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BACKGROUND: Studies have established the central role of the family in the recognition, treatment, and recovery of anorexia nervosa. The objective of this study was to review, synthesize, and critically appraise the literature on parents views on the treatment and recovery process of anorexia nervosa in their adolescent child. METHOD: A systematic search of Medline, PsychINFO, CINHAL, EMBASE, Cochrane library, and SSCI was conducted for qualitative studies published regarding parents views about the treatment of anorexia nervosa. The quality of articles was assessed using the critical appraisal skills program (CASP) and findings were analysed using thematic synthesis. RESULTS: A total of 25 studies from nine countries reporting the views of 357 parents met the inclusion criteria. Four major themes were developed from the analysis: understanding the child and the disease, experience of services and treatment modalities, the role of professionals, and the experience of recovery. CONCLUSION: Parents report struggles with delays in finding help, judgmental attitudes of professionals, and uncertainty about the future. Recognition of the challenges faced by parents and families empowers clinicians to build stronger therapeutic relationships essential for long-term recovery from anorexia nervosa.

Aquatic food systems are important contributors to global food security to satisfy an intensifying demand for protein-based diets, but global economic growth threatens marine systems. Cephalopod (octopus, squid and cuttlefish) fisheries can contribute to food security; however, their sustainable exploitation requires understanding connections between nature's contributions to people (NCP), food system policies and human wellbeing

In this paper, we synthesize and compare 2,961 estimates extracted from 90 papers of the effect of target-country institutions on cross-border merger and acquisition (CBMA) intensity and premia. The synthesis results show statistically significant effects of institutional quality, cultural similarity, corruption control and political stability and effectiveness on CBMA activity, although the economic significance of these effects is modest. Study characteristics such as the choice of target and acquiring countries, estimation techniques and sample selection strongly influence the effect estimates. Moreover, we examine the literature for the possible influence of publication-selection bias on the estimated effects and conclude that the presence of such bias calls into question whether the literature reports true effects of institutions on CBMA activity. The results presented in our quantitative literature review suggest further research efforts to identify the true effect size.

Bakgrund: Den psykiska ohälsan bland befolkningen har ökat under de senaste decennierna och medellivslängden i Sverige ökar kontinuerligt. Risken att drabbas av depression var vanligare hos personer över 65 år. Depression påverkar personens känslor, tankar och beteende negativt. Det är av vikt att upptäcka, diagnostisera och behandla depression för att minska personens lidande samt minska samhällskostnader som depression medför. Personcentrerad vård är ett etiskt förhållningssätt och syftar till att involvera den enskilda personen, samt anpassa vården efter dennes behov. Sjuksköterskor arbetar ofta självständigt i vården av den äldre personen med depression. Syfte: Syftet med studien var att belysa sjuksköterskors upplevelser av att möta och vårda den äldre personen med depression. Metod: En metasyntes (Noblit och Hare, 1988) med kvalitativ design. Resultat: Metasyntesen resulterade i fyra huvudteman; organisationens betydelse, vikten av hög kompetens, vikten av att ge tid, betydelsen av ett holistiskt förhållningssätt. Teamarbete och resurser var grundläggande för att kunna stötta den äldre personen med depression. Kunskap, erfarenhet samt normmedvetenhet underlättade identifiering av depression och bidrog till god omvårdnad. Skapandet av en relation med den äldre personen tog tid och byggdes på tillit samt kontinuitet. Att se till hela personen och relationens betydelse påverkade omvårdnaden positivt. Slutsats: Stöttning från organisationen behöver finnas, mer utbildning behöver erbjudas samt möjlighet att få tid i mötet och vården av den äldre personen med depression för att kunna förbättra omvårdnaden. Det kan inte nog betonas hur viktigt det är att sjuksköterskan får resurser som ger möjligheter att skapa en personcentrerad vård., Background: Mental illness among the population has increased in recent decades and life expectancy in Sweden is continuously increasing. The risk of suffering from depression was generally more common for people over 65 years of age. Depression negatively affects the person's feelings, thoughts and behaviour. It is important to detect, diagnose and treat depression in order to reduce the person's suffering and reduce the societal costs that depression entails. Person-centered care is an ethical approach and aims to involve the individual, as well as adapt care to his or her needs. Nurses often work independently in the care of the elderly person with depression.Aim: The aim of the study was to describe nurses' experiences of meeting and caring for the elderly person with depression. Method: The study is a metasynthesis (Noblit and Hare, 1988) with a qualitative design. Results: The metasynthesis resulted in four main themes; the importance of the organization, the importance of high competence, the importance of giving time, the significanceof a holistic approach. Teamwork and resources were essential in order to be able to support the elderly person. Knowledge, experience and norm awareness facilitated the identification of depression and contributed to good nursing. The creating of a relationship with the older person took time and was built on trust and continuity. Looking at the whole person and the importance of the relationship had a positive impact on nursing. Conclusion: Support from the organization needs to be available, more education needs to be offered as well as the opportunity to have time in the meeting and care of the elderly person with depression in order to improve care. It cannot be emphasized enough how important it is for the nurse to receive resources that provide opportunities to create a person-centered care.

