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Purpose: Mentalization-based treatment (MBT) is a psychotherapeutic approach that aims to increase mentalizing capacity. The purpose of this meta-ethnography was to synthesize the available qualitative literature on MBT to allow for a more thorough understanding of the lived experience of those who have undergone this therapy. Design/methodology/approach: A systematic search of seven databases was carried out. The Critical Appraisal Skills Programme was used to appraise the papers suitable for inclusion. The data were synthesized using a meta-ethnographic approach in which the second-order constructs from each paper were translated and reinterpreted creating a line of argument synthesis. Findings: A total of 11 studies were included in the meta-ethnography. Three overarching themes were identified within the included papers which outlined that participant experience of MBT consisted of three different developmental stages. Navigating the therapeutic process describes the participant's experience of the therapeutic process of MBT. The processes of change in MBT outlined participant reports of mechanisms of change experienced in MBT. Mentalizing self and others described the experience of generalizing new knowledge and skills to the world outside of therapy and unveiled the impact that engaging in MBT had on participants. Originality/value: This meta-ethnography offers new insights into how clients experience MBT as a therapeutic process and offers suggestions for implementation in clinical practice as well as areas of focus for research of this therapeutic approach. [ABSTRACT FROM AUTHOR]

Background: The under‐detection of depression in adolescents suggests that a better understanding of its presentation may be needed. Conceptualizations of adolescent depression are largely the same as adult depression, with minimal consideration of developmental stage. Exploration of first‐hand accounts could help to identify any unique features of adolescent depression. Therefore, this systematic review aimed to understand the lived experience of adolescents with depression to inform clinical practice. Methods: The review was registered with PROSPERO (CRD42020198141). Databases (PsychINFO, CINAL, MEDLINE and EMBASE) were searched in March 2022 to identify peer‐reviewed qualitative studies on first‐hand experiences of adolescent depression. The Joanna Briggs Institute's qualitative data extraction tool and checklist for qualitative research were used to obtain study data and assess methodological quality of included papers. Meta‐aggregation was the method of synthesis, whereby extracted themes from the papers were grouped according to shared meanings. Results: Fifteen papers of mixed methodological quality were identified for inclusion from screening a total of 1,983 references. Studies were published between 2002 and 2021, spanned seven countries and included participants aged 11 to 22 years old. Aggregation of 56 themes resulted in 16 categories and 3 synthesized findings encompassing key aspects of adolescent depression: causes, symptoms and coping. Variability in adolescents' perspectives across these domains was evident. Some symptoms described, such as social disconnection and anger, are not listed in existing diagnostic criteria. Conclusions: Subjective experiences of depression among adolescents vary and may not entirely match diagnostic criteria. Awareness of this when assessing for depression may improve detection and help to ensure adolescents feel understood. [ABSTRACT FROM AUTHOR]

Prostate cancer affects one in nine men, so understanding patients' and their partners experiences is crucial for developing effective treatments. The purpose of this review was to synthesis and report the experiences and views of persons with prostate cancer and their partners. Methods: A qualitative evidence synthesis (QES) was conducted following the eMERGe reporting guideline. Six databases were searched for the relevant literature, and the Critical Appraisal Skills Program (CASP) tool was used for quality appraisal. Results: A total of 1372 papers were identified, and 36 met the inclusion criteria. Four themes emerged: quality of life, relationships and dynamics, treatment journey and survivorship and aftercare. Conclusions: Prostate cancer's impact on patients and partners is significant, requiring comprehensive support, holistic care, tailored assistance, and research into therapies to minimize adverse effects and address emotional distress and relationship strain. Prostate cancer treatment causes physical changes, triggering feelings of loss and grief, and affects coping mechanisms. Drawing on emotional support and education is vital for boosting confidence and resilience, as many patients and partners face fears of recurrence and lifestyle changes, highlighting the need for tailored information and presurgery support. [ABSTRACT FROM AUTHOR]

Background: Shared decision-making is a key element of person-centred care and promoted as the favoured model in preference-sensitive decision-making. Limitations to implementation have been observed, and barriers and limitations, both generally and in the palliative setting, have been highlighted. More knowledge about the process of shared decision-making in palliative cancer care would assist in addressing these limitations. Aim: To identify and synthesise qualitative data on how people with cancer, informal carers and healthcare professionals experience and perceive shared decision-making in palliative cancer care. Design: A systematic review and metasynthesis of qualitative studies. We analysed data using inductive thematic analysis. Data sources: We searched five electronic databases (MEDLINE, EMBASE, PsycINFO, CINAHL and Scopus) from inception until June 2023, supplemented by backward searches. Results: We identified and included 23 studies, reported in 26 papers. Our analysis produced four analytical themes; (1) Overwhelming situation of 'no choice', (2) Processes vary depending on the timings and nature of the decisions involved, (3) Patient-physician dyad is central to decision-making, with surrounding support and (4) Level of involvement depends on interactions between individuals and systems. Conclusion: Shared decision-making in palliative cancer care is a complex process of many decisions in a challenging, multifaceted and evolving situation where equipoise and choice are limited. Implications for practice: Implementing shared decision-making in clinical practice requires (1) clarifying conceptual confusion, (2) including members of the interprofessional team in the shared decision-making process and (3) adapting the approach to the ambiguous, existential situations which arise in palliative cancer care. [ABSTRACT FROM AUTHOR]

Purpose: This article aims to present a systematic review and synthesis of evidence on the experiences, role and use of IPE in IH fields by using a meta-ethnographic approach including key concepts, reciprocal and refutational translation and lines of argument. Inclusion health (IH) practice suggests that the needs of excluded groups are more effectively addressed through collaborative working. Interprofessional education (IPE) occurs when two or more professions engage in shared practice and learning, resulting in improved collaboration and quality of care. Studies on IPE to train staff in fields relating to IH exist, but without a settled consensus on the best approaches/activities to foster inclusive practice. Design/methodology/approach: This synthesis is underpinned by a meta-ethnographic approach. It provides explicit stages of data collection and interpretation, while providing space to engage with emerging themes and concepts iteratively (reflecting on author experiences) and inductively (reasoning and interpretation). This study made use of electronic databases and journals for English language peer reviewed articles between 2000 and 2020. Of the 2217 articles, 19 papers were included. The lead author and reviewer completed the review process and a second reviewer reviewed 10% at each stage. The quality was assessed using a modified CASP checklist. Iterative analysis involved PPI and staff stakeholders. Findings: A total of 16 concepts embedded in 19 papers provide insight into the nature of IPE in IH (IH) for staff. It was found that IPE in IH covers a broad group of practitioners and is a complex activity involving individual and organisation readiness, practical and pedagogical factors, influenced by setting, method, curriculum, lived experience, reflection and a learner-driven approach. Barriers to design, implementation and translation into practice were also found to exist. Practical implications: Most studies used a combination of core learning and group work. Educational modes include mentoring or coaching, reflective practice, immersive learning and people lived experience of exclusion involved in or facilitation thematically centred in trauma-informed informed care, cultural competence, communities of practice and service learning. The aim of these methods was to promote collaboration through identifying shared experiences, problems and tensions and critical reflection of services and organisations. Such transformative learning is reported to challenge stigma, discrimination and misinformation and promote collective empowerment to address social injustice through human connection. Effective models of IPE re-instated the therapeutic relationship and alliances between patients and staff. Social implications: This review also calls for the development of health and care workers' professionalism in relation to their own reflexivity, establishing anti-racist curricula, challenge stigma and ensuring clinicians are aware of and able to negotiate tension and difference identified within the consultation and between themselves. Apart from developing generalist skills, this analysis suggests that IPE in IH may be able to challenge stigma and discrimination towards IH groups by destabilising existing norms and siloed working with the aim of achieving robust interprofessional practice. Originality/value: IPE in IH is a complex activity affected by individual and organisation readiness, setting, experiential, practical and pedagogical factors. Models of teaching are focused on re-instating the therapeutic relationship. There are no systematic reviews in this field and previously there was no settled consensus on the best approaches and learning activities to foster inclusive and collaborative practice. [ABSTRACT FROM AUTHOR]

