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

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

Les violences sexuelles sont un problème majeur de santé publique. Leur révélation à un professionnel de santé pourrait permettre de réduire leur impact dans la vie des victimes. L'objectif de cette métasynthèse, associant revue systématique et analyse des études qualitatives, était d'explorer la littérature qualitative concernant l'expérience de révélation des violences sexuelles subies dans l'enfance par les victimes auprès d'un professionnel de santé. Quatre bases de données et deux journaux ont été utilisées (Medline, PsycINFO, EMBASE, SSCI, Journal of Sexual Abuse et Child Abuse and Neglect) afin d'identifier les études portant sur la révélation de violences sexuelles aux professionnels de santé du point de vue des victimes et des professionnels de santé. La qualité méthodologique des articles a été évaluée par la « Critical Appraisal Skills Programme ». Une analyse thématique des données extraites a ensuite été réalisée. Vingt-six articles ont été inclus, couvrant les données de 673 participants (333 victimes adultes au moment de l'étude, 122 victimes mineures au moment de l'étude et 218 professionnels de santé). L'analyse thématique a produit trois thèmes : (1) révéler ou ne pas révéler à un professionnel de santé, (2) le récit de la révélation par les participants et (3) aspect positif et négatif de la révélation. Nos résultats montrent que les professionnels de santé et les victimes mineures ont un vécu plutôt négatif de l'expérience de révélation qui pourrait se potentialiser et entraver le processus de révélation, alors que certaines victimes adultes reconnaissent rétrospectivement l'importance et l'impact positif que la révélation a eu pour eux. Cette étude permet de dégager des perspectives de recherches dans le champ pédopsychiatrique ainsi que de formuler des propositions cliniques concrètes, en particulier l'implication de victimes adultes dans la sensibilisation et la formation des professionnels de santé concernés. Child sexual abuse is a major public health issue, and disclosure of such abuse to a healthcare professional could mitigate its impact on the survivor's life. Qualitative studies are relevant in this context, focusing as they do on the lived experience of the stakeholders, victims and professionals. We aimed to conduct a metasynthesis, i.e. a systematic review and analysis of qualitative studies, exploring the qualitative literature about the lived experience of child's sexual abuse disclosure. Four databases and two journals were screened (Medline, PsycINFO, EMBASE, SSCI, Journal of Sexual Abuse and Child Abuse and Neglect) so as to identify studies concerning the lived experience of child sexual abuse disclosure from the point of view of survivors or healthcare professionals or both. We used the "Critical Appraisal Skills Program" to assess the methodological quality of each article and performed a thematic analysis of the data extracted to identify key themes and synthesize them. Twenty-six articles were included, covering data from 673 participants (333 survivors, adult at the time of the study; 122 survivors still minor at the time of the study and 218 health professionals). Data analysis produced three themes: (1) to reveal or not to reveal, (2) the narrative of the disclosure by the participants, (3) positive and negative outcomes of the disclosure. Our results show that, on the one hand, health professionals and minor survivors both have a negative experience of disclosure that could impede the process. On the other hand, some adult survivors underlined the importance and the positive impact of such disclosure to a healthcare professional. We identified a gap in the literature regarding disclosure of such abuse within child and adolescent psychiatry services and drew research perspectives. Concrete clinical implications can also be drawn from our results, especially the involvement of adult survivors within the training of concerned healthcare professionals so as to raise awareness among them and help them better cope with the disclosure process. [ABSTRACT FROM AUTHOR]