Trots lagstiftning kring patienters delaktighet i vården ses en tydlig brist på delaktighet vid vårdplanering hos patienter inom psykiatrisk vård. Syftet med det här arbetet var att sammanställa kunskap genom en metasyntes för att nå en djupare förståelse av patienters upplevelser av delaktighet vid vårdplanering i den psykiatriska vården. Detta genom frågeställningarna vad beskriver patienter främjar respektive hindrar delaktighet vid vårdplanering i den psykiatriska vården. Tio artiklar svarade mot vårt syfte och inkluderades. Analysen av dessa resulterade i att tre teman identifierades: 1.“Det yttre lagret: Vårdplanen som ett värdefullt stödverktyg eller en meningslös upprepning” 2. Det mellersta lagret: “Att navigera oenigheter för en känsla av att äga innehållet”, och 3. Det inre lagret: “En vilja att ses som expert men en samtidigt upplevd maktlöshet”. De tre identifierade lagren syntetiserades i syfte att få en djupare förståelse och ny kunskap av patienters upplevelser av delaktighet i vårdplaneringsprocessen. Syntesen visar på tre lager som har en bestämd ordning där kärnan i syntesen och de tre identifierade lagren utgår från individen, som är expert.

This study describes and discusses Narrative Research as a methodological alternative to study and understand the learning of mathematics teachers in hybrid collaborative university-school communities. Under a qualitative approach, a systematic review modality called meta-synthesis, the corpus of analysis is a doctoral thesis that used Narrative Inquire in the Relational perspective, with the leading question: What contributions, limitations and possibilities are shown by the use of Narrative Research to investigate and understand the learning of mathematics teachers who participated in a hybrid or border collaborative university-school community? The results of the meta-synthesis show contributions, challenges and possibilities of Relational Narrative Inquire to investigate teacher learning in hybrid collaborative communities, especially when teachers are also encouraged to investigate their practices narratively, with the collaboration of the teacher educators, and when both groups are committed to discuss and understand what and how they learn in this context., Este estudo descreve e discute a Investigação Narrativa como alternativa metodológica para estudar e compreender a aprendizagem de professores de matemática em comunidades colaborativas híbridas universidade-escola. Sob abordagem qualitativa, modalidade revisão sistemática denominada metassíntese, o corpus de análise é uma tese de doutorado que utilizou a Investigação Narrativa na perspectiva Relacional, tendo como questão norteadora: Que contribuições, limitações e possibilidades são evidenciadas pelo uso da Investigação Narrativa para investigar e compreender as aprendizagens docentes de professores de matemática que participaram de uma comunidade colaborativa híbrida ou fronteiriça entre universidade-escola? Os resultados da metassíntese evidenciam contribuições, desafios e possibilidades da Investigação Narrativa Relacional para investigar a aprendizagem docente em comunidades colaborativas híbridas, sobretudo quando os professores são também encorajados a investigar narrativamente suas práticas, com a colaboração dos formadores, e quando ambos os grupos assumem o compromisso de discutir e compreender o que e como aprendem neste contexto., Este estudio describe y discute la investigación narrativa como una alternativa metodológica, para estudiar y comprender el aprendizaje de los profesores de matemáticas, en comunidades híbridas colaborativas entre la universidad y la escuela. Bajo un enfoque cualitativo y una modalidad de revisión sistemática denominada metasíntesis. El documento bajo análisis es una tesis doctoral que utilizó la investigación narrativa en la perspectiva relacional, con la pregunta orientadora: ¿qué aportes, limitaciones y posibilidades se evidencian con el uso de la narrativa para estudiar y comprender la enseñanza-aprendizaje de profesores de matemáticas, que participaron en una comunidad colaborativa híbrida o fronteriza entre universidad-escuela? Los resultados de la metasíntesis muestran aportes, desafíos y posibilidades de la investigación narrativa relacional, especialmente cuando se anima a los docentes a investigar sus prácticas de forma narrativa, con la colaboración de los formadores, y cuando ambos grupos están comprometidos a discutir y comprender qué y cómo aprenden en este contexto