Aim To explore the use and application of case study research in midwifery. Background Case study research provides rich data for the analysis of complex issues and interventions in the healthcare disciplines; however, a gap in the midwifery research literature was identified. Design A methodological review of midwifery case study research using recognized templates, frameworks and reporting guidelines facilitated comprehensive analysis. Data Sources An electronic database search using the date range January 2005-December 2014: Maternal and Infant Care, CINAHL Plus, Academic Search Complete, Web of Knowledge, SCOPUS, Medline, Health Collection (Informit), Cochrane Library Health Source: Nursing/Academic Edition, Wiley online and ProQuest Central. Review Methods Narrative evaluation was undertaken. Clearly worded questions reflected the problem and purpose. The application, strengths and limitations of case study methods were identified through a quality appraisal process. Results The review identified both case study research's applicability to midwifery and its low uptake, especially in clinical studies. Many papers included the necessary criteria to achieve rigour. The included measures of authenticity and methodology were varied. A high standard of authenticity was observed, suggesting authors considered these elements to be routine inclusions. Technical aspects were lacking in many papers, namely a lack of reflexivity and incomplete transparency of processes. Conclusion This review raises the profile of case study research in midwifery. Midwives will be encouraged to explore if case study research is suitable for their investigation. The raised profile will demonstrate further applicability; encourage support and wider adoption in the midwifery setting. [ABSTRACT FROM AUTHOR]

Communication between patients and clinicians influences the development of therapeutic relationships. Communication is disrupted when the patient has communication impairments after stroke. However, how these communication disruptions influence therapeutic relationships is not well-understood. This qualitative metasynthesis explores the perspectives of people with communication impairment to understand how interpersonal communication influences therapeutic relationships. Four databases were searched for qualitative studies which discussed how communication influenced therapeutic relationships from the perspectives of people with aphasia, dysarthria or apraxia of speech. Additional papers were identified through citation searching and subject experts. Nineteen eligible papers were included and analysed using thematic analysis. Four themes were constructed from the analysis: (1) Relationships provide the foundation for rehabilitation; (2) Different relational possibilities arise from "reading" the clinician; (3) Creating therapeutic relationships through validating interactions and connections; and (4) Creating therapeutic disconnections through invalidating, exclusionary interactions. A therapeutic relationship develops, at least in part, in response to the clinician's communication and how this is received and experienced by the patient. Understanding the characteristics of relationship-fostering communication and knowing how communication influences relationships can help clinicians critically reflect on their communication and better develop therapeutic relationships with people with communication impairment. Practitioner-patient communication can facilitate therapeutic relationships or create therapeutic disconnections. Communication patterns that are commonly evident when a patient has communication impairments can impede therapeutic relationships. Clinicians need to attend to how their communication is received and how it influences people's sense of self. Communication partner training should address the existential and relational needs of people with communication impairment after stroke. [ABSTRACT FROM AUTHOR]

Introduction: Many older people experience memory concerns; a minority receive a diagnosis of Mild Cognitive Impairment (MCI) or Subjective Cognitive decline (SCD). There are concerns that medicalisation of MCI and memory concern may fail to acknowledge subjective experiences. Aim: We explore the meaning individuals give to their memory concerns, with or without a diagnosis of MCI and SCD. Method: We scoped literature exploring subjective experiences of memory concern, with or without a diagnosis of MCI or SCD. We searched CINAHL, PsycINFO and MEDLINE in March 2020, and updated in Sept 2021.We used (Arksey & O'Malley, 2005) framework to guide our scoping review method and thematic analysis to analyse our findings. Results: We screened 12,033 search results reviewing the full texts of 92 papers. We included 24 papers, including a total of 453 participants, the majority of whom were female, from White ethnic majority populations (or from studies where ethnicity was not identified) with high levels of education. In 15 out of 24 studies, 272 participants were diagnosed with MCI. We identified two themes; Making a diagnosis personal and Remembering not to forget. We found that subjective experiences include normative comparison with others of the same age and responses including fear, relief, and acceptance, but culminating in uncertainty. Conclusion: Drawing upon sociology, we highlight the subjective experiences of living with memory concerns, SCD and an MCI diagnosis. We identify a gap between the intended purpose of diagnostic labels to bring understanding and certainty and the lived experiences of those ascribed them. [ABSTRACT FROM AUTHOR]

Aim: The aim of this work is to synthesize and interpret qualitative research examining the experiences of nurses providing care for patients with COVID‐19 in acute care settings in the early stages of the pandemic in different countries. Background: The prevalence of disasters, including the pandemic, is increasing globally. It is important to understand nurses' experiences in depth to effectively manage extraordinary events that may occur in the future. Design: This is a thematic meta‐synthesis study. Methods: Electronic databases, including CINAHL, MEDLINE, PubMed, Web of Science, OVID, and Scopus, were searched for publications from December 2019 to October 2020. The search was updated for publications to 30 May 2022. The thematic synthesis method was used to analyse and interpret the data. Findings The experiences of the nurses giving care to patients with COVID‐19 were grouped under four themes: (1) Difficulties encountered in the care of patients with COVID‐19; (2) mixed emotions experienced in the care of patients with COVID‐19; (3) coping strategies that nurses used in the management of the pandemic; (4) the benefits of the COVID‐19 to nurses. Conclusion: Nurses faced many difficulties and experienced mixed emotions while providing care for patients with coronavirus disease. Perceived social support was seen as the most important strategy for coping with these difficult situations. It is important to be aware of the difficulties and emotions experienced by nurses and support them during the COVID‐19 pandemic for the management of future pandemics. Summary statement: What is already known about this topic? During the COVID‐19 pandemic, the health sector was affected most.Nurses were on the front lines and faced many challenges. What this paper adds? Nurses perceived the COVID‐19 pandemic as a unique experience for their professional identity and personal development despite the difficulties they faced.They saw social support, which would make them feel valuable, as the most important coping strategy. The implications of this paper Lessons learned from nurse experiences in the early stages of the pandemic should be taken into account when planning for a pandemic or other disaster situations.Politicians, health‐care organizations, and nurse managers should increase social support to ensure the well‐being of nurses in busy work environments such as pandemics. [ABSTRACT FROM AUTHOR]

Electroconvulsive therapy (ECT) is a controversial treatment. Research has predominantly focused on clinician assessment of short-term efficacy and, occasionally, on participant experiences of the treatment itself. While service user accounts of the long-term impacts of ECT are reported, they are dispersed throughout the literature and typically tangential to studie's main foci. The aim of this study was to synthesise service-user accounts, within peer-reviewed literature, of long-term impacts of ECT in their daily lives. A qualitative meta-synthesis was conducted. A systematic literature search identified qualitative articles meeting the inclusion criteria. Results sections of eligible papers were analysed thematically. From 16 eligible papers, the review identified 11 long-term impacts, four social influences and five strategies that people employed to navigate these long-term impacts. Limited research has examined long-term experiences of ECT from service-user perspectives. These lived experience perspectives are required to facilitate peer-to-peer learning and assist future service delivery to align with needs of people living with long-term ECT impacts. [ABSTRACT FROM AUTHOR]

AimThe aim of this metasynthesis was to develop an understanding of the existing theoretical perspectives around nurse prescribing and to identify any gaps in knowledge, which would support further research into the lived experience of the nurse prescriber in the primary care setting.BackgroundNurse prescribing has been the focus of many research studies since its introduction, with many benefits to the patient, the prescriber and service identified; however, there remains variation in the utilisation of the prescribing qualification, particularly in primary care settings. Although a range of quantitative and qualitative studies have been undertaken, which aimed to explore the influences on prescribing, few have used a research methodology that supports the in-depth exploration of the nurse prescriber’s experience.MethodsAn extensive literature search was undertaken in April 2015 (20–24), which included UK and non-UK studies since 1999. Inclusion and exclusion criteria were applied to search for studies in which participants included nurse prescribers who practiced in primary or community care settings. Studies that only used a quantitative methodology and those not available in English were excluded. The literature search yielded 124 papers, with 50 papers remaining after the initial screen of full papers against the inclusion/exclusion criteria. The papers were reviewed and graded for their quality, with a further 13 papers excluded.A three-step qualitative analysis technique of metasynthesis was applied to the remaining 37 papers. Identification of similarities and differences enabled first-order interpretations to be identified, which were grouped into broader themes (second-order interpretations) by identifying concepts that applied to two or more studies. Further interpretation through synthesis of translation enabled third-order interpretations to emerge.FindingsFrom the metasynthesis of the 37 papers, nine themes emerged: patient-centred care; benefits to the service; the need for knowledge; professional accountability and boundary setting; safety consciousness; barriers to effective prescribing; role preservation; power-shifts and inter-professional relationships; and culture of prescribing. [ABSTRACT FROM PUBLISHER]

Introduction. This review sought to synthesise the qualitative evidence pertaining to the experiences of myeloma patients and relatives of work, given the distinct symptom burden and illness trajectory. Methods and Designs. CINAHL, Medline, Web of Science, PsychINFO, SocIndex were searched on 22-Apr-2022. No limiters were used for language or date of publication. CASP was used for critical appraisal. An integrative synthesis was conducted to inductively construct analytic themes PROSPERO CRD42022323137. Results. 34 articles were included, published from 2004 to 2022. Nineteen were assessed as having low risk of bias, and four with moderate risk of bias. The following four themes were derived from analysis of the papers: (i) side effects, medicines, and stigma; (ii) relationships; (iii) creation and maintenance of identity; (iv) privilege and income. Conclusion. Myeloma impacts the engagement of patients and relatives in paid and unpaid work, yet very little is currently known on how the cancer impacts these important interdependent systems. Addressing workplace stigma, understanding the role of workplace relationships, the construction of self through work, interpreting data through a lens of life-course and, privilege offer helpful starting points. [ABSTRACT FROM AUTHOR]

