Elisabeth O.C. Hall

Challenges in Approaching Metasynthesis Research

The overall aim of this study was to contribute to the development of metasynthesis through an analysis of the challenges involved. The study grew out of the critique of qualitative metaresearch raised by current developers of metamethodologies. Different views on the application of methodologies have emerged in the literature, contributing to confusion and ambiguity concerning the challenging questions of what, why, how, and who in metasynthesis research, which might increase the risk of misunderstanding. The roots of metasynthesis research are seen as multifaceted and influencing the development of the methods in different directions. The primary worth of metasynthesis is theoretical and/or methodological development (synthesis) combined with the potential for reflection: going beyond and behind the studies (meta). Metasynthesis research has also the potential to raise questions of research collaboration, culture, and language.

The meaning of hope in nursing research: a meta‐synthesis

The aim of this study was to develop a meta-synthesis of nursing research about hope as perceived by people during sickness and by healthy people. A meta-synthesis does not intend to cover all studies about hope; rather it tries to synthesize qualitative findings from different contexts, cultures and times to provide a global picture of the phenomenon under study. Noblit and Hares meta-ethnographic approach was used. The approach is a systematic comparison of studies where each study is translated into the other. Data were 15 qualitative studies published in nursing or allied health journals and conducted in USA, Great Britain, Canada, Australia, Norway, Sweden and Finland. The meta-synthesis resulted in six metaphors that illustrate dimensions of hope. These metaphors permeated the experiences of hope regardless of whether the human being was healthy, chronically or terminally ill. They comprise the complexity of hope and were: living in hope, hoping for something, hope as a light on the horizon, hope as a human-to-human relationship, hope vs. hopelessness and fear: two sides of the same coin, and hope as weathering a storm. Knowing the multidimensionality of hope and what hope means from the patients perspective might help nurses and other healthcare professionals to inspire hope as Florence Nightingale did when she walked with the lamp through the dark corridors and spread hope and light to the patients. We suggest that nurses working with patients with serious conditions such as cancer reflect on the meaning of the metaphors.

A decade of metasynthesis research in health sciences: A meta-method study

The overall aim of this study was to analyze the methods applied in previous metasynthesis research and to inform future researchers of epistemological and methodological issues based on this analysis. Meta-method analysis was applied to a decade of 45 published metasynthesis studies that pertain to nursing and allied health studies. The findings show that the metasynthesis research can be classified into three areas: (1) health, illness and suffering, (2) care and support, and (3) parenting, newborn and childcare. Meta ethnography dominates the research area. Metastudy, metasummary, qualitative metasynthesis, and grounded formal theory are emerging methods. The metasynthesis studies suffer from modifications without explications, use of secondary method references, missing sample and search data and differences in the type of findings and the meta-concepts depicting the findings. The worth of metasynthesis research is questioned when the core ideas of qualitative meta studies, theoretical and/or methodological development (“synthesis”) combined with the potential of going beyond and behind the studies (“meta”), is missing. Metasynthesis research requires knowledge in both the substance and the various qualitative methods, and systematic attendance to the method accompanied by the openness and the creativity of a qualitative approach. Conclusions and recommendations are presented as epistemological reflections and a guide for future metasynthesis research in health sciences.

Hope as experienced in women newly diagnosed with gynaecological cancer.

AIM This article presents findings from a hermeneutic-phenomenological study with the aim to investigate the meaning of the lived experience of hope in women newly diagnosed with gynaecological cancer. METHOD Fifteen women were interviewed the day they were receiving the diagnosis at a gynaecological department of a Danish university hospital. The women, aged 24-87 (median 52 yrs), were diagnosed with ovarian, endometrial, cervical and vulvar cancer. RESULTS Hope was found to be connected to both diagnosis, cure, family life and life itself and closely tied to hopelessness. The newly received cancer diagnosis made the women oscillate between hope and hopelessness, between positive expectations of getting cured and frightening feelings of the disease taking over. Five major interrelated themes of hope were identified: hope of being cured, cared for and getting back to normal, hope as being active and feeling well, hope as an internal power to maintain integration, hope as significant relationships and hope as fighting against hopelessness. Thus, hope was woven together with hopelessness in a mysterious way; it took command through inner strength and courage based on a trust in being cured and of being in relationship with significant others. CONCLUSION The findings of the close relationship between the shades of hope and hopelessness support the need for nurses to continue to practice hope-inspiring nursing. Nurses need to understand the complexity of hope and its close connection to hopelessness when newly diagnosed with a threatening disease as cancer; and the findings might help nurses assist patients in fighting hopelessness.

