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Introduction: Narratives of negative patient experiences expressed in complaints can help health care professionals reflect on their practices. Aims: To synthesise evidence from qualitative primary studies on patients' negative experiences with different health care settings and to obtain a detailed picture of what patients find problematic while receiving health care. Design: Metasynthesis inspired by Sandelowski and Barroso. Methods: A protocol was published in the International Prospective Register of Systematic Reviews (PROSPERO). A systematic search was conducted in CINAHL (EBSCOhost), MEDLINE (EBSCOhost), PsycInfo (Ovid) and Scopus, on 20.04.2021. Backward and forward citations of included reports were searched for relevant studies and the search was completed in March 2022. Two researchers independently screened and appraised the included reports. A metasynthesis using reflexive thematic analysis and a metasummary were conducted. Results: Twenty‐four reports were included, and four main themes were extracted from the metasynthesis: (1) problems with access to health care services; (2) failure to acquire information about diagnosis, treatment and the expected patient role; (3) experiencing inappropriate care and bad treatment; (4) problems with trusting health care service providers. Conclusions: Negative patient experiences impact patients' physical and psychological health, leading to suffering and hampering patients from involving themselves in their health care. Relevance to clinical practice: Narratives of negative patient experiences aggregated from the findings provide knowledge about what patients need and expect from health care providers. These narratives can help health care professionals reflect on the way they interact with patients and improve their practice. Health care organisations need to prioritise patient participation. Reporting method: Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines were followed. Patient or public contribution: Findings were presented and discussed in a meeting with a reference group representing patients, health care professionals and the public. [ABSTRACT FROM AUTHOR]

Aim: To describe and explain the process of transition from cure‐focused to comfort‐focused health care as perceived and reported by patients, family members, and healthcare providers. Background: Moving into the last phase of life due to advanced illness constitutes a developmental transition with increased vulnerability for patients and family. Design: Qualitative metasynthesis. Data sources: Medline, CINAHL, and PsycInfo databases searched from inception through March 2016. Primary research reports published from 1990 to 2015, using qualitative designs to report transition experiences of patients, family members, and/or healthcare providers were included. Review methods: Key elements were extracted and organized into matrices. Findings from each report were analysed using qualitative coding. Results: The sample was 56 unique reports from 50 primary studies. Patients and families emphasized the importance of receiving understandable information, emotional support, respect for personhood and control. The critical juncture of 'realizing terminality' preceded a transition to comfort‐focused care. Subsequently, a shift in goals of care emphasizing comfort and quality of life could occur. Continued provision of information, effective support, respect and control promoted 'reframing perceptions' and capacity to embrace a changed identity. Reframing allowed patient and family to find meaning and value in this last phase of life and to embrace the opportunity to prepare for death, nurture relationships, and focus on quality of living. Conclusion: Understanding the developmental process that can be engaged by patients and families at the end of life provides a theoretical basis that can inform choice and timing of interventions to reduce suffering and enhance positive outcomes. [ABSTRACT FROM AUTHOR]

Aims and objectives: To synthesise and interpret previous findings with the aim of developing a theoretical framework for patient autonomy in a high‐tech care context. Background: Putting 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. Design: Theory development. Methods: The 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. Results: A theoretical framework—the control‐partnership‐transition framework—was 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. Conclusions: An 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 practice: The 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 the strategies employed by patients to achieve autonomy in high‐tech care contexts. The guiding principles for patient autonomy presented could be used in nursing guidelines. [ABSTRACT FROM AUTHOR]