Research on women's experiences of infant feeding and related moral discourse suggests that self‐conscious emotions may be highly relevant to breastfeeding support interactions. However, the emotional impact of receiving support has not been fully explored. The aim of this review is to re‐examine qualitative UK research on receiving breastfeeding support, in order to explore the role of self‐conscious emotions and related appraisals in interactions with professional and peer supporters. From 2007 to 2020, 34 studies met criteria for inclusion. Using template analysis to identify findings relevant to self‐conscious emotions, we focused on shame, guilt, embarrassment, humiliation and pride. Because of cultural aversion to direct discussion of self‐conscious emotions, the template also identified thoughts about self‐evaluation, perceptions of judgement and sense of exposure. Self‐conscious emotions were explicitly mentioned in 25 papers, and related concerns were noted in all papers. Through thematic synthesis, three themes were identified, which suggested that (i) breastfeeding 'support' could present challenges to mothering identity and hence to emotional well‐being; (ii) many women managed interactions in order to avoid or minimise uncomfortable self‐conscious emotions; and (iii) those providing support for breastfeeding could facilitate women's emotion work by validating their mothering, or undermine this by invalidation, contributing to feelings of embarrassment, guilt or humiliation. Those supporting breastfeeding need good emotional 'antennae' if they are to ensure they also support transition to motherhood. This is the first study explicitly examining self‐conscious emotions in breastfeeding support, and further research is needed to explore the emotional nuances of women's interactions with supporters. [ABSTRACT FROM AUTHOR]

Background: Patient empowerment, defined as 'a process through which people gain greater control over decisions and actions affecting their health' (World Health Organization) is a key theme within global health and social care strategies. The benefits of incorporating empowerment strategies in care are well documented, but little is known about their application or impact for patients with advanced, life-limiting illness(s). Aim: To identify and synthesise the international evidence on patient empowerment for adults with advanced, life-limiting illness(s). Design: Systematic review (PROSPERO no. 46113) with critical interpretive synthesis methodology. Data sources: Five databases (MEDLINE, Embase, CINHAL, PsycINFO and Cochrane) were searched from inception to March 2018. Grey literature and reference list/citation searches of included papers were undertaken. Inclusion criteria: empirical research involving patients with advanced life-limiting illness including descriptions of, or references to, patient empowerment within the study results. Results: In all, 13 papers met inclusion criteria. Two qualitative studies explored patient empowerment as a study objective. Six papers evaluated interventions, referencing patient empowerment as an incidental outcome. The following themes were identified from the interpretive synthesis: self-identity, personalised knowledge in theory and practice, negotiating personal and healthcare relationships, acknowledgement of terminal illness, and navigating continued losses. Conclusion: There are features of empowerment, for patients with advanced life-limiting illness distinct to those of other patient groups. Greater efforts should be made to progress the empowerment of patients nearing the end of their lives. We propose that the identified themes may provide a useful starting point to guide the assessment of existing or planned services and inform future research. [ABSTRACT FROM AUTHOR]

We aimed to survey the findings of phenomenological studies built up in the field of diabetes care in Sweden. This is a meta-synthesis of phenomenological studies on experiences related to diabetes in Sweden focusing on learning to live with diabetes. We proceeded by reference to the seven phases of Noblit & Hare. We examined papers from seven phenomenological studies on learning to live with diabetes in Sweden. From the papers, which describe the experience of living with diabetes, three overarching themes were selected—perception and awareness of the body; integration and responsibility; and presence of others who provide support. From those describing the expert's experience, an overarching theme emerged—encouraging reflection in persons with diabetes. We interpreted each of these themes in phenomenological terms and compared them with theories in Japan. Persons with diabetes take responsibility for coping with a range of things brought on by the illness and learn to live with diabetes. Experts support these persons so they can see their world objectively and critically scrutinize it. By building a model of diabetes care in Japan that references Scandinavian human science, it will be possible to find new approaches that support learning at the existential level. [ABSTRACT FROM AUTHOR]

Objectives: This study comprises a synthesis of published qualitative studies from developed countries on the perspectives of carers regarding the oral hygiene toothbrushing practices of preschool children, through the lens of social practice theory. Methods: A search of the following electronic databases was conducted for all available years: MEDLINE, EMBASE and Global Health using the Ovid platform; Dentistry & Oral Sciences Source (DOSS), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus. Included qualitative studies reported primary caregivers' perceptions of oral hygiene practices (focusing on toothbrushing) in preschool children (0–5 years old) in developed countries. A thematic synthesis of the qualitative findings was undertaken for the results of each study. Results: Eleven articles were included in this meta‐synthesis. The focus of this paper was toothbrushing practices. A conceptual map of toothbrushing as a social practice was developed. Key findings included practice elements (meanings, competences, and materials), spatial and temporal aspects, and barriers and facilitators to performance. Conclusions: The application of a social practice lens to published qualitative research on the oral hygiene of preschool children provided insights into the meanings and competences related to toothbrushing, as perceived by primary caregivers. However, it also revealed limited information on material, spatial and temporal aspects of toothbrushing practices, indicating the importance of considering social practice theory as a framework in future research to address this gap. Furthermore, exploring toothbrushing in connection with related social practices has the potential to increase understanding of factors influencing oral health in preschool children. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Complex and chronic disease is placing significant pressure on hospital outpatient departments. Novel ways of delivering care have been developed recently and are often described as 'triage' services. This paper reviews the literature pertaining to definitions and descriptions of orthopaedic/musculoskeletal triage processes, in order to provide information on 'best practice' to assist health care facilities. Method A comprehensive open-ended search was conducted using electronic databases to identify studies describing models of triage clinics for patients with a musculoskeletal/orthopaedic complaint, who have been referred to hospital outpatient clinics for a surgical consultation. Studies were critically appraised using the McMaster quality appraisal tool and ranked using the National Health and Medical Research Council hierarchy of evidence. A thematic analysis of the definitions, processes and procedures of triage described within the literature was undertaken. Results 1930 studies were identified and 45 were included in the review (including diagnostic and evaluative research). The hierarchy of evidence ranged from I to IV; however, the majority were at low levels of evidence and scored poorly on the critical appraisal tool. Three broad themes of triage were identified: presence of a referral, configuration of the triage (who, how and where) and the aim of triage. However, there were significant inconsistencies across these themes. Conclusions This systematic review highlighted the need for standardization of the definition of triage, the procedures of assessment and management and measures of outcome used in orthopaedic/musculoskeletal triage to ensure best-practice processes, procedures and outcomes for triage clinics. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to conduct an integrative review on how nurses prepare families for and support families during withdrawal of life-sustaining treatments in intensive care. Background End-of-life care is widely acknowledged as integral to the practice of intensive care. However, little is known about what happens after the decision to withdraw life-sustaining treatments has been made and how families are prepared for death and the dying process. Design Integrative literature review. Data sources MEDLINE, CINAHL Plus, Psych INFO, PUBMED, Scopus, EMBASE and Web of Knowledge were searched for papers published between 2000-May 2015. Review methods A five stage review process, informed by Whittemore and Knafl's methodology was conducted. All papers were reviewed and quality assessment performed. Data were extracted, organized and analysed. Convergent qualitative thematic synthesis was used. Results From an identified 479 papers, 24 papers were included in this review with a range of research approaches: qualitative ( n = 15); quantitative ( n = 4); mixed methods ( n = 2); case study ( n = 2) and discourse analysis ( n = 1). Thematic analysis revealed the nurses: equipped families for end of life through information provision and communication; managed the withdrawal of life-sustaining treatments to meet family need; and continued care to build memories. Conclusion Greater understanding is needed of the language that can be used with families to describe death and dying in intensive care. Clearer conceptualization of the relationship between the medically focussed withdrawal of life-sustaining treatments and patient/family-centred end-of-life care is required making the nursing contribution at this time more visible. [ABSTRACT FROM AUTHOR]