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

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

Objective The objective of this study was to explore Indigenous people’s experiences and perceptions of hospitalisation and acute care. Methods Systematic procedures were used for the literature search covering the period from 2000 to 2016. Final search was conducted in early September 2016. Quality of the selected studies was assessed using the Critical Appraisal Skills Program. Data extraction was conducted using the data extraction tool from the Joanna Briggs Institute. A thematic approach to synthesis was taken. Statements were assembled to produce aggregated data of the findings, which were then categorised based on similarity of meaning, and the categories were used to produce comprehensive synthesised findings. Data sources The literature search was conducted in the following databases: Cumulative Index to Nursing and Allied Health Literature, Google scholar, Medline, Psychology and Behavioural Sciences, and PsycINFO. Manual searches of the International Journal of Indigenous Health, Menzies website and references of reviewed papers were also conducted. Inclusion criteria were qualitative articles, published in English from across the world, in peer-reviewed journals, that investigated acute health care experiences of Indigenous people. Review methods A metasynthesis of qualitative research studies was conducted following Joanna Briggs Institute guidelines. Findings A total of 21 primary studies met the inclusion criteria. Three themes emerged from the metasynthesis: Strangers in a strange land ; Encountering dysfunctional interactions ; and Suffering stereotyping and assumptions . These themes emphasised the importance of meaningful relationships for Indigenous people and highlighted their cultural marginalisation in hospital settings. Conclusion The findings indicate that healthcare experiences of Indigenous patients and their relatives in acute settings can fall well short of their expectations and needs. It behoves healthcare professionals to firstly be aware of such discrepancies, and secondly to implement strategies that enable inclusive and individualised care. [ABSTRACT FROM AUTHOR]

Background Anorexia nervosa in adolescence has been increasingly documented in numerous quantitative and qualitative studies. Qualitative research, which focuses on subjective experience, is a well-established method to deepen our understanding and provide new insights about specific diseases. Objective We conducted a metasynthesis of qualitative studies to explore how anorexia nervosa is experienced by adolescents, their families, and the health professionals who provide care for them and to compare their perspectives. Review methods Five databases (Medline, PsycINFO, CINHAL, EMBASE, SSCI; 1990–2015) were systematically searched for qualitative studies reporting participants’ views about anorexia nervosa. Article quality was assessed with the Critical Appraisal Skills Program (CASP). We used thematic synthesis to examine and summarize the topics found in the articles selected and develop their central themes. Results We included 30 articles from seven different countries. Two domains of experience were inductively developed from the analysis: (1) constructs and beliefs about etiological theories of anorexia nervosa, and (2) the experience of the disease from the points of view of adolescents, parents, and healthcare providers. Conclusions We found important disparities between the three stakeholders. The adolescents underlined the psychological and emotional aspects of their experience, while the visible state of these patients’ bodies impeded the work of the professionals. These difficulties shed new light on the stakes of treatment of anorexia nervosa in adolescence, which must integrate both its psychological and physical components. [ABSTRACT FROM AUTHOR]

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

Objectives To report the findings of a metasynthesis review of qualitative studies on patient and provider experiences and perspectives on linkage and retention in HIV care. Design The review is an extraction, aggregation, interpretation and synthesis of qualitative findings based on the Sandelowski and Barroso method. Data sources A search of the literature was conducted in the databases Cumulative Index to Nursing and Allied Health, PubMed and PsycInfo for articles published from 2008 to 2013. Inclusion criteria were qualitative research articles published in English from across the world and in peer-reviewed journals. Literature reviews, conference abstracts and grey literature were excluded from this metasynthesis. Review methods The review consisted of a) comprehensive search, b) study classification, c) abstraction of findings, d) synthesis. Of the 4640 citations screened, 69 articles were included for this metasynthesis. Results 69 unique articles from 44 countries were included. This metasynthesis takes into account the perspectives of at least 2263 HIV-positive participants (740 men, 1008 women, 78 transgender individuals and 437 unspecified sex) and 994 healthcare providers, family members and community members. The most salient barriers and facilitators to HIV linkage and retention in HIV care affirm ecological factors that are mostly beyond individual patients’ control. Triadic streams of influence concurrently affect care engagement that include a person’s psychological state upon diagnosis and their informational challenges (intrapersonal stream); one-on-one interactions with providers and their immediate community (social stream); and life demands, overall quality of care experiences and other structural barriers (cultural-attitudinal stream). Each stream’s influence on HIV care engagement varies at any given point to reflect an individual’s evolving and unique experiences with HIV infection throughout the illness trajectory. Conclusion There is sufficient evidence that detail how to best link and retain patients in HIV care. Themes identified indicate going beyond individual-level factors and towards shifting attention and resources to systems that patients navigate. Forceful structural-level actions are needed to correct these long-identified barriers and enhance care engagement facilitators. [ABSTRACT FROM AUTHOR]

