The Evolving Roles and Expectations of Inpatient Palliative Care Through COVID-19: a Systematic Review and Meta-synthesis.

BACKGROUND: Palliative care performed a central role in responding to the systemic suffering incurred by the COVID-19 pandemic. Yet, few studies have elucidated the inpatient palliative care specialists' experiences and perceptions. OBJECTIVE: Systematically review and synthesize the evolving roles and expectations of inpatient palliative care specialists in response to COVID-19. DESIGN: A systematic review and meta-synthesis informed by Thomas and Harden's framework and Pozzar et al.'s approach was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. DATA SOURCES: MEDLINE, EMBASE, CINAHL, and PubMed were systematically searched for articles published between December 2019 and March 2023. We included all peer-reviewed qualitative and mixed-method literature studying the roles and expectations of inpatient palliative care specialists. A mixed-method appraisal tool was used for quality assessment. RESULTS: Of 3869 unique articles, 52 were included. Studies represented North American (n = 23), European (n = 16), South American (n = 4), Oceanic (n = 2), Asian (n = 2), West African (n = 1), Middle Eastern (n = 1), and inter-continental settings (n = 3). Most were reported in English (n = 50), conducted in 2020 (n = 28), and focused on the perspectives of inpatient palliative care clinicians (n = 28). Three descriptive themes captured the roles and expectations of inpatient palliative care specialists: shifting foundations, reorienting to relationships, and evolving identity. Two analytical themes were synthesized: palliative care propagates compassion through a healing presence, and palliative care enhances the systemic response to suffering through nimble leadership. CONCLUSION: Inpatient palliative care specialists responded to the COVID-19 pandemic by establishing their healing presence and leading with their adaptability. To develop institutionally tailored and collaborative responses to future pandemics, future studies are needed to understand how inpatient palliative care clinicians are recognized and valued within their institutions.

Caregivers' burden and deep brain stimulation for Parkinson disease: A systematic review of qualitative studies.

BACKGROUND AND PURPOSE: The impact of subthalamic nucleus deep brain stimulation (STN-DBS) on caregivers' burden is understudied. We perform a systematic review and meta-synthesis aggregating qualitative studies involving partners of people with Parkinson disease (PwP) to explore their experiences and unmet needs. METHODS: A systematic review for retrieving qualitative studies included six databases: MEDLINE, Embase, CINAHL, Cochrane, PsycInfo, and Scopus. Inclusion criteria were as follows: (i) studies on the experience of caregivers of PwP in the context of STN-DBS, (ii) English peer-reviewed articles, and (iii) qualitative or mixed methods studies reporting caregivers' quotations. After the appraisal of included studies, we performed meta-synthesis of qualitative findings. Descriptive themes and conceptual elements related to PwP partners' experiences and unmet needs were generated. RESULTS: A total of 1108 articles were screened, and nine articles were included. Three categories were identified: (i) dealing with Parkinson disease (PD) every day (the starting situation characterized by the impact of PD on ordinary life; the limitations to partners' socialization; partners' efforts in stepping aside for love and care activities), (ii) facing life changes with STN-DBS (the feeling of being unprepared for changes; the fear and concern due to loved ones' behavioral changes; struggling to find an explanation for those changes), and (iii) rebuilding the role of caregiver and partner after STN-DBS. CONCLUSIONS: This meta-synthesis elucidates concerns, challenges, and unmet needs of partners of PwP who underwent STN-DBS. It is important to provide them with information, education, and adequate support to face these challenges. Professionals need to involve partners in the care and decision process, because STN-DBS-related outcomes do not depend solely on the well-being of PwP but also on the well-being of individuals surrounding them.

Understanding the Stigma Experience of Men Living with HIV in Sub-Saharan Africa: A Qualitative Meta-synthesis.

Men living with HIV (MLWH) in sub-Saharan Africa experience poor health outcomes and increased AIDS-related deaths due to stigma influencing testing and treatment uptake and adherence. PRISMA 2020 was used to report a meta-synthesis of the stigma experiences of MLWH in SSA. With the help of an expert librarian, a search of six databases was formulated and performed to examine the available qualitative and mixed method studies with qualitative results relevant to the research question. Studies focused on adult men living with HIV, with five studies specifically examining the HIV experience of men who have sex with men. Study themes were synthesized to describe MLWH's perceived, internalized, anticipated, enacted, and intersectional stigma experiences. Most studies included masculinity as a key theme that affected both testing and treatment adherence upon diagnosis. Future research is needed to better understand subpopulations, such as men who have sex with men living with HIV, and what interventions may be beneficial to mitigate the disparities among MLWH in SSA.