Background: Person-centred approaches to practice are synonymous with effective healthcare. It is therefore important that the nursing workforce values, recognises and demonstrates person-centred practice. This has implications for nursing education and how curricula prepare students for personcentred practice. Aim: To conduct a meta-synthesis of person-centredness in nursing curricula. Method: Meta-synthesis. Results: The meta-synthesis included 48 papers. Four themes were identified: • Moving beyond mediocrity (dissatisfaction with current teaching and learning approaches, and a desire to enhance curricula to promote person-centredness) • Me, myself and I (promoting person-centredness in nursing curricula requires all participants in nursing education to have self-knowledge) • The curricular suitcase (nursing curricula have finite capacity so the inclusion of personcentredness is an essential requirement for the career journey) • Learning elevators (it is important to prioritise learning cultures and experiences that help students understand and enact person-centred practice) Conclusion: This study has found that nurse educators aspire to and are committed to the promotion of person-centred practice. Internationally, a range of pedagogies and curricular developments to promote person-centredness have been positively evaluated. However, there is generally a lack of conceptual clarity about the nature of person-centredness and no evidence of a systematic approach to whole-curriculum development that reflects the theoretical principles of person-centred practice. Implications for practice development: • Person-centred practice is a prominent concept in healthcare policy. If the future nursing workforce is to be prepared for person-centred practice then proficiency standards and nursing curricula should consistently reflect this • Nursing curricula need to be developed to encompass a breadth and depth of learning experiences in academic and practice settings, in order to optimise student learning about those issues that matter most to people in need of healthcare. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Boredom is a big issue on inpatient mental health wards that is linked to poor patient satisfaction, feelings of frustration and increased incidents of self‐harm and aggression.This is even more so for people detained under the Mental Health Act. Where wards have a good range of activities, for example art, music, computer games, gardening and exercise, service users felt less bored and had improved well‐being.Over many years, studies have reported a lack of activities, especially during evenings and weekends. It has also been found that little is known about what activities service users want, or how activities might be meaningful for them. What the paper adds to existing knowledge?: This review found that very few studies have asked service users about what activities would be useful and why.By seeing what makes activities desirable and accessible, we can understand how to improve the experiences of service users on wards.Overall, these data help to understand what impact activities (or lack of activities) have on service users and staff experiences on these wards. What are the implications for practice?: Through identifying the activities most appreciated and engaged with by service users and by asking service users what activities they would like available, we can inform best practice guidance for the commissioning and provision of inpatient mental health care.This will enable service provider organizations to target their effort and resources on supporting good practice and to redirect resources from less useful activities. Background: Concern about the lack of activities on mental health inpatient wards is long‐standing with reports consistently finding that service users receive insufficient access to a range of activities and report high levels of boredom. There is recognition that little is known about what service users want when admitted to inpatient wards. Aim: This review seeks to understand service users' experiences and views in relation to the provision and availability of activities, and to explore the perceived benefits and barriers to service users. Methods: We searched multiple databases (Scopus, MEDLINE, CINAHL, PsycINFO and Embase) for studies that evaluated activities on acute adult inpatient mental health wards. We identified 12 papers across a range of methodological designs from which the narrative synthesis has been analysed. Results: Findings show that the provision of activities is unsatisfactory for many service users, which in turn is related to increased boredom that has a negative impact on service users' well‐being. We explore the benefits and barriers to engagement, providing an insight into the aspects that make an activity important. Conclusion: There are few studies exploring the needs of service users regarding activity provision; therefore, there is limited knowledge about what is meaningful for individuals. [ABSTRACT FROM AUTHOR]

Aim. To understand nurses' perceptions and experiences of work role transitions. Background. Globally an uncertain healthcare landscape exists and when changing work roles nurses experience periods of transition when they may not cope well. A greater understanding of work role transitions may help facilitate workforce retention and successful careers. Design. Mixed methods systematic review. Data sources. Six data bases were searched for peer reviewed primary empirical research, published in English language between January 1990 and December 2014, supplemented by hand and citation searching. Review methods. Evidence for Policy and Practice Information and Co-ordinating Centre methods for systematic reviews principles were followed. Analysis and synthesis of the qualitative and quantitative papers was conducted separately using thematic analysis. A third synthesis combined the narrative findings and a narrative synthesis of results is presented. Results. Twenty-six papers were included. Across nurses' work role transitions two pathways were found: Novice and Experienced. 'Novice' comprises pre-registration and newly qualified nurses. 'Experienced' comprises, Enrolled/Licensed Practical Nurse to Registered Nurse, experienced to specialist nurse and clinical role changes. Each pathway results in different emphasizes of two themes; 'Striving for a new professional self' includes emotional upheaval and identity while 'Know how' includes competence and boundaries. Novice nurses are more susceptible to the extremes of emotional upheaval while experienced nurses' competence eases aspects of transitions while boundary issues pervade. Conclusion. Informed work and educational environments are required for all groups of nurses. Using existing models of transition can facilitate successful individual transitions and develop the workplace. [ABSTRACT FROM AUTHOR]

Purpose: Lung cancer patients are often stigmatized since lung cancer is closely associated with smoking, which is a self-administered life style. The stigma of lung cancer has been examined in some qualitative studies; however, their findings were diverse and not yet synthesized. Therefore, this meta-synthesis study aimed to explore how lung cancer patients experience stigma. Methods: A meta-synthesis method, as suggested by Sandelowski and Barroso in 2007, was applied by aggregating the findings after an evaluation according to consolidated criteria for reporting qualitative research (COREQ). Results: By synthesizing the findings of the selected seven papers, a synthesized theme was emerged as “experiencing external and internal distances, which mandates authentic and consistent supports.” The four sub-themes included ‘experiencing some distance from the surrounded world,’ ‘experiencing self-made distance between the disease and oneself,’ ‘the disease experience causes social isolation and loneliness,’ and ‘there is lack of supportive care for myself.’ Conclusion: Health care providers should be more attentive to supporting lung cancer patients by providing more effective advocacy programs that improve patients’ quality of life. [ABSTRACT FROM AUTHOR]

Objective: To identify healthcare professionals' perceived barriers and facilitators to clinical practice guideline implementation within stroke rehabilitation. Data sources: CINAHL, MEDLINE, EMBASE, AMED, Cochrane library, Academic Search Complete and Scopus. Additional papers were identified through hand searching. Review methods: The review followed the Preferred Reporting Item for Systematic Reviews and Meta-Analysis Protocols systematic review approach. Any empirical research that provided qualitative data on healthcare professionals' perceived factors influencing clinical guideline implementation in stroke rehabilitation was included. One reviewer screened all titles and abstract reviews (n = 669). Another two reviewers independently screened 30% of title and abstract reviews, followed by full-text reviews (n = 61). Study quality was assessed using the mixed-method appraisal tool. Results: Data from 10 qualitative, six quantitative and six mixed-method studies published between 2000 and 2022, involving 1576 participants in total, were analysed and synthesised using modified thematic synthesis approach. The majority of participants were therapists n = 1297 (occupational therapists, physiotherapists, speech and language therapists). Organisational factors (time constraints, resources) alongside healthcare professionals' lack of knowledge and skills were the most cited barriers to guideline implementation. Contradictory attitudes and beliefs towards stroke guidelines applicability to real-life clinical practice and their evidence base were reported. Organisational support in the form of training, local protocols, performance monitoring and leadership were reported as perceived facilitators. Conclusion: Barriers and facilitators are multifactorial and were identified at guideline, individual, team and organisational levels. There is a need to translate perceived barriers and facilitators into implementation interventions especially addressing organisational-level barriers. [ABSTRACT FROM AUTHOR]

Children who grow up in homes affected by domestic violence and abuse (DVA) are at risk of poor outcomes across the lifespan, yet there is limited evidence on the acceptability and effectiveness of interventions for them. A recent review of child‐focused interventions highlighted a gap in understanding the factors influencing the willingness of parents and children to engage with these programmes. We conducted a systematic review of qualitative evidence on the experiences of receiving and delivering interventions with the aim of identifying factors at different levels of the social–ecological context that may influence parent and child readiness to take up interventions. We searched literature till April 2016 and found 12 reports of eight programmes. Two authors independently screened papers for inclusion, extracted data and identified the first‐ and second‐order constructs. The third‐order constructs were derived and fitted to the ecological framework to inform a picture of readiness to engage with interventions. Three key findings emerged from this review: (a) parent and child readiness is influenced by a complex interplay of individual, relationship and organisational factors, highlighting that individual readiness to take up child‐focussed interventions must be viewed in an ecological context; (b) the specific process through which women become ready to engage in or facilitate child‐focussed interventions may differ from that related to uptake of safety‐promoting behaviours and requires parents to be aware of the impact of DVA on children and to focus on children's needs; (c) there are distinct but interlinked processes through which parents and children reach a point of readiness to engage in an interventions aimed at improving child outcomes. We discuss the implications of these findings for both practice and research. [ABSTRACT FROM AUTHOR]