Résumé Objectifs Il s’agit d’une méta-synthèse des études qualitatives explorant la question de l’obésité de l’enfant et de l’adolescent. L’objectif est d’obtenir une vision globale synthétique et originale de la question, afin de proposer des pistes d’adaptation des soins. Méthode Quarante-cinq études qualitatives ont été inclues à l’issue d’une recherche systématique sur les principaux moteurs de recherche en médecine. Ils intègrent les différents points de vue que sont ceux des enfants et des adolescents souffrant d’obésité, ceux de leurs parents, ainsi que ceux des professionnels de santé impliqués dans les soins. L’analyse est thématique. Résultats Les résultats s’organisent autour de trois axes d’expérience communs aux trois groupes : voir et se voir, qui réunit les questions de la représentation de soi et de l’autre obèse, de la prise de conscience et du diagnostic ; comprendre et se comprendre, où l’objectif est de tenter de donner du sens au trouble ; et enfin traiter et se traiter, où l’enjeu est double, celui de l’appréhension globale de la démarche de soin d’une part, et celui de l’évaluation subjective de chaque thérapeutique spécifique d’autre part. Conclusion Les mots sont un enjeu thérapeutique important dans l’obésité de l’enfant et de l’adolescent : la relation médecin-enfant-parent doit être le lieu de la nécessaire circulation des représentations du trouble. Les difficultés d’échange de représentations de l’obésité entre médecin, parents et patient déstabilisent la relation thérapeutique. Summary Aims This metasynthesis of qualitative research deals with the issue of childhood and adolescence obesity. It aims to obtain coherent and original views of this question, in order to suggest therapeutic propositions. Method Forty-five qualitative studies – elicited by web searching on principal medicine databases – were investigated, focusing on clinical and personal experiences of child and adolescent suffering from obesity, their parents, and their carers. The analysis was thematic. Results Themes fall under three main axes: seeing others and oneself, understanding others and oneself, and treating others and oneself. Conclusion Parents-doctor-child relationship in obesity context is impacted by a lack of shared understandings. Each protagonist may exchange his/her viewpoints. Health professionals may take into account the personal experiences of obese children in order to adapt treatment plans. [ABSTRACT FROM AUTHOR]

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

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

Context Chronic obstructive pulmonary disease (COPD) is a life-limiting illness. Despite best available treatments, individuals continue to experience symptom burden and have high health care utilization. Objectives To increase understanding of the experience and ongoing needs of individuals living with COPD. Methods Medline, PsycINFO, CINAHL, and Sociological Abstracts were searched for articles published between January 1990 and June 2013. Metasynthesis of qualitative data followed the principles of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Metasyntheses are increasingly used to gain understandings of complex research questions through synthesizing data from individual qualitative studies. Descriptive and analytical themes were developed through thematic synthesis and expert panel discussion of extracted primary quotes, not the primary data themselves. Results Twenty-two studies were included. Four hundred twenty-two free codes were condensed into seven descriptive themes: better understanding of condition, breathlessness, fatigue, frailty, anxiety, social isolation, and loss of hope and maintaining meaning. These seven themes were condensed further into three analytical themes that described the experience and ongoing needs of individuals with COPD: the need for better understanding of condition, sustained symptom burden, and the unrelenting psychological impact of living with COPD. Conclusion Combining discrete qualitative studies provided a useful perspective of the experience of living with COPD over the past two decades. Further studies into the ongoing needs of individuals with COPD are unlikely to add to this well-established picture. Future research should focus on solutions through the development of interventions that address patients' ongoing needs. [ABSTRACT FROM AUTHOR]