Bakgrund: Hud-mot-hudvård med förälder direkt efter födelsen och efterföljande veckor kan förhindra allvarlig sjukdom och i värsta fall död hos barn. Det har globalt visat sig att barn skulle kunna överleva med små medel då hud-mot-hudvård ger värme, högre grad fungerande amning och anknytning. Syfte: Att beskriva föräldrarnas upplevelser och erfarenheter av att vårda sitt nyfödda barn hud-mot-hud. Metod: Datainsamlingsmetoden var kvalitativ metasyntes med metaetnografi som analysmetod. Artiklar har sökts i databaserna PubMed, CINAHL, Web of Science samt PsycInfo. Efter kvalitetsgranskning valdes 15 artiklar ut. Resultat: Två huvudkategorier identifierades vars rubriker återspeglar examensarbetets resultat: Likt en kokong och Likt en resa. Även åtta underkatogorier identifierades: En svårslagen stund av intim närhet, Känslan av liv, Så nära men ändå så långt borta, I kärlekens tecken, Mot trygghet i familjen, Efter stormens hetta förvandlades livet till en ljum bris, Höjdpunkten för partnern var då de fick barnet nära samt Drömmen blev sann om att bli ett med varann Konklusion: Resultatet beskriver hur hud-mot-hudvård var viktigt för anknytning och amning. Föräldrarna beskrev en tomhet och oro vid avsaknaden av närheten till sitt barn. Sett ur ett globalt perspektiv behövs ökad kunskap samt rutiner för att motverka att hud-mot-hudvård mellan det nyfödda barnet och dess föräldrar uteblir. Klinisk tillämpbarhet: För att, globalt och lokalt, minska sjukdom och död hos nyfödda behöver WHO´s riktlinjer följas och vårdrutiner arbetas fram lokalt. För att ge kunskap om vikten av hud-mot-hudvård hos barnmorskor och vårdpersonal inom Hälso- och Sjukvård världen över föreslås fortsatta studier., Background: Skin-to-skin care with a parent immediately after birth and the following weeks can prevent serious illness and, in the worst case, death of the child. Globally, it has been shown that even limited skin-to-skin contact with a parent can increase infant survival rate. It provides warmth, helps to initiate breastfeeding and creates a secure bond. Purpose: To describe parents' experiences of caring for their newborn baby skin-to-skin. Method: Qualitative metasynthesis was used to gather data with metaethnography as method of analysis. Articles were searched for in the databases PubMed, CINAHL, Web of Science and PsycInfo. After a quality review, 15 articles were selected. Results: Two main categories were identified: Like cocooning and Like a journey. Eight subcategories were identified reflecting the content of the results: A precious moment of intimate closeness, The feeling of life, So close but yet so far away, In the name of love, Towards family confidence, After the storm life turned into a breeze, The summit for the partners´ was when they were close to the child and The dream became true when becoming one with each other. Conclusion: The result described skin-to-skin care as an important way of creating bonds and initiate breastfeeding. Parents described worry and feelings of emptiness when they were separated from their child. Seen from a global perspective, increased knowledge and routines are needed to counteract skinto-skin care between the newborn child and its parents. Clinical applicability: In order to reduce disease and death in newborns globally, WHO´s guidelines need to be followed and care routines developed. To provide knowledge to midwives and healthcare professionals about the importance of skin-to-skin care further studies are needed

Bakgrund: ​Förlossningsdepression är ett tillstånd som drabbar upp till 15 procent av kvinnor i Sverige efter förlossning. Obehandlat kan tillståndet medföra negativa konsekvenser för både kvinnans och barnets hälsa. Barnmorskan har en viktig roll i att tidigt fånga upp kvinnor som utvecklat eller är i risk för att utveckla en förlossningsdepression. ​Syfte: ​Att beskriva kvinnors upplevelser av att genomgå en förlossningsdepression. ​Metod: ​Kvalitativ metasyntes med en metaetnografiskanalysmetod.Datainsamlinghargenomförtsitredatabaser;PubMed,CINAHLoch PsycInfo. Totalt ingår 17 artiklar i metasyntesens resultat, där samtliga genomgått en kvalitetsgranskning. ​Resultat:​Fyra teman identifierades;​En identitet i förändring, En ny roll som moder, En förhindrad anknytning och En känslomässig storm. ​Slutsats: ​Under en förlossningsdepression upplever kvinnor känslor av identitetsförlust, svårigheter att anpassa sig till modersrollen, problem i anknytning med barnet samt en känslomässig berg- och dalbana. Barnmorskan har en betydande roll i förebyggandet och tidig upptäckt av förlossningsdepression. Klinisk tillämpbarhet:​Metasyntesen kan användas av barnmorskor inommödrahälsovården,som utgångspunkt och stöd i förbättringsarbete av vård för kvinnor som utvecklat eller är i risk för att utveckla en förlossningsdepression., Background: Postpartum depression is a condition that affects up to 15 percent of women in Sweden after childbirth. Untreated, this condition can have a negative effect on the health of both the woman and the child. Midwives have an important role in identifying women who have developed or are at risk of developing postpartum depression. ​Aim: ​To describe women's experiences of postpartum depression. ​Method: ​Qualitative metasynthesis with metaethnographic analysis method. Data was collected through three databases; PubMed, CINAHL and PsycInfo. A total of 17 articles are included in the result of this metasynthesis, of which all of them passed a thorough quality critique.​Results: Four themes were identified;Achangingidentity,Anewroleas a mother, A hindered bondingandAnemotionalstorm.​Conclusion:​Duringpostpartumdepression women experience feelingsoflosingtheiridentity,difficultiesadaptingtomotherhood,problemsin bonding with the child as well as a rollercoaster of emotions.Themidwifehasanimportantrolein prevention and early identification of postpartum depression. ​Clinical implications: This metasynthesis can be used by midwives working in maternity care, as atooltoimprovethequality of care for women who have developed or are at risk of developing postpartum depression.