Aims and objectives: To aggregate, synthesise and interpret qualitative research studies of parents’ experiences of caring for a child with special health‐care needs at home. Background: Advances in the field of medical and nursing science have ensured better survival rates for children with chronic illnesses. Many of these children have significant special health‐care needs. Today parents assume a caregiver role, undertaking tasks previously provided by nurses in hospitals. As the complexity of care delivered by parents continues to develop, synthesised knowledge can provide an evidence base that will support and guide nurses when caring for these families. Design: Metasynthesis. Methods: Based upon a systematic search protocol, a structured literature search, covering the years 2003–2016, was conducted in five electronic databases. Ten studies were included and appraised using the Critical Appraisal Skills Program assessment tool. A metasummary and a metasynthesis were undertaken guided by the metasynthesis methodology as described by Sandelowski and Barroso (Handbook for synthesizing qualitative research. New York, NY: Springer, 2007). Results: The results were interpreted and integrated under the overarching theme “unsung heroes, flying blind,” supported by eight elucidating categories that illustrate aspects of the parents’ life world. Conclusions: The enormous burden of care can weaken the parents’ will to carry on and result in a decreased ability to provide care. This can have an impact on the parents’ health, family functioning and the sick child's potential health outcomes. Nurses are in a unique position to help these families and should be better prepared for the role. Relevance to clinical practice: Knowledge of how parents of children with special health‐care needs experience their daily lives can promote trust in nurses and guide them in their efforts to support families with children living with chronic illness. [ABSTRACT FROM AUTHOR]

Aims and objectives To interpret the body of qualitative work focusing on compassion fatigue to distil a common understanding that could then be applied to nursing care. Background Complex demands place extraordinary stress on nurses struggling to work in overburdened healthcare systems. The result can be the inability to care well for others, leading to compassion fatigue, burnout and increased numbers leaving the profession. Metasynthesis offers a means of more fully illuminating compassion fatigue and further understanding of practices which might reduce its negative consequences. Design Metasynthesis. Method As a method designed to facilitate knowledge development, metasynthesis allowed for integration of qualitative study findings conducted between 1992-2016 using defined search terms. Six databases were searched for articles published in English. Nine papers met the criteria for review and metasynthesis was conducted using the meta-ethnographic approach detailed by Noblit and Hare. Results Four themes related to compassion fatigue were found by consensus discussion. The themes included: physical ('just plain worn out') and emotional symptoms ('walking on a tightrope'), triggering factors ('an unbearable weight on shoulders' and 'alone in a crowded room'), and measures to overcome/prevent ('who has my back?'). Conclusions Compassion fatigue is a concept of documented relevance to those in nursing and represents a basic inability to nurture others and engenders a temporal component. Synthesis of studies provides evidence of the veracity of the concept for application to clinical practice and research related to nursing care. Relevance to clinical practice Findings provide insight into the clinical milieu needed to prevent compassion fatigue. A theoretical model is presented which can be used to guide future research, as well as the creation of clinical practice policies which might mitigate the development of compassion fatigue and its potential consequences. [ABSTRACT FROM AUTHOR]

Aim To identify factors that may serve as facilitators and barriers to self-management described by adults living with chronic illness by conducting a qualitative metasynthesis. Background Self-management is an individuals' active management of a chronic illness in collaboration with their family members and clinicians. Design Qualitative metasynthesis. Data sources We analysed studies ( N = 53) published between January 2000-May 2013 that described factors affecting self-management in chronic illness as reported by adults aged over 18 years with chronic illness. Review methods Sandelowsi and Barroso approach to qualitative metasynthesis: literature search; quality appraisal; analysis and synthesis of findings. Results Collectively, article authors reported on sixteen chronic illnesses, most commonly diabetes ( N = 28) and cardiovascular disease ( N = 20). Participants included men and women (mean age = 57, range 18-94) from 20 countries representing diverse races and ethnicities. We identified five categories of factors affecting self-management: Personal/Lifestyle Characteristics; Health Status; Resources; Environmental Characteristics; and Health Care System. Factors may interact to affect self-management and may exist on a continuum of positive (facilitator) to negative (barrier). Conclusion Understanding factors that influence self-management may improve assessment of self-management among adults with chronic illness and may inform interventions tailored to meet individuals' needs and improve health outcomes. [ABSTRACT FROM AUTHOR]