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

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

Objectives: The objective of this study was to synthesize qualitative studies of how adolescents and young adults with chronic diseases experience the transition from paediatric to adult hospital care. Design: The review is designed as a qualitative metasynthesis and is following Sandelowski and Barroso's guidelines for synthesizing qualitative research. Data sources: Literature searches were conducted in the databases PubMed, Ovid, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), ISI Web of Science, and Nordic and German databases covering the period from 1999 to November 2010. In addition, forward citation snowball searching was conducted in the databases Ovid, CINAHL, ISI Web of Science, Scopus and Google Scholar. Review methods: Of the 1143 records screened, 18 studies were included. Inclusion criteria were qualitative studies in English, German or Nordic languages on adolescents' and young adults' transition experiences when transferring from paediatric to adult care. There was no age limit, provided the focus was on the actual transfer process and participants had a chronic somatic disease. The studies were appraised as suitable for inclusion using a published appraisal tool. Data were analyzed into metasummaries and a metasynthesis according to established guidelines for synthesis of qualitative research. Results: Four themes illustrating experiences of loss of familiar surroundings and relationships combined with insecurity and a feeling of being unprepared for what was ahead were identified: facing changes in significant relationships, moving from a familiar to an unknown ward culture, being prepared for transfer and achieving responsibility. Conclusions: Young adults' transition experiences seem to be comparable across diagnoses. Feelings of not belonging and of being redundant during the transfer process are striking. Health care professionals' appreciation of young adults' need to be acknowledged and valued as competent collaborators in their own transfer is crucial, and may protect them from additional health problems during a vulnerable phase. Further research including participants across various cultures and health care systems is needed. [ABSTRACT FROM AUTHOR]

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

Objectives: First to develop a consensus on what is known about men's experiences and involvement in antenatal screening, second to understand whether screening is an appropriate way to engage uninvolved men in pregnancy and third to identify areas requiring further research. Design: A systematic review was conducted to extract relevant qualitative primary research studies, which were subsequently synthesised. Data sources: International qualitative research papers, in English or with English translations, were identified using twenty-three electronic databases, such as CINAHL, MEDLINE, EMBASE, PsycInfo, ASSIA and British Nursing Index. Articles that explored men's views and opinions of antenatal screening and prenatal diagnosis were included. Review methods: Eighteen relevant research studies that met the inclusion criteria were identified. Each one was appraised as suitable for inclusion using a published appraisal tool. Results: Three themes were constructed, which were (1) men's emotional conflicts, (2) men's focus on information and (3) men's influence on decision-making. Men felt a responsibility towards their unborn child to be involved in screening. Despite this, their input was often limited to supporting their partners, and there was no clearly defined, additional role for them as expectant fathers. Thus screening is not likely to be sufficient as an opportunity to encourage men who are uninvolved in pregnancy to become more involved. Nonetheless, engaging men who were involved in the pregnancy and who attended screening appointments was beneficial in encouraging the responsibility they felt towards their unborn child, and in allowing them to support their partners. Conclusions: Healthcare professionals need to engage those men who show willingness to be involved. Nevertheless trying to engage reluctant men in screening, where there is no clearly defined role for them might create further distance between them and the pregnancy. Alternative ways to engage such men in pregnancy are thus required. [ABSTRACT FROM AUTHOR]

