Qualitative synthesis and systematic review in health professions education

Context  Formal qualitative synthesis is the process of pooling qualitative and mixed-method research data, and then drawing conclusions regarding the collective meaning of the research. Qualitative synthesis is regularly used within systematic reviews in the health professions literature, although such use has been heavily debated in the general literature. This controversy arises in part from the inherent tensions found when generalisations are derived from in-depth studies that are heavily context-dependent.Methods  We explore three representative qualitative synthesis methodologies: thematic analysis; meta-ethnography, and realist synthesis. These can be understood across two dimensions: integrative to interpretative, and idealist to realist. Three examples are used to illustrate the relative strengths and limitations of these approaches.Discussion  Against a backdrop of controversy and diverse methodologies, readers must take a critical stand when reading literature reviews that use qualitative synthesis to derive their findings. We argue that notions of qualitative rigour such as transparency and acknowledgment of the researchers’ stance should be applied to qualitative synthesis.

Cancer patients' perceptions of the barriers and facilitators to patient participation in symptom management during an episode of admission

BACKGROUND:: Symptoms by definition are subjective, and patients' role in their assessment and management will impact on patient outcomes; thus, symptom management is an area of acute care practice where facilitation of patient participation is vital if quality outcomes are to be achieved. OBJECTIVE:: This study originated from a large multimethod research program exploring patient participation in symptom management in an acute oncology setting. The purpose of this article is to explore patients' perceptions of the barriers and facilitators to participating in their symptom management during an episode of admission to an acute oncology ward and the relationships between these perceptions and patients' preference for participation. METHODS:: One hundred seventy-one cancer inpatients consented and completed an interview-administered questionnaire. Patients' preference for participation was measured using the Control Preference Scale. Responses to open-ended survey questions were evaluated using content analysis. RESULTS:: Ten categories were identified in the analyses of patient perceptions of the barriers and facilitators to participating in care decisions relating to their symptoms. Patients, irrespective of their Control Preference, reported multiple barriers and facilitators to participating in their symptom management. CONCLUSIONS:: Patients overall perceived information as the most critical component of participation. Irrespective of patients' preference for participation, there were similarities in the barriers and facilitators to the operationalization of participation in the acute care setting reported. IMPLICATIONS FOR PRACTICE:: Understanding patient perceptions of barriers and facilitators of participating in symptom management has provided important insights into person and system factors in the acute care sector impacting quality patient symptom outcomes.

Ongoing challenges responding to behavioural and psychological symptoms of dementia

BACKGROUND: Mid- to late-stage dementia is often characterized by behavioural and psychological symptoms, including, but not limited to physical and verbal aggression. INTRODUCTION: Although there is a considerable research about the prevalence, aetiology, and management of behavioural and psychological symptoms of dementia, there is limited research about the experience of caring for people with such symptoms in long-term aged care facilities. AIM: The aims of the study were to describe: (i) nurses' experiences of caring for people with behavioural and psychological symptoms of dementia in long-term aged care facilities, and (ii) strategies nurses used to deal with these symptoms. METHODS: A qualitative exploratory and descriptive design, involving focus group interviews with 30 nurses from three long-term aged care units in Australia. The transcripts were analysed using inductive content analysis. RESULTS: The findings revealed five interrelated themes: (i) working under difficult conditions, (ii) behavioural and psychological symptoms of dementia: an everyday encounter, (iii) making sense of behavioural and psychological symptoms of dementia, (iv) attempting to manage behavioural and psychological symptoms of dementia, and (v) feeling undervalued. CONCLUSION: This study highlighted the difficult conditions under which nurses worked and the complexity of caring for individuals who have behavioural and psychological symptoms of dementia. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Organizational efforts to enhance the quality of care for individuals with behavioural and psychological symptoms of dementia in long-term aged care facilities should extend beyond staff education to heed nurses' concerns about organizational barriers to interpersonal care.