Experiences of financial toxicity among caregivers of cancer patients: a meta-synthesis of qualitative studies.

OBJECTIVES: The purpose of this study was to explore the experience of financial toxicity among caregivers of cancer patients and to provide recommendations for subsequent intervention strategies. METHODS: Computer searches of PubMed, EmBase, The Cochrane Library, Web of Science, CINAHL (EBSCO), CNKI, Wanfang database, and SinoMed for qualitative studies experience of financial toxicity among caregivers cancer patients. The search time frame was from the establishment of the database to May 2023. The quality of included studies was assessed using the Qualitative Research Checklist from the Joanna Briggs Institute (JBI) Reviewer's Manual. The meta-synthesis was integrated following the meta-aggregation method proposed by the Joanna Briggs Institute (JBI) and reported following the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. RESULTS: A total of nine studies were included, distilling 25 qualitative findings into nine new categories and synthesizing three synthesized findings: caregivers have strong negative experiences that affect their family relationships, daily work and life; caregivers use different strategies to cope with financial toxicity; needs and expectations of caregivers coping with financial toxicity. CONCLUSIONS: Financial toxicity among caregivers of cancer patients affects their daily lives. Receiving timely recognition of this financial burden and providing assistance to enhance their coping skills are crucial in mitigating its impact. Healthcare professionals should focus on the financial toxicity experienced by caregivers of people with cancer, address their supportive needs, and develop a comprehensive support system to improve caregivers' coping abilities and quality of life.

The experiences and perceptions of employers on cancer survivors returning to work: a meta-synthesis of qualitative studies.

PURPOSE: Employers play an important role in the return-to-work (RTW) of cancer survivors (CSs), and recently a substantial number of qualitative studies from the employers' perspective have emerged. This meta-synthesis aims to systematically review these qualitative studies regarding employers' experiences with CSs' RTW. METHODS: Five electronic databases were searched from inception to January 2024 to identify the studies. Three researchers conducted quality assessment of included. Subsequent, we performed thematic integration of the included studies with the NVivo 11 software. RESULTS: Thirteen qualitative studies were included, and 16 topics were finally extracted and summarized into seven categories to form three integrated themes: employers' perspective on facilitators and obstacles for CSs' RTW, employers' response including negative emotion and positive behavior, and employers' need resources from different aspects. CONCLUSION: CSs' RTW is influenced by many factors; the support employers need is also extensive and complex. Employers need more support beyond healthcare.

Promoting patient-centered care in CAR-T therapy for hematologic malignancy: a qualitative meta-synthesis.

BACKGROUND: CAR-T therapy has emerged as a potentially effective treatment for individuals diagnosed with hematologic malignancies. Understanding patients' unique experiences with this therapeutic approach is essential. This knowledge will enable the development of tailored nursing interventions that align with the increasing importance of patient-centered care. OBJECTIVE: To examine and synthesize qualitative data on patients and their family caregivers' experiences during the treatment journey. DESIGN: We conducted a systematic review and qualitative meta-synthesis. Eligible studies contained adult patient or family caregiver quotes about experiences of CAR-T therapy, published in English or Chinese in a peer-reviewed journal since 2015. Data sources included MEDLINE, CINAHL, Embase, PsycINFO, Web of Science, Scopus, Cochrane Library, CNKI, and WanFang. METHODS: Systematic search yielded 6373 identified articles. Of these, 12 reports were included in the analysis, which covered 11 separate studies. Two reviewers independently extracted data into NVIVO 12.0. Qualitative meta-synthesis was performed through line-by-line coding of full text, organization of codes into descriptive themes, and development themes. RESULTS: The qualitative meta-synthesis yielded eight primary themes. Noteworthy revelations from patients and their family caregivers regarding the CAR-T therapy journey encompassed various aspects. Prior to CAR-T therapy, patients experienced a lack of actual choice, struggled with expectations for treatment outcomes, and encountered intricate emotional experiences. During or immediately after CAR-T therapy, patients reported both comfortable and uncomfortable experiences. Additionally, patients emphasized that concerns regarding treatment efficacy and adverse reactions intensified treatment-related distress. After CAR-T therapy, significant changes were observed, and the burden of home-based rehabilitation. Additionally, we found factors contributed to the high CAR-T therapy cost. CONCLUSIONS: To ensure the safety and sustainability of CAR-T therapy, it is crucial to address the physical and psychological aspects of the patient's experience. Effective communication and comprehensive management are highly valued by patients and their caregivers. Further research should investigate ways to reduce burdens and develop self-management education programs for patients and their families.

