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This paper is concerned with the phenomenology of death awareness within the context of being diagnosed with terminal cancer. The objective of the research presented here is to provide a deeper insight into terminally ill cancer patients’ engagement with their mortality.
Method
The analysis forms part of a wider project that involved conducting a metasynthesis of 23 phenomenological studies of the experience of living with the awareness of having terminal cancer published between 2011 and 2016.
Result
The metasynthesis identified four master themes that represent distinct experiential dimensions of living with terminal cancer. This paper focuses on one of these themes, liminality, to provide novel insights into the structure of death awareness whilst living with terminal cancer.
Significance of results
The results suggest that liminality describes an experiential space from within which terminal cancer patients encounter a new relationship with their existence. Liminality offers opportunities for both connection (e.g., with the natural world) as well as disconnection (e.g., from loved ones and others who still have a future) and therefore contains the potential for suffering and distress as well as for joy and a sense of fulfillment. This understanding of liminality can help healthcare professionals provide psychological support for this client group.
The aim of this metasynthesis was to develop an understanding of the existing theoretical perspectives around nurse prescribing and to identify any gaps in knowledge, which would support further research into the lived experience of the nurse prescriber in the primary care setting.
Background
Nurse prescribing has been the focus of many research studies since its introduction, with many benefits to the patient, the prescriber and service identified; however, there remains variation in the utilisation of the prescribing qualification, particularly in primary care settings. Although a range of quantitative and qualitative studies have been undertaken, which aimed to explore the influences on prescribing, few have used a research methodology that supports the in-depth exploration of the nurse prescriber’s experience.
Methods
An extensive literature search was undertaken in April 2015 (20–24), which included UK and non-UK studies since 1999. Inclusion and exclusion criteria were applied to search for studies in which participants included nurse prescribers who practiced in primary or community care settings. Studies that only used a quantitative methodology and those not available in English were excluded. The literature search yielded 124 papers, with 50 papers remaining after the initial screen of full papers against the inclusion/exclusion criteria. The papers were reviewed and graded for their quality, with a further 13 papers excluded.
A three-step qualitative analysis technique of metasynthesis was applied to the remaining 37 papers. Identification of similarities and differences enabled first-order interpretations to be identified, which were grouped into broader themes (second-order interpretations) by identifying concepts that applied to two or more studies. Further interpretation through synthesis of translation enabled third-order interpretations to emerge.
Findings
From the metasynthesis of the 37 papers, nine themes emerged: patient-centred care; benefits to the service; the need for knowledge; professional accountability and boundary setting; safety consciousness; barriers to effective prescribing; role preservation; power-shifts and inter-professional relationships; and culture of prescribing.
The primary purpose of this metasynthesis study was to explore the end-of-life experiences of Indigenous peoples by synthesizing the findings of qualitative research.
Method:
Sandelowski and Barroso's methodology for synthesizing qualitative research was used and included (a) a comprehensive search, (b) appraising reports of qualitative studies, (c) classification of studies, and (d) synthesis of the findings. Research team members guided this process. This team was multidisciplinary and included Indigenous and non-Indigenous researchers from Canada, Australia, New Zealand, and the United States. Following a comprehensive search, 2255 studies were reviewed and assessed against five inclusion criteria: (a) studies on the experiences of Indigenous populations (all genders, 18 + years of age) at the end of life, (b) studies published in English from any country, (c) studies using qualitative and mixed-methods designs, and (d) studies published between 1993 and 2013.
Results:
Some 18 studies met the inclusion criteria, and their findings were synthesized. “Preparing the spirit” for transition to the next life was the overarching theme. “Preparing the spirit” occurred within the context of “where we come from.” Processes involved in “preparing the spirit” were healing, connecting, and protecting; through these processes, “what I want at the end of life” was realized. Although not the focus of the metasynthesis, a significant finding was that the studies reviewed identified very clear barriers within healthcare systems and current healthcare provider practices to “preparing the spirit.”
Significance of results:
The findings provide a beginning understanding of the end-of-life experiences of Indigenous peoples and a foundation for future research. More interpretive qualitative research is critical if palliative care services, the healthcare system, and healthcare providers are to reduce current barriers to “preparing the spirit” for the journey at the end of life.
This paper reports on a recent review of the prevalence of glaucoma, and identifies factors that impact on its variable reporting.
Background
Glaucoma is a recognized chronic degenerative health problem worldwide, in which approximately two-thirds of sufferers are undiagnosed. Therefore it is important to better quantify glaucoma prevalence to plan adequate resources for effective risk screening, diagnosis, management and prevention. Accurate prevalence data also assist in determining the nature of relationships between glaucoma and putative risks.
Methods
A comprehensive search of peer-reviewed databases was conducted to identify and critically appraise secondary evidence published between 2002 and 2007. Glaucoma definitions, prevalence, incidence and risk factor data were extracted and compared in the context of their population descriptors.
Findings
There was no standard definition of glaucoma or standard population descriptors (age, ethnicity, country) utilized by either the primary studies included in the secondary evidence or as inclusion criteria in the secondary evidence. Prevalence for glaucoma of between 1–4% was commonly reported. Despite this, the influence of age and ethnicity on glaucoma prevalence within specific populations was repeatedly highlighted. There was consistency across studies of the decreased risk of white (European) populations compared with other ethnic groups. There was an exponential increase in prevalence of glaucoma over decades of increasing age. There were limited Australian data; however, prevalence of open-angle glaucoma is comparable with international figures. There is a clear need for worldwide agreement on standard epidemiological descriptors of glaucoma, using standard population frameworks, terminology and age groups.
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