Patients' perceptions of participation in nursing care on medical wards

BACKGROUND: Patient participation benefits the patient and is a core concept of patient-centred care. Patients believe in their ability to prevent errors; thus, they may play a vital role in combating adverse event rates in hospitals. AIMS AND OBJECTIVES: To explore hospitalised medical patients' perceptions of participating in nursing care, including the barriers and facilitators for this activity. RESEARCH METHODS: This interpretive study was conducted on four medical wards, in two hospitals. Purposeful maximum variation sampling was operationalised to recruit patients that differed in areas such as age, gender and mobility status. In-depth semi-structured audiotaped interviews were undertaken and analysed using inductive content analysis. RESULTS: Twenty patients participated in the study. Four categories were uncovered in the data. First, valuing participation showed patients' willingness to participate, viewing it as a worthwhile task. Second, exchanging intelligence was a way of participating where patients' knowledge was built and shared with health professionals. Third, on the lookout was a type of participation where patients monitored their care, showing an attentive approach towards their own safety. Fourth, power imbalance was characterised by patients feeling their opportunities for participation were restricted. CONCLUSIONS: Patients were motivated to participate and valued participation. Cultivating this motivation may be crucial to patient empowerment and practices of safety monitoring, a fundamental strategy to addressing patient safety issues in hospitals. Engaging nurse-patient relationships, inclusive of knowledge sharing, is required in practice to empower patients to participate. Educating patients on the consequences of non-participation may motivate them, while nurses may benefit from training on patient-centred approaches. Future research should address ways to increase patient motivation and opportunities to participate.

A tale of two events? Media analysis of the Melbourne 2008 Homeless World Cup

In 2008, Melbourne became the first Australian city to host the Homeless World Cup (HWC), an annual international sporting event that aims to raise the profile of homelessness and social marginalisation. This article first examines relevant print media articles relating to the HWC by identifying key themes through thematic and content analysis. It then examines the polarised reporting of the HWC by two print media outlets, The Age and the Herald Sun, and argues that each outlet's coverage served to reinforce its own established position on the key political and social issues, in this instance homelessness, asylum seeking and immigration. The divergence in the discourses constructed in each paper provides a demonstrative example of the capacity of the media to use events of all sorts to consolidate their political and commercial positions.

Change in schools it’s more like sort of turning an oil tanker : creating readiness for health promoting schools

Purpose – The purpose of this paper is to add to the evidence of best practice in the implementation of the Health Promoting Schools (HPS) framework by examining the process of creating readiness for change in a large international school in South-East Asia. Using a settings-based approach and guided by readiness for change theory the data collected reflects which factors were most influential in the decision of the leadership team (LT) to adopt a comprehensive HPS model. It follows the process of creating readiness in the early stages of adopting a HPS approach and captures the critical factors effecting leader’s beliefs and support for the program. Design/methodology/approach – This research is a case study of a large pre-K-12 international school in South-East Asia with over 1,800 students. A mixed methods qualitative approach is used including semi-structured interviews and document analysis. The participants are the 12 members of the LT. Findings – Readiness for change was established in the LT who adopted a HPS approach. That is, they adopted a comprehensive model to address health-related priorities in the school and changed the school’s mission and accountability processes to specifically include health. Uncovering the reasons why the LT supported this change was the primary focus of this research. Building the motivation to change involved establishing a number of key beliefs three of which were influential in bringing about readiness for change in this case study. These included the belief that leadership support existed for the proposed change, a belief that there was a need for change with a clear discrepancy in the present and preferred operations in relation to addressing the health issues of the school and the belief that HPS was the appropriate solution to address this discrepancy. Research limitations/implications – Adopting a HPS approach is the first phase of implementation. Long-term research may show if the integrity of the chosen model is maintained as implementation continues. The belief construct of valence, that is, the belief that the change will benefit the change recipient, was not reliably assessed in this research. Further research needs to be conducted to understand how this construct is interpreted in the school setting. The belief construct of valence was not reliably assessed in this research. Further research needs to be done to understand how this construct fits in the school setting. Practical implications – This paper provides a promising example of how health can be integrated into the school’s Mission and Strategic Learning Plan. The example presented here may provide strategies for others working in the field of HPS. Originality/value – Creating readiness is an often over-looked stage of building sustainable change. International schools cater to more than three million students are a rarely researched in regards to health education. It is predicted that the numbers of students in international schools will grow to more than six million in the next ten years.