Children's and adolescents' perspectives on living with advanced cancer: A meta-synthesis of qualitative research.

PURPOSE: The quality of life (QOL) experiences of children and adolescents living with advanced cancer have been under-explored. Enhancing QOL for this population is a dominant goal of their healthcare yet, there has been little research identifying aspects that impact their QOL. The purpose of this meta-synthesis was to identify themes of QOL informed from the voices of children and adolescents living with advanced cancer. METHODS: This meta-synthesis utilized meta-ethnography to synthesize data from individual studies in order to develop new conceptual understanding of what is important to children and adolescents about their lives when living with advanced cancer. RESULTS: Our analysis identified themes of QOL relevant to children and adolescents with advanced cancer: (1) feeling supported and wanting to support others; (2) re-establishing normal; (3) suffering and emotional distress; (4) new perspectives; (5) maintaining autonomy; and (6) awareness of time. These themes differed from more traditional dimensions of QOL often applied to children and adolescents with cancer. CONCLUSION: This research is novel as its developed themes originated from the direct voices and expressed perspectives of children and adolescents living with advanced cancer. This is a significant initial step toward both understanding QOL in this specific context and the measurement of QOL for this population.

How children and adolescents understand the quality of their lives while living with advanced cancer that is difficult to cure is largely unknown and has not been extensively studied. A significant number of children and adolescents will live with advanced cancer however, it is not well-understood how children and adolescents define their quality of life (QOL) and which aspects of their lives feel meaningful to them while living with advanced cancer. This is important as their understanding and perspectives of their QOL might be very different from what their parents and healthcare professionals caring for them might identify as meaningful to their QOL. This research used the voices of children and adolescents with advanced cancer that were included in diverse research studies examining children and adolescents' experiences living with advanced cancer to develop themes of QOL for this group of young people. It was important to focus on their voices as we wanted to know directly from children and adolescents living with advanced cancer what feels meaningful and relevant to their lives. Our research identified aspects of QOL important to children and adolescents with advanced cancer that are different from how QOL is traditionally understood for children and adolescents with cancer. These findings can contribute to enhancing the healthcare of children and adolescents living with advanced cancer by suggesting that children and adolescents with advanced cancer have distinct QOL experiences and needs.

Sacred space: a qualitative interpretive meta-synthesis of women's experiences of supportive birthing environments.

BACKGROUND: In the United States there are roughly three million births a year, ranging from cesarean to natural births. A major aspect of the birthing process is related to the healing environment, and how that helps or harms healing for the mother and child. Using the theoretical framework, Theory of Supportive Care Settings (TSCS), this study aimed to explore what is necessary to have a safe and sacred healing environment for mothers. METHOD: This study utilized an updated Qualitative Interpretive Meta-synthesis (QIMS) design called QIMS-DTT [deductive theory testing] to answer the research question, What are mother's experiences of environmental factors contributing to a supportive birthing environment within healthcare settings? RESULTS: Key terms were run through multiple databases, which resulted in 5,688 articles. After title and abstract screening, 43 were left for full-text, 12 were excluded, leaving 31 to be included in the final QIMS. Five main themes emerged from analysis: 1) Service in the environment, 2) Recognizing oneself within the birthing space, 3) Creating connections with support systems, 4) Being welcomed into the birthing space, and 5) Feeling safe within the birthing environment. CONCLUSIONS: Providing a warm and welcoming birth space is crucial for people who give birth to have positive experiences. Providing spaces where the person can feel safe and supported allows them to find empowerment in the situation where they have limited control.

The breastfeeding experience of women with multiple pregnancies: a meta-synthesis of qualitative studies.