Bakgrund: Att genomgå en förlossning kan vara skrämmande och outforskat för den födande kvinnan. För att erhålla en positiv förlossningsupplevelse krävs det att kvinnan känner säkerhet och besitter kontroll under förlossningsprocessen. Ett alternativ som visat sig ha medicinska fördelar för kvinna och barn under förlossning är när kvinnan ligger nedsjunken i vatten under förlossningsarbetet. Syfte: Syftet var att undersöka kvinnors upplevelser av att befinna sig nedsjunken i vatten i samband med förlossningsarbete. Metod: Kvalitativ metasyntes med metaetnografisk analysmetod. Datainsamling har genom sökning i relevanta databaser genererat i 15 artiklar som ligger till grund för resultatet. Resultat: I resultatet identifierades fyra huvudteman: En tro på det naturliga som innefattade en önskan om naturlig förlossning och en medicinsk misstro. En tilltalande förlossning som berörde vattnets välgörande effekter, stärkande flytkraft, hemlik miljö och ett effektivt förlopp. I En stärkande upplevelse framgick att metoden innebar en känsla av kontroll och tillfredsställelse och att stödet från andra ansågs viktigt. Försvårande omständigheter beskrev olika hinder för en god förlossningsupplevelse, det handlade om poolen, negativa inställningar hos vårdpersonal och anhöriga men också en oro eller rädsla hos kvinnan. Slutsats: Förlossningsarbete i vatten innebär möjligheter för kvinnan till positiv förlossningsupplevelse där hon erhåller kontroll och tillfredsställelse. Ökad kunskap behövs hos barnmorskan och annan relevant vårdpersonal för att kunna stödja och erbjuda kvinnan vård efter hennes önskemål och behov. Klinisk tillämpbarhet: Metasyntesens resultat kan användas av barnmorskor och annan vårdpersonal som möter gravida kvinnor. Dels för att informera och stödja kvinnan, dels för vidare implementering av vattenförlossning på kliniker., Background: Giving birth can be an intimidating and unexplored experience for women. In order to obtain a positive birth experience, it is required that women feel safe and in control during the birthing process. Water immersion has been shown to have medical benefits during labor and childbirth.Aim: The aim was to investigate women’s experiences of immersion in water in connection with labor and birth.Method: A qualitative metasynthesis with metaethnographic analysis was used. Searching the relevant databases generated in 15 articles and results are based on this data.Results: In the results, four main themes were identified: A belief in the natural that included desire for a natural childbirth and a medical mistrust. An appealing birth that included the beneficial effects of the water as strengthening buoyancy, homely environment and an efficient process. A strengthening experience showed that the method entailed a feeling of control and satisfaction and that the support from others was considered as important. Aggravating circumstances described obstacles for a good experience. It was about the pool, negative attitudes among care staff and relatives but also a worry or fear for the woman.Conclusion: Water immersion during childbirth means a possibility for the women to have a positive childbirth experience where she can feel in control and satisfaction. Increased knowledge is needed for the midwife and other relevant health care professionals to be able to support and offer the woman care according to her wishes and needs.Clinical applicability: The results of metasynthesis can be used by midwives and other healthcare professionals who meet pregnant women. Partly to inform the woman, to be able to support the woman but also for further implementation of waterbirths in clinics.

Species invasions are a major driver of ecological change, are very difficult to control or reverse, and will increase with climate change and global trade. Invasion sciences consider how species in invaded environments adapt, but neither scientists nor policy makers consider human adaptation to invasive species and how this affects ecosystems and well-being. To address this, a framework conceptualising autochthonous human adaptation to invasions was developed based on the Human Adaptation to Biodiversity Change framework and a case study metasynthesis. Results show that adaptation occurs within different spheres of human activity and organisation at different social-ecological scales; responses have feedbacks within and across these spheres. Adaptation to invasives and other drivers is a set of highly contextual, complex, non-linear responses that make up pathways pursued over time. Most invasive species management and adaptation occurs ‘from below,’ and policies and planned control efforts should support autochthonous adaptation, rather than undermining it.

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

Phenomenography is a qualitative research method based on the assumption that almost any phenomenon will be understood by a group of people in a limited number of ways. Our aim in this article was to identify the different ways work can be understood by healthcare professionals. In a world where the delivery of healthcare is continually changing, a metasynthesis of phenomenographic articles on healthcare professionals' understandings can provide knowledge about the focus and meaning of work for these individuals today. Our metaethnographic synthesis of 14 selected phenomenographic articles identified five different ways of understanding work, ranging from a limited to an all the more comprehensive view on patients and their needs. This range of understandings reveals problem areas and challenges facing healthcare professionals today. The possibility exists as well that limited understandings of work may be negative consequences of current demands for efficiency and all the more limited healthcare resources.

Aims and objectivesTo synthesise and interpret previous findings with the aim of developing a theoretical framework for patient autonomy in a high-tech care context. BackgroundPutting the somewhat abstract concept of patient autonomy into practice can prove difficult as when it is highlighted in healthcare literature, the patient perspective is often invisible. Autonomy presumes that a person has experience, education, self-discipline and decision-making capacity. Reference to autonomy in relation to patients in high-tech care environments could therefore be considered paradoxical, as in most cases, these persons are vulnerable, with impaired physical and/or metacognitive capacity, thus making extended knowledge of patient autonomy for these persons even more important. DesignTheory development. MethodsThe basic approaches in theory development by Walker and Avant were used to create a theoretical framework through an amalgamation of the results from three qualitative studies conducted previously by the same research group. ResultsA theoretical frameworkthe control-partnership-transition frameworkwas delineated disclosing different parts cocreating the prerequisites for patient autonomy in high-tech care environments. Assumptions and propositional statements that guide theory development were also outlined, as were guiding principles for use in day-to-day nursing care. Four strategies used by patients were revealed as follows: the strategy of control, the strategy of partnership, the strategy of trust and the strategy of transition. ConclusionsAn extended knowledge base, founded on theoretical reasoning about patient autonomy, could facilitate nursing care that would allow people to remain/become autonomous in the role of patient in high-tech care environments. Relevance to clinical practiceThe control-partnership-transition framework would be of help in supporting and defending patient autonomy when caring for individual patients, as it provides an understanding of

