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Aims and objectives: To investigate the components of the Amalgamation of Marginal Gains (AMG) performance system to identify a set of principles that can be built into an innovative fundamental nursing care protocol. Background: Nursing is urged to refocus on its fundamental care activities, but little evidence exists to guide practising nurses. Fundamental care is a combination of many small behaviours aimed at meeting a person's care needs. AMG is a successful system of performance management that focusses on small (or marginal) gains, and might provide a new delivery framework for fundamental nursing care. Design: Qualitative interview study. Methods: We undertook in‐depth interviews with healthcare and sports professionals experienced in AMG. We analysed data using open coding in a framework analysis, and then interrogated the data using Normalisation Process Theory (NPT). We triangulated findings with AMG literature to develop an intervention logic model. Results: We interviewed 20 AMG practitioners. AMG processes were as follows: focusing on many details to optimise performance, identification of marginal gains using different sources, understanding current versus optimum performance, monitoring at micro and macro level and strong leadership. Elements of normalisation were as follows: whole team belief in AMG to improve performance, a collective desire for excellence using evidence‐based actions, whole team engagement to identify choose and implement changes, and individual and group responsibility for monitoring performance. Conclusions: We have elicited the processes described by AMG innovators in health care and sport and have mapped the normalisation potential and work required to embed such a system into nursing practice. Relevance to clinical practice: The development of our logic model based on AMG and NPT may provide a practical framework for improving fundamental nursing care and is ripe for further development and testing in clinical trials. [ABSTRACT FROM AUTHOR]

We continue the conversation initiated by Sally Thorne’s observations about “metasynthetic madness.” We note that the variety of labels used to describe qualitative syntheses often reflect authors’ disciplines and geographical locations. The purpose of systematic literature searching is to redress authors’ lack of citation of relevant earlier work and to reassure policy makers that qualitative syntheses are systematic and transparent. There is clearly a need to develop other methods of searching to supplement electronic searches. If searches produce large numbers of articles, sampling strategies may be needed to choose which articles to synthesize. The quality of any synthesis is dependent on the quality of the primary articles; both primary research and qualitative synthesis need to move beyond description and toward theory and explanation. Synthesizers need to pay attention to those articles which do not seem to fit their emerging analysis if they are to avoid stifling new ideas. [ABSTRACT FROM AUTHOR]

This article explores how people with progressive multiple sclerosis give meaning to their experiences. It builds upon the self-management literature, which has captured the tension between the desire for retaining normalcy and the increasing burden of self-management associated with chronic disease progression. This repeat interview study is empirically grounded in 28 interviews with 14 people with progressive multiple sclerosis. We identified gender differences in diagnosis-seeking which impacted subsequent sense-making. Male respondents found a diagnosis of multiple sclerosis difficult to come to terms with, and an enduring sense of loss or anger could inhibit further sense-making. A diagnosis of multiple sclerosis was more difficult to obtain for women respondents, and any sense of certainty that diagnosis provided framed their subsequent sense-making strategies. The complex sequelae of multiple sclerosis require that self-management strategies are both contextual and timely, although even the most accomplished self-managers can lose their sense of self with neurodegeneration. Disease progression can be associated with suicidal ideation, suggesting the need for greater dialogue to ensure that people with multiple sclerosis are adequately supported to fulfil their quality of life at all stages of neurodegeneration. These lay perspectives emphasise the articulation of affect rather than the rendering of a medical diagnosis, although diagnosis may provide a degree of certainty in the short term. The ethos of self-management ensures people attempt to retain their sense of ‘normality’ and existent social roles for as long as possible, but this ethos can negate both one’s ability to self-manage and the management of self. [ABSTRACT FROM AUTHOR]

Having previously conducted qualitative syntheses of the diabetes literature, we wanted to explore the changes in theoretical approaches, methodological practices, and the construction of substantive knowledge which have recently been presented in the qualitative diabetes literature. The aim of this research was to explore the feasibility of synthesizing existing qualitative syntheses of patient perspectives of diabetes using meta-study methodology. A systematic review of qualitative literature, published between 2000 and 2013, was conducted. Six articles were identified as qualitative syntheses. The meta-study methodology was used to compare the theoretical, methodological, analytic, and synthetic processes across the six studies, exploring the potential for an overarching synthesis. We identified that while research questions have increasingly concentrated on specific aspects of diabetes, the focus on systematic review processes has led to the neglect of qualitative theory and methods. This can inhibit the production of compelling results with meaningful clinical applications. Although unable to produce a synthesis of syntheses, we recommend that researchers who conduct qualitative syntheses pay equal attention to qualitative traditions and systematic review processes, to produce research products that are both credible and applicable. [ABSTRACT FROM AUTHOR]

Objectives To identify the needs of caregivers supporting a person with heart failure and to inform the development of a caregiver resource to be used as part of a home-based self-management programme. Methods A qualitative study informed by thematic analysis involving 26 caregivers in individual interviews or a focus group. Results Three distinct aspects of caregiver support in heart failure management were identified. Firstly, caregivers identified needs about supporting management of heart failure including: coping with the variability of heart failure symptoms, what to do in an emergency, understanding and managing medicines, providing emotional support, promoting exercise and physical activity, providing personal care, living with a cardiac device and supporting depression management. Secondly, as they make the transition to becoming a caregiver, they need to develop skills to undertake difficult discussions about the role; communicate with health professionals; manage their own mental health, well-being and sleep; and manage home and work. Thirdly, caregivers require skills to engage social support, and voluntary and formal services while recognising that the long-term future is uncertain. Discussion The identification of the needs of caregiver has been used to inform the development of a home-based heart failure intervention facilitated by a trained health care practitioner. [ABSTRACT FROM AUTHOR]