BACKGROUND: The experiences and challenges associated with breastfeeding multiple births can be considerably more complex than those of singletons. Multiple births refer to the delivery of more than one offspring in a single birth event. Emphasizing the needs and experiences of mothers with multiple births during breastfeeding can enable healthcare providers to design targeted interventions that enhance breastfeeding rates. However, existing breastfeeding and health education resources and practices do not fully meet the needs of women who breastfeed multiples. This review aimed to review and synthesize qualitative studies on the breastfeeding experiences of women with multiple births. METHODS: A systematic search was conducted in 10 electronic databases for papers published from the inception of the database to March 2024. The Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research was utilized to evaluate the methodological quality of the studies included. The thematic synthesis method of Thomas and Harden was employed to integrate and analyze the included literature to derive new categories and conclusions. FINDINGS: Eight studies met the inclusion criteria and quality assessment criteria for this study. Through the integration of their results, four themes were identified: the choice and willingness to breastfeed multiple births; the challenges of breastfeeding multiple births; stage management and individualised adaptation of breastfeeding; and the experience of support. CONCLUSION: Throughout the feeding process from pregnancy to the postpartum period, mothers with multiple births often have predominantly negative experiences with breastfeeding. Consequently, hospitals should create a multidisciplinary follow-up team comprising obstetrics, neonatology, psychology, and community services to offer specialized and personalized support to these women at various stages. SYSTEMATIC REVIEW REGISTRATION: [ https://www.crd.york.ac.uk/PROSPERO/ ], identifier [PROSPERO 2024 CRD42024520348].

Experiences of people living with HIV in low- and middle-income countries and their perspectives in self-management: a meta-synthesis.

INTRODUCTION: Availability of anti-retroviral treatment has changed HIV in to a manageable chronic disease, making effective self-management essential. However, only a few studies in low- and middle-income countries (LMICs) reported experiences of people living with HIV (PLWH) on self-management. METHODS: This meta-synthesis of qualitative studies investigated perspectives of PLWH in LMICs on self-management. Various databases, including PubMed, EMBASE, EBSCO, and CINHAL, were searched through June 2022. Relevant additional articles were also included using cross-referencing of the identified papers. We used a thematic synthesis guided by the "Model of the Individual and Family Self-Management Theory" (IFSMT). RESULT: PLWH in LIMICs experience a variety of challenges that restrict their options for effective self-management and compromises their quality of life. The main ones include: misconceptions about the disease, poor self-efficacy and self-management skills, negative social perceptions, and a non-patient-centered model of care that reduces the role of patients. The experiences that influenced the ability to practice self-management are summarized in context (the condition itself, physical and environmental factors, individual and family factors) and process factors (knowledge and beliefs, relationship with the health care worker, self-regulation skills and abilities, and social facilitation). Context and process greatly impacted quality of life through the self-management practices of the patients. CONCLUSION AND RECOMMENDATION: PLWH encounter multiple challenges, are not empowered enough to manage their own chronic condition, and their needs beyond medical care are not addressed by service providers. Self-management practice of these patients is poor, and service providers do not follow service delivery approaches that empower patients to be at the center of their own care and to achieve an effective and sustainable outcome from treatment. These findings call for a comprehensive well thought self-management interventions.

Socio-ecological factors of girl child marriage: a meta-synthesis of qualitative research.

BACKGROUND: Child marriage of girls is one example of human rights violations, and is increasingly recognized as a key obstacle to global public health. Given the importance of a comprehensive understanding of the motivations for child marriage, this study aimed to identify socio-ecological factors contributing to gills child marriage. METHODS: A comprehensive search was conducted of all English-language studies measuring causes of child marriage between 2000 and October 2022 in the Web of Science, PubMed, Scopus, PsycInfo, ProQuest, Poplin and Google Scholar databases. Girl child marriage is defined as a marriage under the age of 18. In this study, the CASP evaluation checklist was used to collect data. Two independent reviewers reviewed all articles. RESULTS: A total of 34 eligible qualitative articles were included. The most salient causes of child marriage among girls include low skills and knowledge, internal and external beliefs and motivations, and physical advantages at the individual level. Family characteristics and structure contribute to child marriage at the interpersonal level, while environmental and economic factors play a role at the community level. Social factors and cultural norms, as well as the shortcomings and weaknesses of legislation, are also contributing factors at the society level. CONCLUSION: The results showed that cultural beliefs supporting gender inequality and economic status were the most important causes of child marriage. These results can help policymakers and decision-makers implement strategies to reduce gender inequality to prevent child marriage.