El objetivo de esta editorial consiste en reflexionar sobre el concepto de “metasíntesis”. Aunque existe alguna heterogeneidad al referirse a metasíntesis, sí que hay cierto consenso en hablar de la Metasíntesis. La interpretación más esencial es la que la describe como un procedimiento de investigación secundaria, cuyo propósito es revisar y sintetizar de manera rigurosa y con enfoque crítico el conocimiento procedente de investigaciones originales desarrolladas con metodología cualitativa., The aim of this editorial is to reflect on the concept of “metasynthesis”. Although there is some heterogeneity when referring to metasynthesis, there is some consensus in talking about Metasynthesis. The most essential interpretation is the one that describes it as a secondary research procedure, whose purpose is to review and synthesize rigorously and with a critical approach the knowledge coming from original research developed with qualitative methodology., O objetivo deste editorial é refletir sobre o conceito de metasíntese. Embora exista alguma heterogeneidade al referir-se a uma metástase, o que existe é consenso em falar da Metasíntesis. A interpretação mais essencial é a que descrevem como um procedimento de investigação secundária, cujo propósito é revisar e sintetizar de forma rigurosa e com enfoque crítico o conhecimento procedente de investigações originais desenvolvidas com metodologia qualitativa.

The high epidemiological, social, economic and cultural impact of chronic non-communicable diseases affects what quality of life means to those who suffer from such illnesses and their family caregivers. Objective: Describe how the quality of life of those who care for the chronically ill is constructed. Method: Sandelowski and Barroso’s proposal for qualitative metasynthesis was used to develop the study. Results: There are three moments in the process: 1) it is affected (programmed cell destruction), 2) transformed (self-control of development and growth) and 3) redefined (condensation). Construction of the meaning of quality of life for the caregiver is conditioned by four factors: social support, spirituality, ability to care and time. Conclusions: Quality of life is affected and reconstructed by virtue of the meaning the caregiver assigns to it., O alto impacto epidemiológico, social, econômico e cultural das doenças crônicas não transmissíveis afeta o significado de qualidade de vida nas pessoas que as padecem e em seus cuidadores familiares. Objetivo: descrever a forma como se constrói o significado de qualidade de vida de cuidadores de pessoas com doença crônica. Método: pesquisa desenvolvida com a proposta de metassíntese qualitativa de Sandelowski e Barroso. Resultados: apresentam-se três momentos na trajetória: I) afeta-se (destruição celular programada); II) transforma-se (autocontrole do desenvolvimento e crescimento) e III) ressignifica-se (condensação); além disso, quatro fatores condicionantes para a construção do significado de qualidade de vida para o cuidador como são o suporte social, a espiritualidade, a habilidade para cuidar e o tempo. Conclusões: a qualidade de vida é afetada e reconstruída em virtude do significado que o cuidador tenha desta., El alto impacto epidemiológico, social, económico y cultural de las enfermedades crónicas no transmisibles afecta el significado de calidad de vida en las personas que las padecen y en sus cuidadores familiares. Objetivo: describir la forma como se construye el significado de calidad de vida de cuidadores de personas con enfermedad crónica. Método: investigación desarrollada con la propuesta de metasíntesis cualitativa de Sandelowski y Barroso. Resultados: se presentan tres momentos en la trayectoria: 1) se afecta (destrucción celular programada); 2) se trasforma (autocontrol del desarrollo y crecimiento), y 3) se resignifica (condensación); y cuatro factores condicionantes para la construcción del significado de calidad de vida para el cuidador como son el soporte social, la espiritualidad, la habilidad para cuidar y el tiempo. Conclusiones: la calidad de vida se afecta y se reconstruye en virtud del significado que el cuidador tenga de esta.

This metasynthesis aimed to translate, interpret, and present a synthesis of qualitative studies from nurses' perspectives dealing with ethical dilemmas and ethical problems in end-of-life care and to gain a deeper understanding of the phenomena. Nurses and other care professionals need to gain a deeper understanding and alleviate the suffering of patients through evidence-based practice end-of-life care. The metasynthesis, inspired by Noblit and Hare, generated an overarching metaphor, The Loving Eye. The Loving Eye illustrates how nurses are deeply involved with patients as human beings and connotes an inner responsibility to struggle for patients' best interests and wishes at the end of life. With The Loving Eye, nurses can see and feel patients' need to be confirmed, comforted, and healed approaching the end of life.

Poor patient-provider communication in hospital continues to be cited as a possible causal factor in preventable adverse events for patients with severe communication disabilities. Yet to date there are no reports of empirical interventions that investigate or demonstrate an improvement in communication in hospital for these patients. The aim of this review was to synthesize the findings of research into communication in hospital for people with severe communication disabilities arising from lifelong and acquired stable conditions including cerebral palsy, autism, intellectual disability, aphasia following stroke, but excluding progressive conditions and those solely related to sensory impairments of hearing or vision. Results revealed six core strategies suggested to improve communication in hospital: (a) develop services, systems, and policies that support improved communication, (b) devote enough time to communication, (c) ensure adequate access to communication tools (nurse call systems and communication aids), (d) access personally held written health information, (e) collaborate effectively with carers, spouses, and parents, and (f) increase the communicative competence of hospital staff. Currently there are no reports that trial or validate any of these strategies specifically in hospital settings. Observational and evaluative research is needed to investigate the ecological validity of strategies proposed to improve communication.

