for nurses. Organizations must take a realistic approach to implement violence reduction measures and training programs in the ED. [ABSTRACT FROM AUTHOR]