Barriers and facilitators to uptake and use of oral pre-exposure prophylaxis in pregnant and postpartum women: a qualitative meta-synthesis.

BACKGROUND: Acute HIV infection during pregnancy and in the postpartum period increases the risk of vertical transmission. The World Health Organization (WHO) has recommended preexposure prophylaxis for pregnant and postpartum women at risk of acquiring HIV. However, there are significant gaps between the actual practice and the ideal goal of preexposure prophylaxis implementation among pregnant and postpartum women. Therefore, it is important to determine what influences women's implementation of preexposure prophylaxis during pregnancy and in the postpartum period. This review aims to aggregate barriers and facilitators to preexposure prophylaxis implementation among pregnant and postpartum women. METHODS: A range of electronic databases, including PubMed, CINAHL Plus with Full Text, Embase, and Web of Science, were searched for potentially relevant qualitative studies. The search period extended from the establishment of the databases to March 16, 2023. This review used the ENTREQ (Enhancing transparency in reporting of qualitative research synthesis) statement to guide the design and reporting of qualitative synthesis. The methodological quality of the included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. The JBI meta-aggregation method was applied for guiding the data extraction, and the JBI ConQual method was applied for guiding the evaluation of the level of evidence for the synthesis. RESULTS: Of retrieved 2042 studies, 12 met the inclusion criteria. The total population sample included 447 participants, including 231 pregnant and postpartum women, 21 male partners, 75 healthcare providers (HCPs)/healthcare workers (HCWs), 18 policymakers, 37 mothers, and 65 women of childbearing age. A total of 149 findings with credibility ratings of "unequivocal" or "equivocal" were included in this meta-synthesis. Barriers and facilitators to preexposure prophylaxis implementation were coded into seven categories, including three facilitator categories: perceived benefits, maintaining relationships with partners, and external support, and four barriers: medication-related barriers, stigma, barriers at the level of providers and facilities, and biases in risk perception. CONCLUSION: This systematic review and meta-synthesis aggregated the barriers and facilitators of preexposure prophylaxis implementation among pregnant and postpartum women. We aggregated several barriers to maternal preexposure prophylaxis implementation, including medication-related factors, stigma, barriers at the level of providers and facilities, and risk perception biases. Therefore, intervention measures for improving preexposure prophylaxis services can be developed based on these points. PROSPERO NUMBER: CRD42023412631.

Role of machine learning algorithms in suicide risk prediction: a systematic review-meta analysis of clinical studies.

OBJECTIVE: Suicide is a complex and multifactorial public health problem. Understanding and addressing the various factors associated with suicide is crucial for prevention and intervention efforts. Machine learning (ML) could enhance the prediction of suicide attempts. METHOD: A systematic review was performed using PubMed, Scopus, Web of Science and SID databases. We aim to evaluate the performance of ML algorithms and summarize their effects, gather relevant and reliable information to synthesize existing evidence, identify knowledge gaps, and provide a comprehensive list of the suicide risk factors using mixed method approach. RESULTS: Forty-one studies published between 2011 and 2022, which matched inclusion criteria, were chosen as suitable. We included studies aimed at predicting the suicide risk by machine learning algorithms except natural language processing (NLP) and image processing. The neural network (NN) algorithm exhibited the lowest accuracy at 0.70, whereas the random forest demonstrated the highest accuracy, reaching 0.94. The study assessed the COX and random forest models and observed a minimum area under the curve (AUC) value of 0.54. In contrast, the XGBoost classifier yielded the highest AUC value, reaching 0.97. These specific AUC values emphasize the algorithm-specific performance in capturing the trade-off between sensitivity and specificity for suicide risk prediction. Furthermore, our investigation identified several common suicide risk factors, including age, gender, substance abuse, depression, anxiety, alcohol consumption, marital status, income, education, and occupation. This comprehensive analysis contributes valuable insights into the multifaceted nature of suicide risk, providing a foundation for targeted preventive strategies and intervention efforts. CONCLUSIONS: The effectiveness of ML algorithms and their application in predicting suicide risk has been controversial. There is a need for more studies on these algorithms in clinical settings, and the related ethical concerns require further clarification.