Objective During the last two decades research has put forth recovery as an important focus for mental health nursing. These studies describe different aspects of recovery, and without doubt they have contributed to the recovery movement in mental health care. The present study aims at synthesizing research findings in order to promote understanding of recovery as a phenomenon. Methods Qualitative research focusing recovery provided data for the synthesis. The synthesis is based on Noblit & Hare’s description of meta ethnography, and focus is put on synthesising findings from different qualitative methods. The focus of the presentation will be put on the method and how metaphors can be used as means to synthesize and communicate research findings. Results Findings in the form of metaphors describing the process of recovery, and how recovery is experienced, will be used in order to illuminate the method. Conclusion Recovery could metaphorically be described as a process towards reclaiming life, a journey from experiences of being list to feeling at home with oneself. Metaphors is concluded a fruitful tool to describe and communicate this process.

Research indicates the essentiality of dignity as a vital component for quality of life, reconfirming the emphasis on dignity preservation in the international code of nursing ethics. Applying Noblit and Hare's metaethnography, the aim of the study was to develop a theory model by synthesizing 10 qualitative articles from various cultural contexts, exploring nurse and allied healthcare professional perception/practice concerning dignity-preserving dementia care."Advocating the person's autonomy and integrity" which involves "having compassion for the person", "Comfirming the person's worthiness and sense of self" , and "creating a humane and purposeful environment", was identified as a primary foundation for dignity-preserving dementia care. "balancing individual choices among persons no longer able ti make sound decisions, against teh duty of making choices on behalf of the person", which involves "persuasion" and/or "mild restraint", was consideres a crucial aspect in certain comprehensive motive and core value within dignity-preserving dementia care.

This thesis 'The Symphony of Care' consists of four studies focusing on care relationships between patients and professional caregivers. Care relationships are central to the health process and a fundamental element in caregiving. The term care relationship is widely used in caring science but lacks a clear definition, which can create misunderstanding and can constitute an obstacle when attempting to optimize care relationships. The aim of this thesis is to describe the phenomenon of care relationships in order to add to the body of knowledge in caring science.The main research questions are: • What is a care relationship within the caring science field? • How can a care relationship be optimized to improve its caring function, in order to promote health? The ontological foundation of this thesis is caring science. Phenomenology and Lifeworld theory are used as its epistemological bases. Reflective Lifeworld Research is used as a methodological approach. The four studies were conducted in different contexts and cultures- the first two empirical studies were performed in China and the remaining two, a metasynthesis and a secondary analysis, were carried out in a Swedish context. The results show that care relationships are temporary intentional relationships between a person who needs help and a helper. The purpose of this relationship is to support the patient in his/her dynamic health process, which is unique for each person in different times and contexts. Care relationships are fragile because the patient is vulnerable and the demand on the helper is great. It is an inter-human relationship between equals, which can at the same time be an asymmetric relationship due to the professionalism with the caregiver and the vulnerability with the patient. A care relationship is not independent, but is affected by internal factors such as the two individuals' lifeworlds and external factors such as health policies, organization, economics, health culture and environment.

Evidence of mental ill-health and social and emotional problems among Australia’s Indigenous young people can be found across most measures of health, education, employment and involvement in the justicesystem. Countering this are the reports of programs and projects that have assisted Indigenous young people to succeed in life by overcoming adversity and building strength and resilience. This report presents a cross case analysis and metasynthesis of key findings of six case studies of social and emotional wellbeing programs for Aboriginal youth across Australia. It provides a set of Critical Success Factors to guide policy, resource allocation and practice in the field that are considered to be essential for effectiveness, sustainability, ability to grow in scope and reach and to achieve full potential.

Many papers in the recent literature on participatory approaches emphasize the need to take better account of the complexity of the social contexts in which they are conducted. Without attention to power asymmetries, there is a risk that the most powerful stakeholders will have greater influence on the outcomes of the participatory process than marginalized stakeholders. However, very few authors address the question of how to deal with such power asymmetries. This question puts designers of participatory processes in a dilemma. On the one hand, if they claim a neutral posture, they are accused of being naively manipulated by the most powerful stakeholders and of increasing initial power asymmetries; but, on the other hand, if they adopt a nonneutral posture and decide to empower some particular stakeholders, their legitimacy to do so is questioned. We test a particular posture to overcome this dilemma: that is, a “critical companion” posture, which strategically deals with power asymmetries to avoid increasing initial power asymmetries, and which suggests that designers should make explicit their assumptions and objectives regarding the social context so that local stakeholders can choose to accept them as legitimate or to reject them. Legitimacy is seen as the product of a coconstruction process between the designers and the participants. This posture was tested in the context of a participatory process conducted in northern Thailand to address a conflict between the creation of a national park and two local communities. While we show that this posture makes it possible for designers to be both strategic and legitimate at the same time, it also raises new questions and new dilemmas. Can we, and should we, really make all our assumptions explicit? How can we deal with stakeholders who refuse to engage in any form of dialog? We conclude that there is no “right” posture to adopt, but that designers need to be more reflexive about their own postures.

