When risk becomes illness: The personal and social consequences of cervical intraepithelial neoplasia medical surveillance

[Abstract] Background, After the early detection of cervical intraepithelial neoplasia (CIN), medical surveillance of the precancerous lesions is carried out to control risk factors to avoid the development of cervical cancer. Objective. To explore the effects of medical surveillance on the personal and social lives of women undergoing CIN follow-up and treatment. Methodology. A generic qualitative study using a poststructuralist perspective of risk management was carried out in a gynecology clinic in a public hospital of the Galician Health Care System (Spain). Participants were selected through purposive sampling. The sample consisted of 21 women with a confirmed diagnosis of CIN. Semistructured interviews were recorded and transcribed, and a thematic analysis was carried out, including researcher triangulation to verify the results of the analysis. Findings. Two main themes emerged from the participants’ experiences: CIN medical surveillance encounters and risk management strategies are shaped by the biomedical discourse, and the effects of “risk treatment” for patients include (a) profound changes expected of patients, (b) increased patient risk management, and (c) resistance to risk management. While doctors’ surveillance aimed to prevent the development of cervical cancer, women felt they were sick because they had to follow strict recommendations over an unspecified period of time and live with the possibility of a life-threatening disease. Clinical risk management resulted in the medicalization of women’s personal and social lives and produced great uncertainty. Conclusions. This study is the first to conceptualize CIN medical surveillance as an illness experience for patients. It also problematizes the effects of preventative practices in women’s lives. Patients deal with great uncertainty, as CIN medical surveillance performed by gynecologists simultaneously trivializes the changes expected of patients and underestimates the effects of medical recommendations on patients’ personal wellbeing and social relations

Double-layer masking of suffering after pregnancy loss: a grounded theory study from a male perspective

[Abstract] Introduction: Men can express different responses after pregnancy loss. This loss can interfere with their expectation of parenthood, new life, and future hopes. Expectations from the social construction of gender can encourage them to maintain an image that contradicts their actual feelings. This can lead to isolation, distancing, and difficulties in seeking support. The scarcity and low representation of men in previous studies makes research that captures the complexity of their experience necessary. The aim of this study was to explore how men confront the suffering caused by pregnancy loss. Methods: This study is part of a larger research project focusing on the experiences of parents and midwives following pregnancy loss. In this study, 22 cisgender and white heterosexual men who experienced pregnancy losses participated in semistructured interviews. Data were analyzed iteratively using constructivist grounded theory methods. Results: The substantive theory of double-layer masking of suffering emerged as way to explain the confrontation of suffering after pregnancy loss from the male perspective. The themes, (1) suffering beyond physical loss, (2) rationalization in the search for meaning, and (3) keeping a façade with others, show the impact that this loss had on men, which was masked by the meaning they gave to the situation and by its social expression. Discussion: The findings provide a theoretical conceptualization of the masking these men use to deal with the suffering they experienced from this situation. These aspects provide reasons for including these individuals in the assistance given by midwives after a pregnancy loss. Collaboration between specialized and primary care, along with staff training and support, is necessary for the provision of couple-centered care after pregnancy loss

Multicultural coping experiences of parents following perinatal loss: a meta-ethnographic synthesis

Review paper[Abstract] Aims: To synthesize research findings regarding the coping experiences of parents following perinatal loss. Design: Noblit and Hare's interpretive meta-ethnography was followed. Data sources: A comprehensive systematic search of the published literature (2013-2018) was undertaken in five databases, complemented by supplementary searches. Review methods: Fourteen studies met the research objective and inclusion criteria. Results: Five themes describe the coping strategies used by parents who experience perinatal loss. The themes were synthesized into the metaphor Staying afloat in the storm. Conclusion: Parents use coping strategies to manage perinatal loss and the use of these strategies is conditioned by cultural, social, and individual factors. This study has implications for evidence-based practice by showing care needs and the importance of implementing emotional and patient-centred care interventions. Impact: This meta-ethnography highlights the care needs of parents following perinatal loss, facilitating understanding of coping experiences. Increased knowledge about these experiences may contribute to the development and implementation of nursing and midwifery interventions that include emotional and patient-centred care

Walking a tightrope: a meta-synthesis from frontline nurses during the COVID-19 pandemic