A meta-synthesis of the experience of paediatric nurses in communication with children.

AIM: This study aimed to conduct a meta-synthesis to explore the experiences of paediatric nurses in communication with children. METHOD: We conducted a meta-synthesis review, following the outline proposed by Sandelowski, Barrosso & Voils. Our search encompassed six electronic databases, namely PubMed, Scopus, EBSCO (MEDLINE), Web of Science, SAGE, and Wiley. The Primary keywords used were "nurse", "child", "communication", and "qualitative". We included qualitative articles in English within the field of paediatric nursing between 1990 and 2023. Initially, 1980 records were identified which reduced to 1339 references after removing duplicates. Subsequently, we assessed 112 full-text articles for eligibility and 14 relevant studies were ultimately included in our review. Quality appraisal was conducted using the Critical Appraisal Skill Programme checklist with no study being excluded based on quality criteria. Data were synthesized using the qualitative thematic analysis method. RESULTS: The data analysis yielded three themes and seven sub-themes. These themes include swinging between triadic and dyadic communication, applying a hybrid of communication methods, and influential factor in communication. CONCLUSIONS: This study highlighted the significance of establishing a balanced approach between dyadic communication (nurse and child) and triadic communication (nurse-parent-child) in paediatric care. Paediatric nurses emphasized the simultaneous use of verbal and non-verbal methods to enhance effective communication. Additionally, identifying the influential factors in communication can aid in developing and improving nurses' competency in communication skills within paediatric departments. IMPLICATIONS: Understanding the communication process and the factors that influence it can be instrumental in equipping paediatric nurses with enhanced communication skills in their practice. IMPACT: Establishing a balanced approach between dyadic communication (nurse and child) and triadic communication (nurse-parent-child) in paediatric care is crucial. Paediatric nurses emphasized the simultaneous use of verbal and non-verbal methods to enhance effective communication. Identifying the influential factors in communication can aid in developing and improving nurses' competency in communication skills within paediatric departments.

Inpatients' experiences of falls: A qualitative meta-synthesis.

OBJECTIVES: Identify and synthesize published qualitative research reporting inpatient experiences of a fall to determine novel insights and understandings of this longstanding complex problem. RESEARCH DESIGN: Qualitative meta-synthesis. METHODS: Online databases were searched to systematically identify published research reporting inpatient experiences of a fall. The included studies were inductively analysed and interpreted then reported as a meta-synthesis. DATA SOURCES: Databases Ovid MEDLINE, Embase, Ovid Emcare, CINAHL Complete, Scopus and ProQuest Dissertations and Theses Global were searched on 3rd August, 2023. RESULTS: From 10 included publications, four new themes of inpatients' experiences of a fall were constructed. Themes one, two and three related to antecedents of patient falls, and theme four related to consequences. Theme one, 'My foot didn't come with me: Physiological and anatomical changes', encompassed patients' experiences of medical conditions, medication, and anatomical changes. These aspects contributed to alterations in balance and strength, and misconceptions of capability in activities of daily (inpatient) living. Theme two, 'I was in a hurry: Help-seeking', encompassed patients' experiences striving for independence while balancing power and control, minimizing their own needs over care of others', and unavailability of support. Theme three, 'I couldn't find the call light: Environment and equipment', encompassed patients' experiences of not being able to reach or use equipment, and environment changes. Theme four, 'It was my fault too: Blame and confidence', encompassed patients' expressions of blame after their fall, blame directed at both themselves and/or others, and impacts on confidence and fear in mobilizing. CONCLUSIONS: Inpatient falls are embedded in a complexity of individual, relational, and environmental factors, yet there are potential ways forward both informed and led by the patient's voice. Strength-based approaches to address the tenuous balance between independence and support may be one opportunity to explore as a next step in complementing the existing multifaceted interventions. IMPACT: Inpatient falls are a complex and costly health safety and quality problem. Despite global initiatives in the prevention of inpatient falls, they remain intractable. This meta-synthesis provides an in-depth exploration of extant qualitative data on patients' experiences of falls in hospitals. Four themes were constructed expressing the inpatients' experiences: physiological and anatomical changes, help-seeking, environment and equipment, and blame and confidence. Novel considerations for future investigation are offered, drawing from self-determination theory and positive psychological interventions. IMPLICATIONS FOR PATIENT CARE: This meta-synthesis elicits new considerations for future interventions based on people's experiences of their fall in hospital, offering healthcare professionals novel directions in fall prevention. REPORTING METHOD: The review was reported according to the Enhancing transparency in reporting the synthesis of qualitative research statement (ENTREQ; Tong et al., 2012). PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution. REGISTRATION: PROSPERO CRD42023445279.

