Ashleigh E. Butler

A Guide to Writing a Qualitative Systematic Review Protocol to Enhance Evidence‐Based Practice in Nursing and Health Care

BACKGROUND The qualitative systematic review is a rapidly developing area of nursing research. In order to present trustworthy, high-quality recommendations, such reviews should be based on a review protocol to minimize bias and enhance transparency and reproducibility. Although there are a number of resources available to guide researchers in developing a quantitative review protocol, very few resources exist for qualitative reviews. AIMS To guide researchers through the process of developing a qualitative systematic review protocol, using an example review question. METHODOLOGY The key elements required in a systematic review protocol are discussed, with a focus on application to qualitative reviews: Development of a research question; formulation of key search terms and strategies; designing a multistage review process; critical appraisal of qualitative literature; development of data extraction techniques; and data synthesis. The paper highlights important considerations during the protocol development process, and uses a previously developed review question as a working example. IMPLICATIONS FOR RESEARCH This paper will assist novice researchers in developing a qualitative systematic review protocol. By providing a worked example of a protocol, the paper encourages the development of review protocols, enhancing the trustworthiness and value of the completed qualitative systematic review findings. LINKING EVIDENCE TO ACTION Qualitative systematic reviews should be based on well planned, peer reviewed protocols to enhance the trustworthiness of results and thus their usefulness in clinical practice. Protocols should outline, in detail, the processes which will be used to undertake the review, including key search terms, inclusion and exclusion criteria, and the methods used for critical appraisal, data extraction and data analysis to facilitate transparency of the review process. Additionally, journals should encourage and support the publication of review protocols, and should require reference to a protocol prior to publication of the review results.

Parents' experiences of healthcare provider actions when their child dies: An integrative review of the literature

Purpose To review, critique and synthesise current research studies that examine parental perceptions of healthcare provider actions during and after the death of a child. Conclusions Five main themes were synthesised from the literature: staff attitudes and affect; follow-up care and ongoing contact; communication; attending to the parents; and continuity of care. Practice Implications This review helps to identify important aspects of paediatric end-of-life care as recognised by parents, with the intention of placing the family at the centre of any future end-of-life care education or policy/protocol development.PURPOSE To review, critique and synthesise current research studies that examine parental perceptions of healthcare provider actions during and after the death of a child. CONCLUSIONS Five main themes were synthesised from the literature: staff attitudes and affect; follow-up care and ongoing contact; communication; attending to the parents; and continuity of care. PRACTICE IMPLICATIONS This review helps to identify important aspects of paediatric end-of-life care as recognised by parents, with the intention of placing the family at the centre of any future end-of-life care education or policy/protocol development.

Ethical and Practical Realities of Using Letters for Recruitment in Bereavement Research

Recruitment of participants into bereavement research may present many challenges for the research team. At present, there is little consensus for researchers and ethics committees on the most appropriate method of recruitment. There is some evidence that participants prefer to be contacted about research studies via letters. However, recruitment involving the use of a letter can occur in a number of ways, each with ethical and practical benefits and limitations. In a study of the experiences of bereaved parents, we used letters in three ways: direct mailing from the research team with an opt-out option; permission to mail letters obtained by social workers from a hospital-based follow-up program during routine contact; and letters mailed from the hospitals PICU research nurse at the hospital with instruction on how to opt in. In this paper, the practical and ethical realities of each method are highlighted, using examples from our own experiences. Nineteen parents also provided reflections in follow-up phone calls. While direct researcher contact is perhaps the most feasible for researchers, ethical concerns may render it unacceptable. While contact via a known member of a follow-up program is more ethically appropriate for participants, it also presents significant practical issues. We suggest that contact via a representative of the healthcare institution provides the best balance of ethical and practical acceptability for both participants and the research team, but responsiveness to the ethical and practical requirements of the study is crucial in ensuring it can be successfully undertaken.

Family Experience and PICU Death: A Meta-Synthesis

BACKGROUND AND OBJECTIVES: The PICU is the most common site for inpatient pediatric deaths worldwide. The impact of this clinical context on family experiences of their child’s death is unclear. The objective of the study was to review and synthesize the best available evidence exploring the family experience of the death of their child in the PICU. METHODS: Studies were retrieved from CINAHL Plus, OVID Medline, Scopus, PsycINFO, and Embase. Gray literature was retrieved from greylit.com, opengrey.edu, Trove, Worldcat, and Google scholar. Study selection was undertaken by 4 reviewers by using a multistep screening process, based on a previously developed protocol (International Prospective Register of Systematic Reviews 2015:CRD42015017463). Data was extracted as first-order constructs (direct quotes) or second-order constructs (author interpretations) onto a predeveloped extraction tool. Data were analyzed by thematic synthesis. RESULTS: One main theme and 3 subthemes emerged. “Reclaiming parenthood” encompasses the ways in which the parental role is threatened when a child is dying in the PICU, with the subthemes “Being a parent in the PICU,” “Being supported,” and “Parenting after death” elucidating the ways parents work to reclaim this role. The review is limited by a language bias, and by the limitations of the primary studies. CONCLUSIONS: When a child dies in a PICU, many aspects of the technology, environment, and staff actions present a threat to the parental role both during and after the child’s death. Reclaiming this role requires support from health care providers and the wider community.