Using Sandelowski and Barroso’s Meta-Synthesis Method in Advancing Qualitative Evidence

The purpose of this article was to iteratively account for and discuss the handling of methodological challenges in two qualitative research syntheses concerning patients’ experiences of hospital transition. We applied Sandelowski and Barroso’s guidelines for synthesizing qualitative research, and to our knowledge, this is the first time researchers discuss their methodological steps. In the process, we identified a need for prolonged discussions to determine mutual understandings of the methodology. We discussed how to identify the appropriate qualitative research literature and how to best conduct exhaustive literature searches on our target phenomena. Another finding concerned our status as third-order interpreters of participants’ experiences and what this meant for synthesizing the primary findings. Finally, we discussed whether our studies could be classified as metasummaries or metasyntheses. Although we have some concerns regarding the applicability of the methodology, we conclude that following Sandelowski and Barroso’s guidelines contributed to valid syntheses of our studies.

Ethical challenges embedded in qualitative research interviews with close relatives

Nurse researchers engaged in qualitative interviews with patients and spouses in healthcare may often experience being in unforeseen ethical dilemmas. Researchers are guided by the bioethical principles of justice, beneficence, non-maleficence, respect for human rights and respect for autonomy through the entire research process. However, these principles are not sufficient to prepare researchers for unanticipated ethical dilemmas related to qualitative research interviews. We describe and discuss ethically challenging and difficult moments embedded in two cases from our own phenomenological interview studies. We argue that qualitative interviews involve navigation between being guided by bioethics as a researcher, being a therapist/nurse and being a fellow human being or even a friend. The researchers’ premises to react to unexpected situations and act in a sound ethical manner must be enhanced, and there is a need for an increased focus on the researchers’ ethical preparation and to continually address and discuss cases from their own interviews.

The perceived and predicted implications of psychiatric genetic knowledge among persons with multiple cases of depression in the family

Laegsgaard MM, Stamp AS, Hall EOC, Mors O. The perceived and predicted implications of psychiatric genetic knowledge among persons with multiple cases of depression in the family.

The elderly patient's dignity. The core value of health

This study shows how care providers in hospital practice perceive the elderly patients dignity as a core value in health promoting care towards the elderly. Fifteen focus group interviews were conducted with care providers who told about their nursing practice experience. The interviews were analysed using a phenomenological hermeneutical approach. The results disclose that when caring for the elderly patients health potential, care providers saw dignity as the core value of health. Dignity was found to capture three themes: autonomy, identity, and worthiness. These themes reflect the principles of nursing practice, protecting, enhancing and promoting the elderly patients health potential. It is suggested that these themes of dignity provide a frame of reference in elder care; they shape the understanding of when health issues become a concern for health-promoting care for the elderly patient and what goals should be defined.

The challenge of integrating justice and care in neonatal nursing

The aim of this study was to explore neonatal nurses’and mothers of preterm infants’experiences of daily challenges. Interviews took place asking for good, bad and challenging experiences. Data were analysed using qualitative content analysis and findings were clustered in two categories: good and challenging experiences, each containing three themes. The good experiences were: managing with success as a nurse, small things matter for mothers, and a good day anyhow for mothers and nurses. The challenging experiences were: mothering in public, being pulled between responsibilities, and adverse things stick under the nurses’skin. The study shows that small daily clinical matters become big issues and could lead to moral distress, and that nurses integrate ethics of justice and ethics of care while mothers are concerned about health and well-being of their specific infant only. The challenge for nursing to integrate fairness and sensitive care in family-oriented neonatal care is discussed.

Evidence-based care and childbearing : a critical approach

Developing the best care for clients and patients is a paramount aim of all health care practices, which therefore, should be based on best evidence. This is also crucial for care during the childbearing period here defined as pregnancy, childbirth, and infancy. However, due to dominance of the evidence-based medicine (EBM) model, health care practice has encountered problems especially regarding its relationship to qualitative research. In this article, we analyze and discuss how research based on a lifeworld perspective fits with evidence-based care (EBC), and how a circular model instead of a hierarchy is suitable when attributing value to knowledge for EBC. The article focuses on the history of EBM and EBC, the power of the evidence concept, and EBC from a narrow to a broad view. Further qualitative research and its use for developing EBC is discussed and examples are presented from the authors’ own lifeworld research in the Nordic childbearing context. Finally, an alternative circular model of knowledge for EBC is presented. In order to develop evidence-based care, there is need for multiple types of scientific knowledge with equal strength of evidence, integrated with clinical experience, setting, circumstances and health care resources, and incorporating the experiences and clinical state of the childbearing woman and her family.