From Screening to Synthesis: Using NVivo to Enhance Transparency in Qualitative Evidence Synthesis

Aims and objectives The aim of this qualitative evidence synthesis was to explore the experiences and perceptions of health care staff caring for people with dementia in the acute setting. This paper focuses on the methodological process of conducting framework synthesis using NVivo for each stage of the review: screening, data extraction, synthesis and critical appraisal. Background Qualitative evidence synthesis brings together many research findings in a meaningful way that can be used to guide practice and policy development. For this purpose, synthesis must be conducted in a comprehensive and rigorous way. There has been previous discussion on how using NVivo can assist in enhancing and illustrate the rigorous processes involved. Design Qualitative Framework Synthesis. Methods Twelve documents, or research reports, based on nine studies, were included for synthesis. Conclusion The benefits of using NVivo are outlined in terms of facilitating teams of researchers to systematically and rigorously synthesise findings. NVivo functions were used to conduct a sensitivity analysis. Some valuable lessons were learned and these are presented to assist and guide researchers who wish to use similar methods in future

Protocol for a systematic review and thematic synthesis of patient experiences of central venous access devices in anti-cancer treatment

Background: Three types of central venous access devices (CVADs)—peripherally inserted central catheters (PICCs), skin-tunnelled central catheters (Hickman-type devices), and implantable chest wall Ports (Ports)—are routinely used in the intravenous administration of anti-cancer treatment. These devices avoid the need for peripheral cannulation and allow for home delivery of treatment. Assessments of these devices have tended to focus on medical and economic factors, but there is increased interest in the importance of patient experiences and perspectives in this area. The aim of this systematic review is to synthesise existing research regarding patient experiences of these CVADs to help clinicians guide, prepare, and support patients receiving CVADs for the administration of anti-cancer treatment. Method: A systematic search of MEDLINE, Embase, and CINAHL research databases will be carried out along with a supplementary reference list search. This review will include quantitative, qualitative, and mixed methods studies published in peer-review journals, reporting some aspect(s) of patient experiences or perspectives regarding the use of PICC, Hickman, or Port CVADs for the administration of anti-cancer drugs. The methodological quality and risk of bias of included papers will be assessed using the Mixed Methods Appraisal Tool (MMAT). Relevant outcome data will be extracted from included studies and analysed using a thematic synthesis approach. Discussion: The results section of the review will comprise thematic synthesis of quantitative studies, thematic synthesis of qualitative studies, and the aggregation of the two. Results will aim to offer an account of current understandings of patient experiences and perspective regarding PICC, Hickman-type, and Port devices in the context of anti-cancer treatment. Confidence in cumulative evidence will be assessed using the Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach

Dealing with daily emotions—supportive activities for the elderly in a municipal care setting

There are diverse descriptions of supportive activities in nursing to be found in the literature. What they have in common is their association with good care outcomes, but they may differ depending on the context in which the care is given. In a Swedish municipal elderly care setting, registered nurses (RN) work in a consultative way and they describe a part of their tasks as comprising supportive activities without specifying what kind of supportive activities they mean. The aim of the study was to explore the main concern of the support given by RN to a group of patients in an elderly home care setting. The study was conducted using Grounded Theory. Data were collected using nonparticipant observations regarding the supportive activities of 12 RN at the home of 36 patients between the ages of 80 and 102. Most of the home visit lasted about 40 min but some lasted for 90 min. The central category was about dealing with daily emotions. This was done by encouraging the situation and reducing the patient's limitations, but situations also occurred in which there was a gap of support. Support was about capturing the emotions that the patient expressed for a particular moment, but there were also situations in which RN chose not to give support. To develop a holistic eldercare, more knowledge is needed about the factors causing the RN to choose not to provide support on some occasions

Older women, intimate partner violence and mental health: a consideration of the particular issues for health and health care practice.