Researching people who are bereaved

Conducting qualitative research, especially in areas considered ‘sensitive’, presents many challenges. The processes involved in such research often expose both participants and the research team to a vast array of risks, which may cause damage to their personal, professional, social and cultural worlds. Historically, these risks have been considered independent of each other, with most studies exploring only the risks to participants or only risks to researchers. Additionally, most researchers only consider risks during data collection, frequently overlooking risks that might be present during other phases of the research project. We aim, therefore, to bring together this fractured literature to enable an integrated exploration of the current academic discourse relating to risks to participants with the literature exploring risks to researchers across all phases of the research process. This article draws on personal experiences to highlight ethical issues and risks encountered by both participants and researchers throughout all phases of a research project. Beginning in recruitment, we discuss the risk of secondary distress in participants arising from researcher contact and then explore the concept of informed consent during grief and bereavement research. We then focus on risks present during data collection, examining risks for participants, such as emotional distress, and potential safety risks for the research team. Finally, we consider the risks which arise in data analysis, including both confidentiality and the possibility of researcher burnout. Previous recommendations are summarised, with new management strategies suggested based on lessons learned along the way.

Learning style preferences of Australian accelerated postgraduate pre-registration nursing students: A cross-sectional survey

Graduate entry programs leading to registration are gaining momentum in nursing. These programs attract student cohorts with professional, cultural, gender and age diversity. As a consequence of this diversity, such accelerated programs challenge traditional pedagogical methods used in nursing and require different approaches. To date, however, there has been limited research on the learning styles of students undertaking these programs to inform academics involved in their delivery. Kolbs Experiential Learning model has been used widely in a variety of educational settings because it is based on the theory of experiential learning. More recently VARK (Visual, Aural, Read/write and Kinaesthetic) model has become popular. The aim of this study was to investigate the learning styles of two cohorts of graduate entry nursing students undertaking an accelerated masters-level program. This was a cross-sectional survey of two cohorts of Master of Nursing Practice students enrolled at a large Australian university. The students were more inclined toward converging (practical) and least toward concrete experience (experiencing) learning styles. The majority of students were more inclined toward kinaesthetic and least toward aural learning style. Findings have implications for academics engaged in teaching graduate entry nursing students.

Gradually Disengaging: Parent–Health care Provider Relationships After a Child’s Death in the Pediatric Intensive Care Unit

When a child dies in the intensive care unit, many bereaved parents want relationships with their child’s health care staff to continue in the form of follow-up care. However, the nature of these relationships and how they change across the parents’ bereavement journey is currently unknown. This article explores early and ongoing relationships between parents and health care staff when a child dies in intensive care. Constructivist grounded theory methods were used to recruit 26 bereaved parents from four Australian pediatric intensive care units into the study. Data were collected via audio-recorded, semistructured interviews and analyzed using the constant comparative methods and theoretical memoing. Findings show that these relationships focus on Gradually disengaging, commonly moving through three phases after the child dies: Saying goodbye, Going home, and Seeking supports. These findings provide guidance to health care staff on what families need as they leave the intensive care unit and move through bereavement.

Critical care nurses’ experiences of caring for a dying child: A qualitative evidence synthesis

AIM To synthesize qualitative research examining the experience of critical care nurses caring for a dying child. BACKGROUND Caring for a dying child remains one of the most difficult aspects of nursing, potentially leading to personal and professional distress. A thorough understanding of this experience for critical care nurses allows for improved delivery of care and support for the nurse. DESIGN A qualitative evidence synthesis was undertaken, informed by Thomas and Hardens thematic synthesis methodology. DATA SOURCES Studies were retrieved from CINAHL Plus, Scopus, OVID Medline, and Embase, alongside hand-searching reference lists in February 2016. REVIEW METHODS Two reviewers independently assessed each study using a multistep screening process and performed critical appraisal of each included study. Data were extracted onto a predeveloped tool and analysed using thematic analysis. RESULTS There is a blurred line between the role of the nurse as a person or a professional while caring for the child and family throughout hospitalization and during and after the death. Each stage of care involves tasks and emotions that highlight the changing dominance of the nurse as either a person or professional. CONCLUSION Personal, interpersonal, and contextual factors affect delivery of care and impact of the death of the child on the critical care nurse. Reviewing individual and institutional practices could improve provision of care, interprofessional collaboration, and support provided to staff involved.