Aims and objectives To interpret, describe and analyse the results of various qualitative studies and comprehensively elucidate the self-monitoring of blood glucose experiences of diabetic patients, and to make recommendations based on these findings for clinical practices. Background Patients exhibited both positive and negative perceptions towards the self-monitoring of blood glucose. Numerous recent qualitative studies have explored the self-monitoring of blood glucose experiences of diabetic patients; however, no integrated results have been provided. Design Qualitative metasynthesis. Methods A systematic literature search of English and Chinese databases was undertaken, covering the period between January 2004 and April 2014. The following databases were searched: CINAHL, Pub Med, MEDLINE, Cochrane Library, Airiti library and Psyc Info. Seven studies were assessed in the final analysis; the Joanna Briggs Institute Qualitative Assessment and Review Instrument was used to evaluate these studies. Results The self-monitoring experiences of patients with diabetes were divided into five themes: perceived disease severity, effects on daily life, lifestyle adjustments after becoming aware of blood glucose levels, determining the meaning of self-monitoring, and the differences between diabetic patients who use and do not use insulin. Individual differences in blood glucose self-monitoring vary widely among diabetic patients. Conclusions These differences result from personal cognition and feelings concerning blood glucose monitoring. Insights into and discussions regarding the self-monitoring of blood glucose experiences of diabetic patients enable health care professionals to understand the factors that influence the intentions of patients to perform self-monitoring of blood glucose and facilitate establishing customised self-monitoring of blood glucose treatment plans. Relevance to clinical practice Health care professionals must adopt flexible and individualised criteria to determine patient cognitive misconceptions, understand negative emotional reactions and provide individualised assistance. [ABSTRACT FROM AUTHOR]

Aim To aggregate, interpret and synthesize findings from qualitative studies of patients' experiences on being transferred/in transition from one hospital to another or from one ward to another. Background Studies about patients' experiences of transfer focused on concepts such as transfer stress, transfer anxiety, and translocation syndrome; however, a meta-synthesis on experiences of transition across different patient populations was lacking. Design The meta-synthesis approach was based on the guidelines by Sandelowski and Barroso. Data source Six electronic databases were searched for articles published between the years 1999-2011, based on the target phenomenon: patients' experiences of transition after transfer between hospitals or units. Reference lists of included articles were screened for eligible papers. Review methods Data were analysed into meta-summary and meta-synthesis. The qualitative content analysis process started with a search for common themes, concepts, and metaphors. Results Fourteen qualitative studies were included. Three main categories were identified: transfer as unpredictable, scary and stressful; transfer as recovery and relief; and transfer as sliding into insignificance. The meta-synthesis showed patients' experiences of transitions as critical events where nurses need to focus on patient outcome of transfer as safe, predictable, and individual. Conclusion It was difficult for patients to leave their experiences behind when feeling unimportant. Evidence existed for clinical nurses to continue the development of care quality and safety for patients in transfer/transition. Intervention studies and policy development to improve transfers and transitions for patients are recommended. [ABSTRACT FROM AUTHOR]

duggleby w., hicks d., nekolaichuk c., holtslander l., williams a., chambers t. & eby j. (2012) Hope, older adults, and chronic illness: a metasynthesis of qualitative research. Journal of Advanced Nursing 68(6), 1211-1223. Abstract Aim. To report a metasynthesis review of qualitative research studies exploring the hope experience of older persons with chronic illness. Background. Hope is a psychosocial resource used by persons to deal with their chronic illness experience. Data sources. A comprehensive search of multiple databases for studies of the hope experience (published 1980-2010) was completed. Inclusion criteria were included qualitative studies of the hope experience of persons (all genders; mean age 60 years and older), with chronic illnesses, and publications in any language and country. Review methods. The metasynthesis followed four procedural steps: (a) comprehensive search, (b) quality appraisal, (c) classification of studies, and (d) synthesis of findings. Results. Twenty studies were included in the metasynthesis representing research from a variety of different countries and populations with differing medical diagnoses. The characteristics of hope included: (a) dynamic or situational nature, (b) multiple co-existing types, (c) objects that were desirable realistic possibilities, (d) future-focused, and (e) involvement of choice/will. Hope as 'transcending possibilities' represented the integration of two processes of transcendence and positive reappraisal. Reaching inwardly and outwardly and finding meaning and purpose were sub-processes of transcendence, whereas re-evaluating hope in light of illness and finding positive possibilities were sub-processes of positive reappraisal. Conclusions. The concept of hope may differ for older adults vs. younger adults in its interaction with suffering. Resources for hope are both internal and external. Finding meaning and positive reappraisal are important strategies to help older adults with chronic illness maintain their hope. [ABSTRACT FROM AUTHOR]