AIMS AND OBJECTIVES: The purpose of this meta-synthesis was to explore qualitative evidence in older women with a history of Intimate partner violence (IPV) and their accounts and experiences of mental health. BACKGROUND: Intimate partner violence significantly impacts the health and wellbeing of women who experience it. However, women who experience intimate partner violence do not form a homogenous group and the effect on older women has not been adequately distinguished. While there is a growing body of evidence to address this deficit, studies to date have tended to concentrate on older women's experiences of intimate partner violence in totality and as such mental health issues have been subsumed as a part of the whole. DESIGN: Meta ethnographic synthesis of qualitative evidence. METHODS: A systematic search of PUBMED, Cumulative Index to Nursing and Allied Health Literature (CINAHL), COCHRANE, Medline and PsycInfo, Sci was completed. The search included articles published up until the end of December 2015. RESULTS: The review identified that intimate partner violence exerts a significant impact on the mental health of older women. Iintimate partner violence for women in later life is inherently complex, especially where the boundaries of violence and vulnerability have been blurred historically both within the intimate partner violence discourse and through provision and practice. CONCLUSIONS: This paper adds to the developing knowledge and understanding of intimate partner violence for older women as a part of the growing body of evidence of the impact of IPV on the health and wellbeing of those who experience abuse more generally. When age and gender intersect with IPV, there are specific implications and health professionals and service providers need to be aware of these This article is protected by copyright. All rights reserved

Intensive care nurses' experiences of providing end-of-life care after treatment withdrawal: a qualitative study.

Aim and objectives. To explore the experiences of intensive care nurses who provided end-of-life care to adult patients and their families after a decision had been taken to withdraw treatment. Background. End-of-life care following treatment withdrawal is a common phenomenon in intensive care. Less is known about nurses’ experiences of providing care for the dying patient and their family in this context, when compared to specialist palliative care. Design. Descriptive exploratory qualitative study. Methods. A purposive sample of 13 intensive care nurses participated in a semi-structured face-to-face interview. Transcribed data was analysed using the principles of interpretative phenomenological analysis. Results. The essence of nurses’ experiences of providing end-of-life care after the withdrawal of treatment was interpreted as doing the best to facilitate a comfortable and dignified death’. Four master themes included: caring for the dying patient and their family; providing and encouraging presence; reconnecting the patient and family; and dealing with emotions and ambiguity. Uncertainties were evident on processes and actions involved in treatment withdrawal, how to reconnect patients and their family effectively and how to reduce the technological environment. Conclusions. Providing end-of-life care after a decision has been taken to withdraw treatment was a common aspect of intensive care. It was evident that nurses were doing their utmost to support patients and families at the end of life, despite the multiple challenges they faced. Relevance to clinical practice. The interpretive findings from this study should assist intensive care unit nurses to better understand and develop their role in providing high-quality end-of-life care after treatment withdrawal. Practice guidelines should be developed to reduce ambiguity and support the delivery of high-quality care for adults as they approach the final stages of life in intensive care units

International study on nurses' views and experiences of compassion

BACKGROUND: Compassion is considered the cornerstone of nursing practice. However, the recent failures in delivering high-quality compassionate nursing care in the UK's National Health Service have brought the topic of compassion to the attention of the public, service providers, policy makers and academics. AIM: The aim of this study was to explore the nurses' views and experiences of a number of compassion-related issues in nursing and describe similarities and differences at an international level as well as from the different nursing roles of the participating nurses. METHODS: An exploratory, cross-sectional descriptive study, using the International Online Compassion Questionnaire. A total of 1323 nurses from 15 countries completed the questionnaire. RESULTS: The majority of participants (59.5%) defined compassion as "Deep awareness of the suffering of others and wish to alleviate it" but definitions of compassion varied by country. Of participants, 69.6% thought compassion was very important in nursing and more than half (59.6%) of them argued that compassion could be taught. However, only 26.8% reported that the correct amount and level of teaching is provided. The majority of the participants (82.6%) stated that their patients prefer knowledgeable nurses with good interpersonal skills. Only 4.3% noted that they are receiving compassion from their managers. A significant relationship was found between nurses' experiences of compassion and their views about teaching of compassion. CONCLUSION: Our study is unique in identifying the views and experiences of nurses from 15 different countries worldwide. The findings reveal that compassion is neither addressed adequately in nursing education nor supported in the practice environment by managers. LIMITATIONS: Self-report bias was inherent to our survey study design. Furthermore, the individual cultural differences and similarities in the findings are difficult to extrapolate owing to the fact that our analysis was at country level, as well as at the level of the participating nurses. IMPLICATIONS FOR NURSING POLICY: Understanding the influence of culture on nurses' views about compassion is critical in the current multicultural healthcare environment and merits further research. This will potentially drive changes in nursing education (ensuring that compassion is taught to nurses) and in the way healthcare leaders and managers foster a compassionate culture within their organizations (e.g. by leading by example and compassionate to their staff). © 2016 International Council of Nurses