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

There is growing interest in synthesizing qualitative research. Despite certain philosophical and methodological difficulties, such syntheses are potentially useful in enriching the insights of empirical qualitative work in a particular area. This paper reports an interpretive review of research into the subjective experience of fibromyalgia syndrome (FMS), utilizing principles of metasynthesis. Twenty-three separate studies were identified. Each study was evaluated using methodological criteria to provide a context for interpretation of substantive findings. Principal findings were extracted and synthesized under four broad categories: experience of symptoms, search for diagnosis, legitimacy, and coping. Our findings re-emphasised the point that pain in FMS is ambiguous and invisible, raising questions of credibility and legitimacy. People with a diagnosis of FMS appear to frame the experience of symptoms within the biomedical model, where FMS is viewed as an organic entity potentially identifiable through biomedical tests. The subjective meaning and perceived legitimacy of the diagnostic label appear to be important factors in the subjective experience of FMS. Coping strategies adopted can be subsumed under Mannerkorpi, K., Kroksmark, T., Ekdahl, C. [1999. How patients with fibromyalgia experience their symptoms in everyday life. Physiotherapy Research International, 4(2), 110–122.] notions of ‘struggling’, ‘adapting’, ‘in despair’ and ‘giving up’. Most studies had at least one identified methodological shortcoming, though it is not straightforward to identify the significance of such shortcomings. We conclude that there is scope for further research into the subjective experience of FMS, and into the methodology of metasynthesis, especially in relation to methodological appraisal. [Copyright &y& Elsevier]

The public should be informed about overtesting and overdiagnosis. Diverse qualitative studies have examined public understandings of this information. A synthesis was needed to systematise the body of evidence and yield new, generalisable insights. Synthesise data from qualitative studies exploring patient and public understanding of overtesting and overdiagnosis. We searched Scopus, CINAHL, Ovid MEDLINE and PsycINFO databases from inception to March 18, 2020. We included published English-language primary studies exploring the perspectives of patients/the public about overtesting/overdiagnosis from any setting, year and relating to any condition. Only qualitative parts of mixed-methods studies were synthesised. We excluded studies that only examined overtreatment or sampled people with specialised medical knowledge. Two authors independently selected studies, extracted data, assessed the methodological quality of included studies using the CASP tool, and assessed confidence in the synthesis findings using the GRADE-CERQual approach. Data was analysed using thematic meta-synthesis, utilising descriptive and interpretive methods. We synthesised data from 21 studies, comprising 1638 participants, from 2754 unique records identified. We identified six descriptive themes, all graded as moderate confidence (indicating they are likely to reasonably represent the available evidence): i) high confidence in screening and testing; ii) difficulty in understanding overuse; iii) acceptance that overuse can be harmful; iv) rejection or problematisation of overuse; v) limited impacts of overuse information on intended test and screening uptake; vi) desire for information and shared decision-making regarding overuse. The descriptive themes were underpinned by two analytic themes: i) perceived intrinsic value of information and information gathering, and; ii) differences in comprehension and acceptance of overuse concepts. This study identified novel and important insights about how lay people interpret overuse concepts. It will guide the development of more effective public messages about overuse, highlighting the importance of interpretative frameworks in these communications. • First qualitative meta-synthesis of global research about lay understandings of overuse. • Rigorous and comprehensive: Four databases systematically searched, CASP and GRADE-CERQual used. • Two layers of analysis summarised, synthesised, and re-examined data from 21 studies. • Detailed findings about which aspects of overuse are counter-intuitive, why, and how to address it. • Shows a need for research among CALD populations, in LMICs, and accounting for health literacy. [ABSTRACT FROM AUTHOR]

• Family members often feel disempowered and pre-judged by the worker and the child protection system. • To achieve partnership with family members, the worker must work to redress this power imbalance. • The worker can lay practical foundations to establish trust between family members and workers. • Trust between family members and worker mitigates when legislative power has to be implemented. • Children and young people in particular looked for security through continuity with their worker. This metasynthesis brings together what is known about family members' perspectives of their relationship with social care practitioners as a starting point for developing a pan-European training resource for practitioners. Four databases were searched for qualitative literature with search terms relating to family members and social care practitioners. After the application of inclusion and exclusion criteria, 35 studies were critically appraised and were included in the metasynthesis. Three broad themes were identified through a thematic analysis of the studies' findings: family members' perspectives of the system; perceptions of how they were viewed by their worker; and view of their worker. The following aspects are discussed: whether partnership between family and worker is possible within a legal framework; the detrimental effects of cultural bias; and practical foundations for building trust. Recommendations are made for practical support, reflection on cultural practice and broader service provision. [ABSTRACT FROM AUTHOR]