Review[Abstract] Nursing staff plays a key role in the public health response to the COVID-19 pandemic, being in the front line of care. This study sought to synthesise the qualitative literature on care experiences of frontline nurses during the COVID-19 pandemic. A search was conducted on five databases in January 2021. Fifteen qualitative studies met the inclusion criteria and were included in the research, being submitted to interpretive meta-synthesis according to the eMERGe guide. The final synthesis included a line of argument that shows the experiences of frontline nurses during the COVID-19 pandemic, divided into three major themes: 'Instability on the edge of a cliff: unpredictable and unknown context,' 'The price of walking the tightrope: the uncertainty surrounding care,' and 'Finding the balance to reach the other side: dealing with the emotional demands of care.' Although essential in the health response to the COVID-19 pandemic, nurses experienced an emotional impact arising from the hampered care provision. Our results point to need for strengthening the training of nurses and future nurses, creating and promoting measures that contribute to their psycho-emotional well-being, ensuring a safe environment for their clinical practice, and promoting their participation in decision-making processes

Cultivating learning in vitro: a meta-ethnography of learning experiences of nursing students regarding high-fidelity simulation

Review[Abstract] Objectives: To synthesise the experience of nursing students in their final years regarding high-fidelity simulation in acute and critical care. Background: For the complex and changing healthcare environment, new tools are required to help health students, educational staff and managers to design and present rewarding educational simulations. Due to the complexity and limited learning opportunities in real settings, high-fidelity simulation enables students to acquire skills for the provision of acute and critical care in a controlled environment that closely imitates reality; however, the literature on students' learning experiences with this education methodology is still limited. Design: This study followed Noblit and Hare's interpretive meta-ethnography, which was written and reviewed for reporting clarity against the EQUATOR checklist using the eMERGe. Data sources: A comprehensive systematic search strategy was carried out in five databases: PubMed, Scopus, CINAHL, Web of Science and PsycINFO. Review methods: Ten studies met the research objective and inclusion criteria. Results: The metaphor 'Cultivating learning in vitro' and four themes were developed to describe the learning experiences of nursing students regarding high-fidelity simulation in acute and critical care. The themes were as follows: Learning roots-Ways to learn during high-fidelity simulation; Learning stimulants-Elements that favour learning; Learning impairments-Elements that hinder learning; and Learning flourishing-Results after high-fidelity simulation. Conclusions: Seeing, doing and reflecting constituted the main sources of learning. Students identified the stimulating and debilitating aspects of learning which could help in the design of simulation sessions and promote their incorporation into nursing curricula. Finally, 'the flowering of the plant' represents the learning outcomes developed in a controlled and safe environment. Relevance to clinical practice: The results of this meta-ethnography provide keys to promote change in teaching planning in relation to acute and critical care

Novice Nurses’ Transition to the Clinical Setting in the COVID‐19 Pandemic: A Phenomenological Hermeneutic Study

Financiado para publicación en acceso aberto: Universidade da Coruña/CISUG[Abstract] Background: : The COVID-19 pandemic both exposed and increased weaknesses in the healthcare system, so that novice nurses have become a more vulnerable group during this context. Aim: : This study sought to illuminate experience of novice nurses in providing care during the COVID-19 pandemic. Method: : It consists of a qualitative study conducted with data collected by means of semi-structured interviews, audio recorded, transcribed, anonymised, and analysed in the light of the phenomenological hermeneutic approach. Fourteen registered novice nurses from two health areas in northwest X, being twelve women and two men, who experienced the COVID-19 pandemic within their first five years of professional experience, were selected through a non-statistical snowball sampling. Results: : After analysing the narratives, we identified four main themes: "Transitioning to a hostile, unknown and uncertain clinical setting from inexperience," "Invisible wounds because of being on the front line," and "Healing to return to the front line." Discussion: : The uncertainty of an unknown illness and the lack of support during the COVID-19 pandemic has been affecting novice nurses, impacting their health conditions. At the same time, this context created opportunities for professional development. According to the interviewees, self-care and social support were elements to cope with exhaustion. Conclusion: : Our study investigates the experiences of a group barely approached in the literature, highlighting the reality and difficulties of these nurses in transitioning to the clinical setting and providing insights to managerial leaders and educators.Funding for open access charge: Universidade da Coruña/CISU

Encountering Parents Who Are Hesitant or Reluctant to Vaccinate Their Children: A Meta-Ethnography

[Abstract] Health professionals play an important role in addressing parents who are hesitant or reluctant to immunise their children. Despite the importance of this topic, gaps remain in the literature about these experiences. This meta-ethnography aimed to synthesise the available body of qualitative work about the care experiences of community and hospital health professionals in encounters with parents hesitant or reluctant to vaccinate their children. The aim is to provide key information for the creation of strategies that address vaccine hesitancy or refusal and ensure public trust in vaccination programs, which are required in a pandemic context such as the current one. (2) Methods: Noblit and Hare’s interpretive meta-ethnography of 12 studies was followed. A line of argument synthesis based on a metaphor was developed. (3) Results: The metaphor “The stone that refuses to be sculpted”, accompanied by three themes, symbolises the care experiences of health professionals in their encounters with parents that hesitate or refuse to vaccinate their children. (4) Conclusions: The creation of clearer communication strategies, the establishment of a therapeutic alliance, health literacy and the empowerment of parents are recommended. The incorporation of health professionals in decision making and the strengthening of multidisciplinary teams interacting with such parents are also include