Improving reporting of meta-ethnography: The eMERGe reporting guidance

The aim of this study was to provide guidance to improve the completeness and clarity of meta?ethnography reporting. Evidence?based policy and practice require robust evidence syntheses which can further understanding of people's experiences and associated social processes. Meta?ethnography is a rigorous seven?phase qualitative evidence synthesis methodology, developed by Noblit and Hare. Meta?ethnography is used widely in health research, but reporting is often poor quality and this discourages trust in and use of its findings. Meta?ethnography reporting guidance is needed to improve reporting quality. The eMERGe study used a rigorous mixed?methods design and evidence?based methods to develop the novel reporting guidance and explanatory notes. The study, conducted from 2015 to 2017, comprised of: (1) a methodological systematic review of guidance for meta?ethnography conduct and reporting; (2) a review and audit of published meta?ethnographies to identify good practice principles; (3) international, multidisciplinary consensus?building processes to agree guidance content; (4) innovative development of the guidance and explanatory notes. Recommendations and good practice for all seven phases of meta?ethnography conduct and reporting were newly identified leading to 19 reporting criteria and accompanying detailed guidance.The bespoke eMERGe Reporting Guidance, which incorporates new methodological developments and advances the methodology, can help researchers to report the important aspects of meta?ethnography. Use of the guidance should raise reporting quality. Better reporting could make assessments of confidence in the findings more robust and increase use of meta?ethnography outputs to improve practice, policyand service user outcomes in health and other fields. This is the first tailored reporting guideline for meta?ethnography.This article is being simultaneously published in the following journals: Journal of Advanced Nursing, Psycho?oncology, Review of Education, PLoS One and BMC Medical Research Methodolog

Facilitating a dedicated focus on the human dimensions of care in practice settings: Development of a new Humanised Care Assessment Tool (HCAT) to sensitise care.

There is limited consensus about what constitutes humanly sensitive care, or how it can be sustained in care settings. A new Humanised Care Assessment Tool may point to caring practices that are up to the task of meeting persons as humans within busy healthcare environments. This paper describes qualitative development of a tool that is conceptually sensitive to human dimensions of care informed by a lifeworld philosophical orientation. Items were generated to reflect eight theoretical dimensions that constitute what makes care feel humanly focused. An action research group process in 2014-2015 with researchers, service users, healthcare professionals in two diverse clinical settings (stroke rehabilitation and dermatology) was used. Feedback on conceptual content, transparency of meaning and readability was then gained from a panel in Sweden and third year student nurses in the UK. The tool can be applied to attune staff to human dimensions of care, offering items which point to concrete examples of humanising and dehumanising features of practice in ways that have not yet been fully captured in the caring literature. Based on theoretically-led experiential items, with dedicated focus on what makes people feel more, or less than human, it may offer improvement on available assessments of care

How do women at increased breast cancer risk perceive and decide between risks of cancer and risk-reducing treatments? A synthesis of qualitative research

Objective: Risk‐reducing procedures can be offered to people at increased cancer risk, but many procedures can have iatrogenic effects. People therefore need to weigh risks associated with both cancer and the risk‐reduction procedure in their decisions. By reviewing relevant literature on breast cancer (BC) risk reduction, we aimed to understand how women at relatively high risk of BC perceive their risk and how their risk perceptions influence their decisions about risk reduction. Methods: Synthesis of 15 qualitative studies obtained from systematic searches of SCOPUS, Web of Knowledge, PsychINFO, and Medline electronic databases (inception‐June 2015). Results: Women did not think about risk probabilistically. Instead, they allocated themselves to broad risk categories, typically influenced by their own or familial experiences of BC. In deciding about risk‐reduction procedures, some women reported weighing the risks and benefits, but papers did not describe how they did so. For many women, however, an overriding wish to reduce intense worry about BC led them to choose aggressive risk‐reducing procedures without such deliberation. Conclusions: Reasoning that categorisation is a fundamental aspect of risk perception, we argue that patients can be encouraged to develop more nuanced and accurate categorisations of their own risk through their interactions with clinicians. Empirically‐based ethical reflection is required to determine whether and when it is appropriate to provide risk‐reduction procedures to alleviate worry