Parkinson's disease is a chronic, progressive neurodegenerative disease which affects more than ten million people worldwide. Living with Parkinson's disease has a high impact on everyday life, and may affect quality of life negatively. Individualized coping strategies are needed to deal with the disease on a daily basis and still enjoy a social life. The aim of this study was to identify and describe strategies for coping adopted by individuals living with Parkinson's disease in their daily lives. The study is designed as a meta-ethnographic metasynthesis and follows Sandelowski and Barroso's guidelines for synthesizing qualitative research. Based on an exhaustive literature search in the following databases: CINAHL, MEDLINE, PsychINFO, Scopus and Swemed, as well as Mednar, parkinson.org, Google Scholar and OpenGrey, with no limit on the search date, 14 articles were included. The data were analyzed through a taxonomic and inductive analysis focusing on coping with Parkinson's disease in daily life. The findings revealed that the overarching motivation for patients to cope with Parkinson's disease was maintaining normality and preserving the self. The coping strategies used were: Staying independent, Focusing on the present and Avoiding challenging situations. Coping with Parkinson's disease is an ongoing and complex process of balancing the strategies used, while holding on to the 'self' that pre-dated Parkinson's disease, and at the same time adjusting one's identity to embrace living with a chronic condition. In this process, optimism and positive thinking would seem to be very fruitful. Further, the synthesis revealed that relatives often act as informal caregivers and hence as an important support in daily life. Healthcare professionals must know about coping strategies in order better to support the patients. [ABSTRACT FROM AUTHOR]

Teen dating violence (TDV) is one of the main socio-health and educational problems during adolescence. Although there are several international surveys and indicators that provide different figures of victimisation and the perpetration of violence among immigrant and indigenous adolescents, there are few studies that delve into the characteristics and cultural dimensions of dating violence in these groups. The purpose of this review is to bring together and interpret the qualitative studies on TDV among immigrant adolescents that have been developed in the last 10 years to review the associated cultural aspects. For this purpose, six electronic databases and specialised research journals were searched. Only 10 qualitative studies met the selection criteria, of which 3 analysed young Asians and 7 analysed Latinos in English-speaking countries (9 in the US and 1 in New Zealand). The thematic analysis approach was used to cross-culturally compare and interpret the findings of the studies. The results show differences in the conception of dating, love and violence among adolescents of Asian, Latin and Western origin. A different weight is observed in institutions that reproduce intimate partner violence according to different family models, gender roles and axiological-normative systems (the shame-honour system and honour-based violence). Finally, cultural differences in the impact of migrations are analysed according to the type of society of origin and destination, the levels of acculturation and generational status. These dimensions should be considered when designing TDV prevention programmes for multicultural contexts or when focusing on immigrant groups. [ABSTRACT FROM AUTHOR]

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

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

Many women do not label their unwanted sexual experiences as rape or sexual violence, but rather use various labels that suggest a different understanding of the events. This metasynthesis provides new insights and empirical evidence of how girls and women discuss their unwanted sexual experiences, and identifies factors that impede or promote such labeling. Qualitative data of 9 studies were synthetized using Noblit and Hare's (1988) framework. Results show that victims can frame sexual violence within rape scripts that may lead to minimization, normalization, self-blame or rationalization of the event. Some participants hold an ambivalent discourse, which suggests that labeling is a fluctuating process. Finally, seeking social support, or receiving educational information seem to facilitate the labeling of sexual violence. The implications for intervention and sexual violence prevention programs are discussed. • Labeling is a complex process that can have an impact on the well-being of victims. • Adherence to rape scripts and rape myths may prevent the labeling of sexual violence. • Non-respect of consent and educational information or social support promote the labeling of sexual violence. [ABSTRACT FROM AUTHOR]