Objective: To synthesise how post-stroke sexuality is experienced by stroke survivors and partners of stroke survivors. Methods: MEDLINE, PubMed, SCOPUS, CINAHL and PsycINFO were searched from inception to May 2018 using a combination of relevant Medical Subject Headings and Free Text Terms. Only papers published in English reporting original qualitative research were included. Methodological quality was assessed using the Critical Appraisal Skills Programme Qualitative Research Checklist. All text presented as 'results' or 'findings' in the included studies was extracted and subjected to a thematic analysis and synthesis which was discussed and agreed by the research team. Results: The initial search yielded 136 unique papers with a further 8 papers identified through reference checking. Following full-text review, 43 papers were included in the final synthesis. Two analytical themes were identified: sexuality is silenced and sexuality is muted and sometimes changed, but not forgotten. These themes were made up of six descriptive themes: struggle to communicate within relationships, health professionals don't talk about sexuality, sexuality and disability is a taboo topic, changes to pre-stroke relationships, changed relationship with the stroke survivor's own body and resuming sexual intimacy – adaptation and loss. Conclusion: Stroke has a profound impact on how sexuality is experienced by both stroke survivors and partners of stroke survivors. Despite this, post-stroke sexuality is rarely discussed openly. Stroke survivors and partners value sexuality and may benefit from strategies to support adjustment to post-stroke sexuality. [ABSTRACT FROM AUTHOR]

Aims: To synthesise the existing literature, which focuses on the impact of critical incidents on nurses and midwives, and to explore their experiences related to the support they received in the current healthcare environment to move on from the event. Design: Systematic review and qualitative synthesis. Data sources: The electronic databases CINAHL, MEDLINE, PsycINFO, PubMed, Embase and Nursing and Allied Health (ProQuest) were systematically searched from 2013–2018, and core authors and journals identified in the literature were manually investigated. Review methods: Qualitative studies of all research design types written in English were included according to the PRISMA reporting guidelines. The methodological quality of included studies was evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Results: A total of 7,520 potential publications were identified. After removal of duplicate citations, study selection and appraisal process, 11 qualitative primary research papers progressed to the meta‐synthesis by meta‐aggregation. The 179 findings and sub‐findings from the included studies were extracted, combined and synthesised into three statements addressing three different aspects within the context of critical incidents: the experiences of the impact, the perceptions of support and the ability to move on. Conclusion: This review illuminated that moving‐on after critical incidents is a complex and wearisome journey for nurses and midwives. More attention should to be drawn to second victims within general nursing and midwifery practice to strengthen their ability to navigate the aftermath of critical incidents and reclaim the professional confidence indispensable to remain in the workforce. [ABSTRACT FROM AUTHOR]

Aim: To explore the attitudes and experiences of allied health students working with older adults on residential aged care placements. Method: A systematic literature search was conducted to identify studies of any design describing allied health student experience of residential aged care placements. Online databases searched to identify potentially relevant documents included Scopus, Web of Science, PubMed, CINAHL Complete (EBSCOhost) and Health and Medicine (ProQuest). Studies were excluded if residential aged care facilities or allied health professional students could not be extracted from the data. No restrictions were applied to methodological design, language, geographical location or year of publication. The Mixed Methods Appraisal Tool was used to assess methodological quality. Extracted studies were analysed to identify the study design, participant and placement characteristics, study methodology and student experience measures. Data from the included studies were analysed thematically using meta‐synthesis. Results: Six studies (total number of participants, n = 308) met inclusion criteria, with four papers scoring a 5/5 on the Mixed Methods Appraisal Tool. Studies included undergraduate and master's students from physiotherapy (n = 3), speech language pathology (n = 2), dietetics (n = 1) and audiology (n = 1). Placement length varied from two to 15 h, between one and six residential aged care visits. Three themes were identified; (1) Opportunity to improve skills and gain confidence, (2) Development of empathy and shift in attitudes towards older adults and (3) Recognised challenges associated with older adults and residential aged care settings. Conclusion: While the size of the evidence‐base is limited, the studies were largely consistent in demonstrating an increase in positive attitudes towards older adults following residential aged care placements. Future research, innovations and planning around workforce size, preparation and motivation must be prioritised to ensure older adults receive the care they need and deserve. [ABSTRACT FROM AUTHOR]

The nursing profession comprises Australia's largest regulated health workforce yet its practice boundaries are poorly understood. The ambiguity surrounding the practice scope of nurses limits the profession's ability to fully respond to Australia's current and emerging health system challenges. The aim of this review is to explore the concept of scope of practice of registered nurses (RN) in Australia, as reflected in contemporary literature. An integrative review of literature relating to the scope of practice of the Australian registered nurse published between 2007 and 2014 was conducted. Twenty primary papers and nine secondary source papers were included in the review. Themes that arose from the analysis are: Scope of practice – an elusive concept; Scope of practice and context; Scope of practice and boundaries; and Scope of practice and advanced practice. Discussion of these themes includes consideration of the professional, legal and ethical significance of scope of practice for the RN, as well as the legislative, professional and contextual influences on, and challenges to, defining scope of practice at both a professional and individual level. For the Australian registered nursing workforce to continue to be a significant and influential contributor to Australia's dynamic healthcare context, a clearly articulated scope of practice is both necessary and overdue. [ABSTRACT FROM AUTHOR]

Background: patient and public involvement (PPI) in research can enhance its relevance. Older care-home residents are often not involved in research processes even when studies are care-home focused. Objective: to conduct a systematic review to find out to what extent and how older care-home residents have been involved in research as collaborators or advisors. Methods: a systematic literature search of 12 databases, covering the period from 1990 to September 2014 was conducted. A lateral search was also carried out. Standardised inclusion criteria were used and checked independently by two researchers. Results: nineteen reports and papers were identified relating to 11 different studies. Care-home residents had been involved in the research process in multiple ways. Two key themes were identified: (i) the differences in residents' involvement in small-scale and large-scale studies and (ii) the barriers to and facilitators of involvement. Conclusions: small-scale studies involved residents as collaborators in participatory action research, whereas larger studies involved residents as consultants in advisory roles. There are multiple facilitators of and barriers to involving residents as PPI members. The reporting of PPI varies. While it is difficult to evaluate the impact of involving care-home residents on the research outcomes, impact has been demonstrated from more inclusive research processes with care-home residents. The review shows that older care-home residents can be successfully involved in the research process. [ABSTRACT FROM AUTHOR]

Objective: Systematic reviews of mistletoe therapy (MT) trials in cancer show promising results in improvement of patients' quality of life during chemotherapy and reduction of fatigue. However, patients' experiences of side effects and the acceptability, tolerability, and perceived benefits of MT have not been systematically reviewed. The aim of this study was to systematically review and synthesise the results of qualitative studies of cancer patients' experiences of using MT. Design: A systematic search was conducted in MEDLINE, Embase, PsychLIT, CINAHL, and AMED to identify qualitative studies of MT. Articles were screened independently by two reviewers and critically appraised using the Critical Appraisal Skills Programme tool. A thematic synthesis of the findings was carried out. Results: One hundred and seventy-three papers were identified; 156 were excluded at initial screening. Seventeen papers were read in full, 14 of which were excluded. Three articles about patients' experiences of MT alongside conventional treatment were included in the synthesis, either as a monotherapy (two articles) or as part of a package of anthroposophic treatment (one article). Patients reported demonstrable changes to their physical, emotional, and psychosocial well-being following MT, as well as a reduction in chemotherapy side effects. Self-reported side effects from MT were few, and the studies suggest good adherence to the therapy. Self-injection gave patients a sense of empowerment through involvement in their own treatment. Conclusions: A systematic search revealed a small number of qualitative studies of MT in cancer. These were effectively combined to provide a detailed overview of patients' experiences in order to complement the developing evidence base from trials. Given the variation in context of MT delivery across the articles, it is not possible to ascribe changes in patients' quality of life specifically to MT. The results of this review will help in the design of outcome measures that more fully capture patients' experiences. It is essential to embed qualitative research of patients' experiences of MT and other CAM therapies within future trials. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to describe case management as experienced by patients with heart failure and their health professionals with the aim of understanding why case management might contribute in reducing hospital admissions. Background: Heart failure is a common cause of unplanned hospital admission. The evidence for case management in patients with heart failure for reducing admissions is promising. Design: Systematic review and qualitative evidence synthesis. Data source: Searches were conducted in Medline, Psychinfo, Kings Fund database and Cinahl from inception of each database to 16 February 2017. Review methods: Robust systematic review methodology was used to identify qualitative studies describing the experiences of patients with heart failure and healthcare providers of case management. Data were synthesized thematically, and analytic themes were developed. Findings: Five studies (six papers) from which nine descriptive themes were used to determine three analytic themes. This synthesis showed that case management provides positive quality of care for patients, increases perceived access to services and creates more time to ask questions and develop trusted relationships. For health professionals, case management enhanced care by improved relationships with both patients and colleagues although concerns remained around resources, training and inter-professional conflict. Conclusions: This synthesis emphasizes the importance of the quality of being cared for as a patient and caring as a health professional. Case management enhances communication between patients and health professionals, supports patient self-care and self-management and can be an important contributing factor in reducing unplanned admissions for patients with heart failure. [ABSTRACT FROM AUTHOR]