The link between task-focused care and care beyond technique: a meta-ethnography about the emotional labour in nursing care

Review[Abstract] Objective: To synthesise the available body of qualitative work regarding the experiences of registered nurses and nursing students in managing emotional demands of care. Background: Care is the central part of nursing, and its provision is linked to interaction with patients. Comprehensive care allows emotions to be considered as an essential part of care. However, the emotional commitment that care demands poses a challenge for the nursing staff. Design: Noblit and Hare's interpretive meta-ethnography, which was written and reviewed for reporting clarity using the eMERGe. Methods: A comprehensive systematic search strategy was undertaken in PubMed, CINAHL, Scopus, Web of Science and PsycINFO in January 2020. The search included terms related to the sample population, phenomenon of interest, purpose of the study and type of research. Original or mixed qualitative articles in English, Spanish and Portuguese were included if they addressed the emotional labour experiences of nurses or nursing students. Results: A line-of-argument synthesis based on the metaphor The link between task-focused care and care beyond technique was developed. Three themes from analogous and refutational translations of findings in the included nine papers emerged: (1) forces to get involved in care; (2) the cost of caring and (3) need to vent. Conclusion: Nursing staff and students managed the emotional demands by adjusting their involvement in care. Care beyond technique is provided by nurses who have strength and motivation in themselves and in the interaction with patients to become emotionally involved in care. Task-focused care avoids emotional exposure to patient suffering due to the personal cost involved. Venting and distancing are required to emotionally reconstruct themselves and to re-engage in care. Relevance to clinical practice: Increased knowledge about these experiences may raise awareness of the emotional demands as part of the care process, to prevent their impact and favour their support

Immigrant women’s occupational struggles during the socioeconomic crisis in Spain: Broadening occupational justice conceptualization

[Abstract] Occupational scientists claim that further development of the concept of occupational justice is needed to enact the discipline’s commitment to social transformation. We argue that immigrant women’s experiences of occupations in Spain can contribute to this dialogue. Although research on occupations after migration has expanded internationally, limited studies have adopted a critical stance towards health and occupation simultaneously. Thus, we propose that advancing understanding of immigrant women’s experiences of daily participation in occupations and identifying health/well-being mediators to generate actions to promote health from a critical perspective might advance the conceptualization of occupational justice. A participatory health research study informed by Epistemologies of the South was undertaken with six women from Latin America. Data were generated through group discussion, interviews, diaries and Metaplan. A critical narrative analysis and a participatory thematic analysis were performed. Immigrant women's daily life in Spain (shared trajectories and experiences, occupational struggles, and health and well-being mediators and consequences) and an Agenda for change set by the participants (Daily challenges to overcome and possible formula to improve daily living) are reported. Findings are aligned with previous research revealing similar threats to occupational rights, impact on health and the strategies used to navigate both. New insights from the findings expand occupational justice conceptualization, portraying how structural elements such as class, gender and ethnicity shape occupational opportunities which create daily injustices negotiated through occupations, namely occupational struggles. These occupational struggles impact both negatively and positively on well-being. A specific action agenda towards occupational justice is recommended by the participants

Primary healthcare midwives’ experiences of caring for parents who have suffered an involuntary pregnancy loss: a phenomenological hermeneutic study

[Abstract] Objective: To illuminate the experiences of primary healthcare midwives who care for parents who have suffered an involuntary pregnancy loss. Design: The phenomenological hermeneutic approach developed by Lindseth and Norberg was used to carry out narrative interviews. Setting and participants: A purposive sample of 11 public primary healthcare midwives from a municipality in northern Spain, was selected. The participants' ages ranged between 26 and 62 years, and they were all women. Findings: Four main themes were identified: (1) handling adversity, (2) finding a motive to get involved, (3) providing care from the rear, and (4) avoiding emotional connections with the parents. For the midwives, caring for parents who had suffered an involuntary pregnancy loss meant leaving their own comfort zone and handling adversity. They described acting in different ways such as going beyond task-focused care, following their intuition or avoiding encounters with the parents. Conclusions: More knowledge and preparation in terms of communication skills and bereavement is crucial for midwives in order to meet the needs of parents who have suffered an involuntary pregnancy loss. A caring organizational culture and supportive leadership will facilitate care continuity between specialized and primary healthcare and promote the welfare of midwives