Experience and caring needs of patients with psoriasis: A qualitative meta-synthesis.

BACKGROUND: As a chronic skin disease, psoriasis often affects the physical, psychological and social status of the patient, which in turn impacts on their experience of illness and needs. However, there is no review of qualitative research that integrates and analyses the experiences and needs of these three influences from a holistic perspective. METHODS: This review follows the ENTREQ guidelines. Six English databases (JBI, Cochrane Library, PubMed, PsyINFO, CINAHL and Embase) and three Chinese databases (CNKI, VIP and Wanfang) were searched from January 2012 to October 2022. Literature was included if it was relevant to the experience of illness and caring needs of patients with psoriasis. The JBI-QARI was used to rate the quality of included studies. RESULTS: Eleven studies were included in the meta-synthesis. Four analytical themes were identified for analysis: physical challenges, psychological discomfort, social phenomena and caring needs. CONCLUSIONS: The combined physical, psychological and social effects of psoriasis and the consequent caring needs should be emphasised. Health professionals, including doctors and nurses, should be aware of the multiple changes in patients and their coping strategies, provide information about psoriasis, monitor and follow-up regularly over time and obtain feedback to inform further treatment and care so as to develop high-quality therapeutic interventions to help and guide patients with their coping strategies. RELEVANCE TO CLINICAL PRACTICE: These findings describe the physical, psychological and social experiences of illness and caring needs of patients with psoriasis. Healthcare professionals should be more aware of patients' easily overlooked psychological and social distress, providing prompt attention and recognition of patients' experiences and needs, offering relevant assistance and support and enhancing daily, regular follow-up to help them improve their understanding of and ability to manage their illness. NO PATIENT OR PUBLIC CONTRIBUTION: This is a meta-synthesis without direct patient involvement.

A meta-synthesis exploring nurses' experiences of assisted dying and participation decision-making.

AIMS AND OBJECTIVES: To explore nurses' experiences of assisted dying and understand how their perspectives inform their participation decision-making. BACKGROUND: Assisted dying is a complex and contentious issue with the potential to create moral unrest for nurses. The nursing role in assisted dying varies between jurisdictions. DESIGN: Systematic review. A meta-synthesis using thematic analysis. METHODS: Three electronic databases were searched for primary qualitative studies published in English, from New Zealand, Australia or Canada, up to October 2022. Seven articles were included; themes were analysed and key themes were established. Reporting adhered to PRISMA. RESULTS: The findings highlight the complexity of nurses' decision-making about participation or non-participation in assisted dying and the moral, philosophical and social influences that impact on their decision-making. This is presented as a spectrum of influence which persuades or dissuades nurses to participate in assisted dying. The 12 themes have been categorised into four key themes: personal persuaders, personal dissuaders, professional persuaders and professional dissuaders. CONCLUSIONS: The findings suggest that nurses should be involved in policy and procedure guideline development and be offered education and training programmes to ensure safe, confident and informed practice. The need for mentorship programmes was also prevalent in the research. RELEVANCE TO CLINICAL PRACTICE: It is crucial that nurses be offered education and training in assisted dying. Clear policy and procedure guidelines are essential, and nurses should be involved in the development of these.

Factors impeding physical activity in older hospitalised patients: A qualitative meta-synthesis.