Introduction Health professionals are frequently exposed to traumatic events due to the nature of their work. While traumatic and adverse labour and birth events experienced by women are well researched, less attention has been given to midwives' and nurses' experiences of these events and the impact it has on their lives. Aims and objectives To undertake a meta-ethnographic study of midwives' and nurses' experiences of adverse labour and birth events. Methods Scopus, CINHAL PLUS, MEDLINE and PUBMED databases were searched using subject headings and keywords. The search was limited to papers published in peer-reviewed journals from 2004-October 2016. Quality appraisal was undertaken using the Critical Appraisal Skills Programme tool. Inclusion criteria Papers had to be qualitative or have a substantial qualitative component. Studies were included if they primarily focused on midwives' or nurses' perspectives or experiences of complicated, traumatic or adverse labour and birth events. Analytic strategy A meta-ethnographic approach was used incorporating methods of reciprocal translation guided by the work of Noblit and Hare (1988, Meta-Ethnography: Synthesizing qualitative studies (Vol. 11). Newbury Park: Sage publications). Findings Eleven qualitative studies were included in the final sample. Four major themes were (i) feeling the chaos; (ii) powerless, responsible and a failure; (iii) 'It adds another scar to my soul'; and (iv) finding a way to deal with it. Conclusion Midwives and nurses feel relatively unprepared when faced with a real-life labour and birth emergency event. While many of the midwives and nurses were traumatised by the experience, some were able to view their encounter as an opportunity to develop their emergency response skills. Relevance to clinical practice Witnessing and being involved in a complicated or adverse labour and birth event can be traumatic for nurses and midwives. Organisational and collegial support needs to be available to enable these health professionals to talk about their feelings and concerns. [ABSTRACT FROM AUTHOR]

Background The indication for implantable cardioverter-defibrillators (ICDs) to prevent sudden death is now consolidated. However, there is no unanimous agreement on how patients experience certain aspects of their lives after an ICD implant. Various clinical studies have evaluated the impact of ICDs on patient mortality, survival, and their beneficial effects. Given the growing number of qualitative studies, a synthesis of qualitative evidence became desirable. Aims To explore and synthesize the results of qualitative studies addressing the experiences of patients with an ICD. Methods We employed a systematic review and meta-synthesis. PubMed, CINAHL, and PsycINFO were systematically searched to identify qualitative studies published between January 2005 and October 2020, which investigate the experience of patients living with an ICD. Selected studies were assessed for quality by two reviewers independently. Results A total of 24 papers were selected. Six themes emerged: fear and insecurity, the need for information, new impacts on life, living with ICD shocks, gender differences, and the role of the family. These results could help clinicians and researchers to develop new strategies and interventions to improve the quality of life in these patients. Conclusion This meta-synthesis underlines the difficulties experienced by patients with ICD implants. Despite the advanced therapeutic management programmes for this type of intervention, it is necessary to adopt and implement the current post-discharge care plans, where the family's involvement is essential to help patients adapt to their new lifestyle. [ABSTRACT FROM AUTHOR]

Background: Mindfulness‐based Cognitive Therapy (MBCT) is a relapse‐prevention intervention for people experiencing major depression. Three qualitative meta‐syntheses investigating experiences of taking part in MBCT and/or Mindfulness‐based Stress Reduction (MBSR) across different diagnostic populations reported themes including control, choice, group processes, relationships and struggles. As multiple studies have been published since, we aimed to update, systematically review and synthesize the experiences of participants with depression taking part in MBCT. Methods: Four databases were searched systematically (PsycInfo, Web of Science, Medline and CINAHL) up to and including 12 November 2021. Twenty‐one qualitative studies met the review criteria. All papers were rated as fair using a quality appraisal tool. Meta‐ethnography was applied. Results: Across 21 studies of participants with current or previous depression who had participated in MBCT, three overarching themes were developed: 'Becoming skilled and taking action', 'Acceptance' and 'Ambivalence and Variability'. Participants became skilled through engagement in mindfulness practices, reporting increased awareness, perspective and agency over their experiences. Participants developed acceptance towards their experiences, self and others. There was variability and ambivalence regarding participants' expectations and difficulties within mindfulness practices. Limitations: Many studies were conducted in MBCT‐research centres that may hold conflicts of interest. Many studies did not address the impact of the participant–researcher relationship thus potentially affecting their interpretations. Studies were skewed towards the experiences of female participants. Conclusions: Our findings help to enhance participant confidence in MBCT, alongside understanding the processes of change and the potential for difficulties. MBCT is beneficial and provides meaningful change for many but remains challenging for some. [ABSTRACT FROM AUTHOR]

Background. Freebirthing or unassisted birth is the active choice made by a woman to birth without a trained professional present, even where there is access to maternity provision. Aim. To integrate the findings of the current literature on the phenomenon of freebirthing, asking the question: ‘Why do some women choose to freebirth?' Design. A metasynthesis was carried out based upon Noblit and Hare’s (1988) meta-ethnography. Searches were carried out in March 2013 and updated in March 2014 using 15 key databases. Inclusion criteria were applied: primary qualitative work, in English, focusing upon women who had freebirthed intentionally. A quality appraisal was carried out. This paper reports the findings from international studies, as there were no studies based on a UK population. Findings and key conclusions. Four studies were found that incorporated data collected from 272 women. The studies identified were based in the US (n=3) and in Australia (n=l). Four key themes were generated: rejection of the medical and midwifery models of birth; faith in the birth process; autonomy; and agency. There was a prevailing sense of opting to freebirth in order to retain choice, control and autonomy over their bodies during the birth process. Implications for practice. For some, within their particular context of maternity provision, the biomedical model of childbirth is clearly not acceptable, therefore, it is important practitioners identify and address women's bio-psychosocial needs. Even the midwifery model of childbirth is apparently not satisfactory, suggesting the gulf between the midwifery philosophy of care and that which is currently practised needs attention. For some women, a previous negative experience with maternity care provision motivated their decision to freebirth. It is, therefore, important that maternity service providers improve the quality of care provision so women feel dignified, supported, and are participatory in the care that they receive. A UK-based study is being undertaken in order to establish the motivations of women who choose to freebirth in the UK. [ABSTRACT FROM AUTHOR]

Introduction: Graduate attributes are the personal qualities, skills and competencies, and values that students develop during their time at university to prepare them for work, and enable them to contribute to their communities. Occupational therapy education may foster well‐rounded individuals if the development of graduate attributes is embedded within curriculum design and delivery. Methods: This study identifies and synthesises existing knowledge on how graduate attributes are embedded in occupational therapy curricula. We conducted a scoping review following PRISMA extension for scoping review guidelines, and a qualitative research synthesis to reach a new conceptual understanding of the process of developing desired graduate attributes during occupational therapy curriculum development. Results: Ten discipline‐specific occupational therapy graduate attributes were identified. Three themes from the analysis of 15 papers explained how these attributes are embedded in curricula: Using a theoretical framework, a Graded process of active learning, and Collaborative curriculum design. Conclusion: Occupational therapy education is enhanced by being explicit about the desired graduate attributes that underpin curriculum design and delivery. Further work is needed to understand the benefits of including service users' perspectives and the value of clinical fieldwork education. [ABSTRACT FROM AUTHOR]