Introduction Urinary incontinence with co-morbid depression has been found to have a significant effect on quality of life. Examining the associations between the psychosocial factors related to urinary incontinence and mental health may help in improving the care for patients with these conditions. The aim of this research study is to explore the relationship between mental health status and urinary incontinence, focusing on the role of psychosocial factors. Materials and Methods A search of Medline, CINAHL and SCOPUS databases yielded 15 studies on the topic, and 10 studies were found to be in scope. A metasynthesis using Noblit and Hare’s approach of meta-ethnography was undertaken. This involved a number of steps including determining how studies are related and identifying major themes. Results Three psychosocial aspects of urinary incontinence appear to influence mental health status: living with, management of and attitudes about incontinence. Other smaller component themes included control, seeking help and personal beliefs. Discussion Psychosocial factors appear to mediate the relationship between urinary incontinence and mental health status. An increased awareness of the major psychosocial issues that can influence both incontinence and mental health may contribute to a better management of the condition as well as reduce the burden of the condition on individuals. Conclusion Incontinence and psychological wellbeing are intertwined and this adversely affects a number of aspects of life. Enquiring about the mental health status of those with incontinence should include an assessment of psychosocial factors to help reduce the burden of incontinence. To improve the management of these conditions, further research should investigate whether psychological issues precede incontinence or vice versa.

Background: Access to health services is an important health determinant. New research in health equity is required, especially amongst economic migrants from developing countries. Studies conducted on the use of health services by migrant populations highlight existing gaps in understanding which factors affect access to these services from a qualitative perspective. We aim to describe the views of the migrants regarding barriers and determinants of access to health services in the international literature (1997–2011). Methods: A systematic review was conducted for Qualitative research papers (English/Spanish) published in 13 electronic databases. A selection of articles that accomplished the inclusion criteria and a quality evaluation of the studies were carried out. The findings of the selected studies were synthesised by means of metasynthesis using different analysis categories according to Andersen’s conceptual framework of access and use of health services and by incorporating other emergent categories. Results: We located 3,025 titles, 36 studies achieved the inclusion criteria. After quality evaluation, 28 articles were definitively synthesised. 12 studies (46.2%) were carried out in the U.S and 11 studies (42.3%) dealt with primary care services. The participating population varied depending mainly on type of host country. Barriers were described, such as the lack of communication between health services providers and migrants, due to idiomatic difficulties and cultural differences. Other barriers were linked to the economic system, the health service characteristics and the legislation in each country. This situation has consequences for the lack of health control by migrants and their social vulnerability. Conclusions: Economic migrants faced individual and structural barriers to the health services in host countries, especially those with undocumented situation and those experimented idiomatic difficulties. Strategies to improve the structures of health

Background: The prescribing of opioids has increased internationally in developed countries in recent decades within primary and secondary care.1 The majority of patients with chronic non-malignant pain (CNMP) are managed by their GP.2 Recent qualitative studies have examined the issue of opioid prescribing for chronic non-malignant pain (CNMP) from a GP viewpoint. Several factors have been reported to influence the prescribing of opioids for CNMP including aetiology of pain condition, co-morbidities, access to specialised care, history of drug abuse and professional scrutiny. We require a better understanding of problems GP’s face when making opioid prescribing decisions, and interventions to provide better supports in the prescribing of opioids for CNMP.The aim of this study is to identify and synthesize the qualitative literature describing the factors influencing the nature and extent of opioid prescribing in CNMP in primary care. A theoretical model is then proposed which seeks to explain the relationship between factors influencing prescribing of opioids for CNMP by GPs. Methods: MEDLINE, Embase, PsychINFO, Cochrane Database, International Pharmaceutical Abstracts, Database of Abstracts of Reviews of Effects, CINAHL and Web of Science were systematically searched from January 1986-Feb 2018. Studies that documented GP’s experiences and behaviours relating to prescribing opioids for chronic non-alignant pain in a primary care setting were included. Studies were excluded if they were non-English language, theoretical or methodological articles, policy documents, conference abstracts or presentations, or where quotations were not clearly attributed to GPs participating in the study.The reviewers then independently assessed the full text of the articles using the Critical Appraisal Skills Programme (CASP) tool for qualitative research. The papers were coded by two researcher and these codes organised using Thematic Network Analysis. Basis themes were defined initia

The aims of this review were to systematically identify, critically appraise and synthesize the results of existing qualitative literature exploring the views and experiences of intimate relationships amongst people with intellectual disabilities. Fourteen peer-reviewed articles were identified through a systematic search of eight databases, reference lists, citations, and relevant journals. The identified articles were appraised for quality, then synthesized using a metaethnography approach. No study met all quality criteria and references to ethical approval were often lacking. Interpretation of the findings suggested three key themes: the meaning of intimate relationships, external constraints and facilitators, and managing external constraints. Though many people with intellectual disabilities desire and benefit from intimate relationships, they experience restrictions that others do not, which can lead to isolation and loneliness. Intimate relationships are not always necessarily linked with sexual behavior; therefore, intimate relationships warrant their own focus in future research, as well as in education and training for people with intellectual disabilities and their caregivers. Within this, a commitment to transparency over research processes is needed, in particular with reference to how ethical approval was obtained, since this has been a shortcoming of research with this focus to date.