BACKGROUND: Older hospitalised patients have low levels of physical activity and multiple impairing factors. AIMS: To systematically evaluate the perceived barriers to physical activity among older patients during hospitalisation, and provide reference for future intervention programs. DESIGN: Following ENTREQ, do a systematic evaluation and synthesis of qualitative investigations. METHODS: An exhaustive exploration was conducted across the CNKI, Wanfang Database, VIP Database, China Biomedical Literature Database, PubMed, Embase, Cochrane Library and Web of Science from their inception until August, 2023 to identify qualitative research on obstacles to physical activity among older hospital patients. The quality of the literature was evaluated using the Joanna Briggs Institute's critical appraisal tool for qualitative research. Meta-synthesis method was used to integrate the results. RESULTS: In total, 8 literatures were included, 43 themes were extracted, and analogous research results were amalgamated to generate 10 categories and 3 syntheses: individual level, interpersonal influencing factors and hospital environment and resources level. CONCLUSION: Older inpatients are faced with multiple barriers to physical activity. Medical staff should pay attention to changes in physical activity during hospitalisation, identify barriers to physical activity in older inpatients and provide references for promoting physical activity programs for the older. NO PATIENT OR PUBLIC CONTRIBUTION: This study is a meta-synthesis and does not require relevant contributions from patients or the public. WHAT IS ALREADY KNOWN: Older patients are at low physical activity levels during hospitalisation. Older inpatients are faced with multiple barriers to physical activity. WHAT THIS PAPER ADDS: Factors of physical activity impairment in hospitalised older patients should be considered in the context of health status, psychological factors, motivation and social support. Disease-induced psychological fallout has a greater impact on physical activity in the older.

Complex journeys of adolescents after induced abortion: A qualitative systematic review.

PROBLEM: Adolescents face unique challenges in accessing sexual healthcare, particularly regarding induced abortion experiences. Prior research, often quantitative or biased towards young adults, overlooks this. This review aims to address adolescents' specific post-abortion experiences to inform comprehensive reproductive healthcare needs. ELIGIBILITY CRITERIA: Qualitative and mixed-methods studies exploring the experiences of adolescents following induced abortion were included. Studies reporting these experiences from third-person perspectives were excluded. SAMPLE: Five electronic databases (CINAHL, PubMed, PsycINFO, Web of Science, and Embase) were searched from the databases' inception through March 2024. Of the 2834 articles retrieved, 45 studies were included in this review. RESULTS: Using a meta-synthesis approach combining Sandelowski & Barroso's qualitative metasummary with Braun & Clarke's thematic analysis, three main themes emerged: Post-abortion experiences and emotions, Social dynamics and support, and Life post-abortion and future perspectives. CONCLUSIONS: Adolescents who underwent abortion faced physical and emotional challenges, adopted various coping strategies, and had mixed experiences with social support and healthcare providers. To address these challenges, the provision of comprehensive reproductive health information, access to safe and legal abortion options, and support for their physical, social, and emotional well-being is necessary. Healthcare providers must ensure that adolescents are equipped with necessary skills to navigate their reproductive health journeys with informed choices and confidence. IMPLICATIONS: Future research exploring adolescents' experiences, considering cultural beliefs, involving multiple stakeholders, and conducting longitudinal studies, is warranted. Healthcare providers should implement practice changes, including providing accurate information, offering tailored mental health support, and undergoing adolescent-friendly training, to enhance care for adolescents.

Caregiving experiences of caregivers of children with rare diseases: A qualitative meta-synthesis.

PROBLEM: Most rare diseases occur in childhood and are difficult to diagnose and treat. The caregivers are faced with the challenge of providing care to the children afflicted with these rare diseases, resulting in a significant burden of care and an altered family dynamic. ELIGIBILITY CRITERIA: A meta-synthesis review was conducted to explore the caregivers' experience of children with rare diseases using eight electronic databases PubMed, Web of Science, the Cochrane Library, EMBASE, VIP database, Wan Fang, Chinese BioMedical Literature Database, and China National Knowledge Infrastructure from each database's inception to October 5, 2023. SAMPLE: 4207 records were identified and 20 eligible studies were included. RESULTS: Three themes emerged: (1) Life is changed by "rare"; (2) many unmet needs; (3) Strive to adapt and grow. CONCLUSIONS: Caregivers of children with rare diseases are full of stress and challenges in the process of caring for them, and their lives have changed greatly due to "rare". Appropriate measures need to be taken to reduce the burden on caregivers. IMPLICATIONS: According to the findings, both the medical and health systems, as well as society, should pay attention to the care load and unmet requirements of carers of children with rare diseases, and offer them with practical supportive services. Finally, it can improve the quality of life for caregivers and families of children with rare diseases, as well as stimulate the development of rare diseases.