There is a significant diversity in approach to 'resilience' in the context of mental health recovery following experiences of psychosis, varying from clinically measurable outcomes to a personal trait within a recovery 'journey'. Given the contested nature of resilience within mental health literature, this study aimed to complete a scoping review to synthesise understandings of resilience by individuals with experiences of psychosis. Drawing on the holistic and person-centred principles that underpin social work approaches to mental distress, these perspectives are considered in the statutory, policy and critical contexts of British social work, establishing learning for practice. A meta-synthesis of qualitative studies was completed, drawing on searches of five databases (Social Care Online, APA PsychInfo, Cinahl, Medline and Web of Science), identifying twelve relevant papers. A thematic analysis identified three overarching themes (personal, social and professional factors) and eight associated sub-themes (personal responsibility, use of experience, coping strategies, peer support, social relationships, contribution, relationships with professionals and structured support). The study identifies systemic and life-course approaches as empowering service user engagements with psychosis, recovery and resilience, suggesting that the social work profession is well placed to engage with resilience enhancement in the context of mental health recovery. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis (MS) is a chronic serious condition of uncertain course and outcome. There is relatively little literature on the experiences of people who live with a person with MS. They inhabit a locus of care that spans caring for (a relational act) and caring about (a moral stance, addressing fairness, compassion and justice) the person with MS. Methods: Using the theoretical lens of personhood, we undertook a scoping review and meta‐synthesis of the qualitative literature on the experiences of people who live with a person with MS, focusing on the nature of, and constraints upon, caring. Results: Of 330 articles, 49 were included in the review. We identified five themes. One of these—seeking information and support—reflects the political economy of care. Two are concerned with the moral domain of care: caring as labour and living with uncertainty. The final two themes—changing identities and adapting to life with a person with MS—point to the negotiation and reconstitution of personhood for both the person with MS and the people they live with. Conclusion: People with MS are embedded in relational social networks of partners, family and friends, which are fundamental in the support of their personhood; the people who live with them are 'co‐constituents of the patient's identity' assisting them to make sense of their world and self in times of disruption due to illness. Support services and health care professionals caring for people with MS are currently very much patient‐centred; young people in particular report that their roles are elided in the health system's interaction with a parent with MS. There is a need to look beyond the person with MS and recognize the relational network of people who surround them and broaden their focus to encompass this network. Patient and Public Involvement: Our research team includes four members with MS and two members with lived experience of living or working with people with MS. A third person (not a team member) who lives with a partner with MS provided feedback on the paper. [ABSTRACT FROM AUTHOR]

Assistive technology can provide a key tool to enabling independence, greater inclusion and participation in society for individuals with chronic conditions. This potential is currently not always realized due to barriers to accessing and using assistive technology. This review aims to identify the common barriers to acquiring and using assistive technology for users with chronic conditions through a systematic meta-synthesis. This differs from other systematic reviews by applying a transdiagnostic approach to identify if barriers are common across chronic conditions. A systematic literature search of five scientific databases (PubMed, SCOPUS, PsycINFO, CINAHL and Medline) was conducted to identify relevant qualitative studies. The search was conducted in November 2019. For the identified articles, thematic content analysis was conducted and the methodological quality was evaluated using the Critical Appraisal Skills Programme (CASP) checklist for qualitative research. Forty papers met the inclusion criteria and were included in the analysis. Fifty-one descriptive themes grouped into six overarching analytical themes were identified from the studies. The analytical themes identified were: the design and function of the assistive technology, service provision, information and awareness, psychological barriers, support network and societal barriers. The barriers are interconnected and common across different health conditions. More involvement in personalized care for developing strategies, adaptation of home technologies and provision of assistive technology could overcome the service provision and design barriers to assistive technology. Accessible information and providing greater awareness will be important to overcoming information, psychological and societal barriers to assistive technology. Individuals with chronic conditions face complex barriers to acquiring and using assistive technology as a result of the devices themselves, their individual context, the healthcare context where assistive technology is provided and wider societal barriers. The provision of assistive technology needs to change away from the traditional medical model of the "expert" clinician and instead focus on more user involvement to deliver personalised care that utilises the users lived knowledge and experiences. Assistive technology provision should be considered alongside how to adapt everyday mainstream technology to meet user needs; the provision of devices should encourage creative problem solving rather then relying on pre-defined prescription lists of assistive technology. [ABSTRACT FROM AUTHOR]

Purpose: Health professionals view falls after stroke as common adverse events with both physical and psychological consequences. Stroke survivors' experiences are less well understood. The aim of this systematic review was to explore the perception of falls-risk within the stroke recovery experience from the perspective of people with stroke. Methods: A systematic literature search was conducted. Papers that used qualitative methods to explore the experiences of individuals with stroke around falls, falls-risk and fear of falling were included. Two reviewers independently assessed the methodological quality of papers. Meta-ethnography was conducted. Concepts from each study were translated into each other to form theories that were combined through a "lines-of-argument" synthesis. Results: Four themes emerged from the six included qualitative studies: (i) Fall circumstances, (ii) perception of fall consequences, (iii) barriers to community participation and (iv) coping strategies. The synthesis revealed that stroke survivors' perceived consequences of falls exist on a continuum. Cognitive and emotional adjustment may be required in the successful adoption of coping strategies to overcome fall-related barriers to participation. Conclusions: Stroke survivors' fall-related experiences appear to exist within the context of activity and community participation. Further research is warranted due to the small number of substantive studies available for synthesis. Implications for Rehabilitation: Health care professionals should recognize that cognitive and emotional adjustment may berequired for stroke survivors to accept strategies for overcoming falls-risk, including dependenceon carers and assistive devices. Several factors in addition to physical interventions may be needed to minimize falls-risk whileincreasing activity participation. These factors could include increasing public awareness about the effects of stroke and falls-risk,and ensuring access to psychological services for stroke survivors. Rehabilitation professionals should reflect on whether they perceive there to be an appropriatelevel of fear of falling post-stroke. They should understand that stroke survivors might not conceptualize falls-risk in this way. [ABSTRACT FROM AUTHOR]

Objectives: The optimal care of people with dementia in general hospitals has become a policy and practice imperative over recent years. However, despite this emphasis, the everyday experience of staff caring for this patient group is poorly understood. This review aimed to synthesise the findings from recent qualitative studies in this topic published prior to January 2014 to develop knowledge and provide a framework to help inform future training needs. Method: A systematic search of the literature was conducted across five academic databases and inclusion/exclusion criteria applied to the retrieved papers. A meta-ethnographic approach was utilised to synthesise the resulting 14 qualitative papers. Results: Five key themes were constructed from the findings: overcoming uncertainty in care; constraints of the environmental and wider organisational context; inequality of care; recognising the benefits of person-centred care; and identifying the need for training. These themes explore the opportunities and challenges associated with caring for this group of patients, as well as suggestions to improve staff experiences and patient care. Conclusion: The synthesis highlighted a lack of knowledge and understanding of dementia within general hospital staff, particularly with regard to communication with patients and managing behaviours that are considered challenging. This limited understanding, coupled with organisational constraints on a busy hospital ward, contributed to low staff confidence, negative attitudes towards patients with dementia and an inability to provide person-centred care. The benefits of dementia training for both ward staff and hospital management and peer discussion/support for ward staff are discussed. [ABSTRACT FROM AUTHOR]

This paper presents a meta-synthesis of the literature on community-based self-management to support experiences of people diagnosed with type 2 diabetes. The aim was to synthesise findings on both formal and informal self-management support with particular reference to the relevance and influence of the social context operating at different levels. The review forms part of EU- WISE, a project financed through EU's 7th Framework Programme. The review was performed by systematically searching MEDLINE, PubMed, EMBASE, CINAHL, Psyc INFO and Web of Science for English language publications between 2005 and 2014 presenting research conducted in Europe on the experiences and perspectives of self-management concerns of patients diagnosed with type 2 diabetes. The search yielded 587 abstracts, which were reduced through search strategy refinement and eligibility and quality criteria to 29 papers that were included in the review. This review highlights the relevance of contextual factors operating at micro- and macro-levels. The synthesis yielded six second-order thematic constructs relating to self-management: sense of agency and identity, the significance and meaning of social networks, minimal disruption of everyday life, economic hardship, the problem of assigning patients' responsibility and structural influences of primary care. Using a line of argument synthesis, these themes were revisited, and a third-order construct, connectivity emerged which refers to how links in daily life are interwoven with peoples' social networks, local communities, economic and ideological conditions in society in a way which support self-management activities. This meta-synthesis indicates a need to heed the notion of connectivity as a means of mobilising and supporting the self-management strategies of people with type 2 diabetes in everyday life. [ABSTRACT FROM AUTHOR]

Aim: To identify the symptoms and quality of life impacts that are important from the perspective of patients with varicose veins and to compare identified themes to items in varicose vein patient‐reported outcome measures (PROMs). Background: Varicose veins are common worldwide and are considered a chronic condition with implications for quality of life. Treatment is predominantly conservative; therefore, understanding patients' experiences of living with varicose veins is important to inform the provision of clinical care. PROMs are often used to collect data about patients' quality of life. Design: Thematic synthesis of qualitative research reported according to ENTREQ guidelines. Methods: Multiple electronic databases, including MEDLINE and CINAHL, were systematically searched to identify qualitative research examining experiences of adults with varicose veins. Thematic synthesis was then conducted on the included studies. Results: Three studies met the inclusion criteria; the quality of the studies was high. The range and intensity of reported symptoms and participant's experiences of living with varicose veins were varied. Five overarching themes were identified: physical, psychological and social impact of varicose veins, adapting to varicose veins and reasons for seeking treatment. The overall key theme to emerge was adaptation, with patients demonstrating how they adapted to the various impacts. Conclusion: This review demonstrates that varicose veins have a wide range of symptoms and may have a significant impact on quality of life; people made significant adaptations to enable them to live their lives as fully as possible. Relevance to Clinical Practice: Healthcare professionals need to be aware of the range of symptoms and their impact on quality of life. The use of PROMs to gather information about quality of life and symptoms is well established globally; however, PROMs currently used may not capture the full extent of the impact on patient's quality of life. [ABSTRACT FROM AUTHOR]