Background: The prescribing of opioids has increased internationally in developed countries in recent decades within primary and secondary care.1 The majority of patients with chronic non-malignant pain (CNMP) are managed by their GP.2 Recent qualitative studies have examined the issue of opioid prescribing for chronic non-malignant pain (CNMP) from a GP viewpoint. Several factors have been reported to influence the prescribing of opioids for CNMP including aetiology of pain condition, co-morbidities, access to specialised care, history of drug abuse and professional scrutiny. We require a better understanding of problems GP’s face when making opioid prescribing decisions, and interventions to provide better supports in the prescribing of opioids for CNMP.The aim of this study is to identify and synthesize the qualitative literature describing the factors influencing the nature and extent of opioid prescribing in CNMP in primary care. A theoretical model is then proposed which seeks to explain the relationship between factors influencing prescribing of opioids for CNMP by GPs. Methods: MEDLINE, Embase, PsychINFO, Cochrane Database, International Pharmaceutical Abstracts, Database of Abstracts of Reviews of Effects, CINAHL and Web of Science were systematically searched from January 1986-Feb 2018. Studies that documented GP’s experiences and behaviours relating to prescribing opioids for chronic non-alignant pain in a primary care setting were included. Studies were excluded if they were non-English language, theoretical or methodological articles, policy documents, conference abstracts or presentations, or where quotations were not clearly attributed to GPs participating in the study.The reviewers then independently assessed the full text of the articles using the Critical Appraisal Skills Programme (CASP) tool for qualitative research. The papers were coded by two researcher and these codes organised using Thematic Network Analysis. Basis themes were defined initia

The aims of this review were to systematically identify, critically appraise and synthesize the results of existing qualitative literature exploring the views and experiences of intimate relationships amongst people with intellectual disabilities. Fourteen peer-reviewed articles were identified through a systematic search of eight databases, reference lists, citations, and relevant journals. The identified articles were appraised for quality, then synthesized using a metaethnography approach. No study met all quality criteria and references to ethical approval were often lacking. Interpretation of the findings suggested three key themes: the meaning of intimate relationships, external constraints and facilitators, and managing external constraints. Though many people with intellectual disabilities desire and benefit from intimate relationships, they experience restrictions that others do not, which can lead to isolation and loneliness. Intimate relationships are not always necessarily linked with sexual behavior; therefore, intimate relationships warrant their own focus in future research, as well as in education and training for people with intellectual disabilities and their caregivers. Within this, a commitment to transparency over research processes is needed, in particular with reference to how ethical approval was obtained, since this has been a shortcoming of research with this focus to date.

Background: The prescribing of opioids has increased internationally in developed countries in recent decades within primary and secondary care.1 The majority of patients with chronic non-malignant pain (CNMP) are managed by their GP.2 Recent qualitative studies have examined the issue of opioid prescribing for chronic non-malignant pain (CNMP) from a GP viewpoint. Several factors have been reported to influence the prescribing of opioids for CNMP including aetiology of pain condition, co-morbidities, access to specialised care, history of drug abuse and professional scrutiny. We require a better understanding of problems GP’s face when making opioid prescribing decisions, and interventions to provide better supports in the prescribing of opioids for CNMP.The aim of this study is to identify and synthesize the qualitative literature describing the factors influencing the nature and extent of opioid prescribing in CNMP in primary care. A theoretical model is then proposed which seeks to explain the relationship between factors influencing prescribing of opioids for CNMP by GPs. Methods: MEDLINE, Embase, PsychINFO, Cochrane Database, International Pharmaceutical Abstracts, Database of Abstracts of Reviews of Effects, CINAHL and Web of Science were systematically searched from January 1986-Feb 2018. Studies that documented GP’s experiences and behaviours relating to prescribing opioids for chronic non-alignant pain in a primary care setting were included. Studies were excluded if they were non-English language, theoretical or methodological articles, policy documents, conference abstracts or presentations, or where quotations were not clearly attributed to GPs participating in the study.The reviewers then independently assessed the full text of the articles using the Critical Appraisal Skills Programme (CASP) tool for qualitative research. The papers were coded by two researcher and these codes organised using Thematic Network Analysis. Basis themes were defined initia

The aims of this review were to systematically identify, critically appraise and synthesize the results of existing qualitative literature exploring the views and experiences of intimate relationships amongst people with intellectual disabilities. Fourteen peer-reviewed articles were identified through a systematic search of eight databases, reference lists, citations, and relevant journals. The identified articles were appraised for quality, then synthesized using a metaethnography approach. No study met all quality criteria and references to ethical approval were often lacking. Interpretation of the findings suggested three key themes: the meaning of intimate relationships, external constraints and facilitators, and managing external constraints. Though many people with intellectual disabilities desire and benefit from intimate relationships, they experience restrictions that others do not, which can lead to isolation and loneliness. Intimate relationships are not always necessarily linked with sexual behavior; therefore, intimate relationships warrant their own focus in future research, as well as in education and training for people with intellectual disabilities and their caregivers. Within this, a commitment to transparency over research processes is needed, in particular with reference to how ethical approval was obtained, since this has been a shortcoming of research with this focus to date.