Refugees and asylum seekers often experience violent conflict, profound loss, and exposure to physical, sexual, and relational traumas. Psychotherapy approaches that involve the body and movement can address embodied trauma and other mental health concerns with culturally and linguistically adaptable interventions. This meta-synthesis examines 11 qualitative and case studies published since 2014 on the use of body-based interventions with refugees. The synthesis employs meta-ethnographic methodology and identifies themes related to three categories: considerations for clinicians and treatment, intervention elements, and reported therapeutic outcomes. Themes for clinicians and treatment included: cultural competence, language barriers, attending and attunement, and barriers to treatment. Intervention elements emphasised in the studies were safety, ritual, metaphor, and embodiment, while reported therapeutic outcomes consisted of here and now presence, freedom of expression, increased bodily awareness, improved physical health, and improved emotional experiencing. Suggestions for future research and clinical practice conclude the paper. [ABSTRACT FROM AUTHOR]

The article discusses a metasynthesis approach to measure the sexual and reproductive health of people with physical disabilities in various developed and developing countries from 1995 to 2011. It mentions the emergence of four themes in the study such as reproductive health, sexual attractiveness, sexual health knowledge and sexual health issues. The research states a model to explain the internal and external factors in the reproductive and sexual life of people with physical disabilities.

Aim: This systematic review was conducted to provide a deeper understanding of male nurses' motivations for choosing nursing as a profession. Methods: A systematic literature review of qualitative data was conducted. CINAHL, Pubmed, PsychINFO, Pubmesh, and Embase were searched from January 1970 to December 2013. Qualitative studies which described male nurses' motivations for choosing nursing were selected. Data collection and analysis: Relevant data were extracted from the included papers and were coded and then synthesised under four main themes. Results: Four main themes were identified which described male nurses' motivations for choosing nursing; 'Early exposure to nursing and other health care professionals', 'Choosing nursing as a profession by chance', 'Choosing nursing because of extrinsic motivating factors', and 'Choosing nursing because of intrinsic motivating factors'. Conclusions: To help encourage more men to enter and remain in nursing, recruitment and retention strategies need to focus on addressing the gender stereotypes associated with the nursing profession. [ABSTRACT FROM AUTHOR]

Objective The use of self-practice and self-reflection has been proposed as an efficacious strategy in the training of therapists. It has been argued to enhance therapist skills, and a key factor in the development of expertise. This systematic literature review investigated the effect of self-practice and self-reflection on therapist skills development. Method Studies were identified through Medline, Academic Search Complete, PsychINFO, PsycARTICLES, Proquest, ISI, CINAHL, Cochrane, and Scopus databases. Additional studies were identified through lateral searches of relevant papers' reference lists and direct correspondence with authors of unpublished material. The selection criteria were studies that investigated the effect of self-practice and/or self-reflection on therapist skill development. There was no restriction on sample sizes, design of studies, dates of publication, or peer-reviewed papers. All studies were published in English. Results Ten studies were included in this review. A thematic analysis was undertaken to analyse qualitative data. Due to inconsistency in the variables investigated across the quantitative studies, quantitative results were not subject to a meta-analysis but simply reported. Finally, qualitative and quantitative data were juxtaposed in a meta-synthesis. Conclusion The meta-synthesis revealed inconsistencies between the qualitative and quantitative literature and a gap in relation to declarative knowledge. Methodological limitations across studies are discussed and recommendations for future research provided. [ABSTRACT FROM AUTHOR]

Aim To examine qualitative research exploring older people's experiences of falling and the perceived risk of falling in the community. This will contribute new insights into how falling is perceived by the older community. Background Falls are a major problem for older people and healthcare services across the world. Accidental falls in the community are a persistent problem that is generally recognised as an intrinsic risk of ageing. This review provides a new synthesis of evidence that considers older people's perception of falls in the community as new insights are needed if the increasing problems of falls are to be addressed. Design Synthesis of the qualitative literature employing Noblit and Hare's method of reciprocal translation. CINAHL, Medline, EMBASE, Psych INFO and BNI were searched 1999-2015. Methods Noblit and Hare's method of reciprocal translations was used to conceive this meta-ethnographic synthesis. The ENTREQ statement was employed as a tool for reporting the synthesis of qualitative research. The PRISMA statement was used for reporting the different phase of the literature search, and the Critical Appraisal Skills Programme qualitative research checklist was used as an appraisal framework. Results Eleven papers fit the inclusion criteria and revealed a series of themes. These were falls as a threat to personal identity, falls as a threat to independence, falls as a threat to social interaction and carefulness as a protective strategy. Conclusion Many older people reject the label of 'at risk of falling' because of the perceived implication of dependency and incompetence. To be considered 'at risk' of falling is perceived as threatening the identity of individuals who are comfortable maintaining their own independence. However, there are also those who accept the risk of falling and in doing so choose carefulness as a personal strategy to manage the risk. For the majority of older people, maintaining independence is the key motivator influencing their actions. Independence to pursue social interaction safeguards against loss of identity, social isolation and negative feelings of dependency. Falling in the community is a problem that persists, despite intervention of local health teams. This article contributes to a body of evidence on older people's experience of falling in the community with the aim of providing new insights for nurses as they approach the issues with patients. Implications for practice Management of falls risk improves through constructive, proactive health behaviour. Promoting a positive attitude towards living well encourages older people to engage in healthy, risk reducing behaviours. Older people reject the designation of 'at risk of falling' due to a perceived association with dependency and incompetence. The negative association is a barrier to engaging at-risk populations with fall prevention interventions. [ABSTRACT FROM AUTHOR]

Aims: To understand factors influencing the experience of carers for people with dementia, when that person moves from living in the community to living in residential care. Specifically, we aimed to identify facilitators and inhibitors of carer adjustment during this transition. Method: A systematic search of CINAHL, EMBASE, PubMed, and PsycINFO databases was conducted. Nine qualitative articles published between 2001 and 2017, based on the experiences of 141 carers, were included. Thematic analysis was applied to the data, with the concepts of transition inhibitors and facilitators being used to structure the analytic process. Results: Analysis produced five themes, representing factors that could affect carer experiences of the focal transition-process: modifying the difficulty of this process according to their presence or absence. The themes were (1) Connection, pertaining to the carer feeling connected to the person with dementia and professionals during this transition; (2) Informed & Informing, relating to exchange of information between the carer and facility staff or health professionals; (3) The facility: welcoming & skilful, dealing with carer perceptions of the facility and their confidence in the staff; (4) It's What You Make of It, discussing the meaning the carer made of the admission and the impact this had; and (5) Sharing Responsibility, addressing how carers were affected by the perceived sharing of responsibility for care-provision. Conclusions: A supportive network has a significant role to play in facilitating this transition for carers. However, further research into what carers would find useful during this time is needed. [ABSTRACT FROM AUTHOR]

Aims: To identify and synthesize the available evidence of youths with asthma and their experience of self‐management education. Design: Systematic literature review of qualitative studies with meta‐synthesis of findings. Data sources We searched five databases, CINAHL Complete, Embase, MEDLINE (EBSCO) PsycINFO, ASSIA and the Global Index Medicus (formerly the WHOLIS). Initial search in September 2019 and updated in July 2020 and July 2022. Review Methods: The systematic review was conducted in accordance with the JBI methodology for systematic reviews of qualitative evidence. Qualitative data were extracted, meta‐summarized and then meta‐synthesized. Results: Eighteen studies were identified for inclusion in this review and three themes were identified: The theory and practice gap, contemporary health‐seeking preferences and the psychosocial impacts of living with asthma. Conclusion: The needs of youths with asthma are specific and must be measurable against the change in asthma outcomes for this group. They have unmet self‐management educational needs that stakeholders, involved in their care and support, should address. Education and practice policy should focus on youth‐centric approaches. Through meaningful engagement with youths, stakeholders can identify their support needs, requirements and preferences to successfully underpin the theory and practice of self‐management education. Impact This review synthesized evidence of youths with asthma and their experiences of self‐management education, highlighting their specific self‐management information needs. The findings highlight several implications for healthcare professionals in education, practice and research. This age profile is under‐explored and further research into this population would work towards filling the theory and practice gap and highlighting the identified psychosocial issues faced by this group. [ABSTRACT FROM AUTHOR]