Eat, drink and gamble: marketing messages about 'risky' products in an Australian major sporting series

BACKGROUND: To investigate the alcohol, gambling, and unhealthy food marketing strategies during a nationally televised, free to air, sporting series in Australia. METHODS/APPROACH: Using the Australian National Rugby League 2012 State of Origin three-game series, we conducted a mixed methods content analysis of the frequency, duration, placement and content of advertising strategies, comparing these strategies both within and across the three games. RESULTS: There were a total of 4445 episodes (mean = 1481.67, SD = 336.58), and 233.23 minutes (mean = 77.74, SD = 7.31) of marketing for alcoholic beverages, gambling products and unhealthy foods and non-alcoholic beverages during the 360 minutes of televised coverage of the three State of Origin 2012 games. This included an average per game of 1354 episodes (SD = 368.79) and 66.29 minutes (SD = 7.62) of alcohol marketing; 110.67 episodes (SD = 43.89), and 8.72 minutes (SD = 1.29) of gambling marketing; and 17 episodes (SD = 7.55), and 2.74 minutes (SD = 0.78) of unhealthy food and beverage marketing. Content analysis revealed that there was a considerable embedding of product marketing within the match play, including within match commentary, sporting equipment, and special replays. CONCLUSIONS: Sport is increasingly used as a vehicle for the promotion of range of 'risky consumption' products. This study raises important ethical and health policy questions about the extent and impact of saturation and incidental marketing strategies on health and wellbeing, the transparency of embedded marketing strategies, and how these strategies may influence product consumption.

Nurses' views of patient participation in nursing care

AIMS: To explore nurses' views of patient participation in nursing care on medical wards. BACKGROUND: Nurses have frequent contact with patients, highlighting their potential role in enabling patient participation. However, some nurses' actions and attitudes act as barriers, failing to achieve core requirements of patient participation. Discovering nurses' views may assist in developing strategies to encourage patient participation in hospitals. DESIGN: Interpretive study. METHODS: Twenty nurses were recruited from four medical wards, located in two Australian hospitals. In-depth semi-structured interviews were conducted between November 2013-March 2014 and analysed using content analysis. FINDINGS: Five categories emerged from the nurses' views. The first category, acknowledging patients as partners, showed nurses respected patients as legitimate participants. In the second category, managing risk, nurses emphasized the need to monitor participation to ensure rules and patient safety were maintained. Enabling participation was the third category, which demonstrated nurses' strategies that enhanced patients' participation. The fourth category was hindering participation; encapsulating nurses' difficulty in engaging patients with certain characteristics. In the final category, realizing participation, nurses believed patients could be involved in physical activities or clinical communication. CONCLUSION: Nurses have a crucial role in promoting patient participation. Through acknowledging and enabling participation, nurses may facilitate patient participation in a range of nursing activities. The nurse's role in enacting participation is complex, having to accommodate each patient's risks and characteristics, highlighting the need for good assessment skills. Education, policy and research strategies are essential to foster nurses' pivotal role in patient participation.

Lessons in building capacity in sexuality education using the health promoting school framework: from planning to implementation

Purpose – The health promoting school model is rarely implemented in relation to sexuality education. This paper reports on data collected as part of a five-year project designed to implement a health promoting and whole school approach to sexuality education in a five campus year 1-12 college in regional Victoria, Australia. Using a community engagement focus involving local and regional stakeholders and with a strong research into practice component, the project is primarily concerned with questions of capacity building, impact and sustainability as part of whole school change. The paper aims to discuss this issue. Design/methodology/approach – Using an action research design, data were collected from parents, students, teachers and key community stakeholders using a mixed methods approach involving surveys, interviews, document analysis and participant observation. Findings – Sexuality education has become a key school policy and has been implemented from years 1 to 9. Teachers and key support staff have engaged in professional learning, a mentor program has been set up, a community engagement/parent liaison position has been created, and parent forums have been conducted on all five campuses. Research limitations/implications – The translation of research into practice can be judged by the impact it has on teacher capacity and the students’ experience. Classroom observation and more longitudinal research would shed light on whether the espoused changes are happening in reality. Originality/value – This paper reports on lessons learned and the key enabling factors that have built capacity to ensure that sexuality education within a health promoting, whole school approach will remain sustainable into the future. These findings will be relevant to others interested in building capacity in sexuality education and health promotion more generally.

Selecting, training and assessing new general practice community teachers in UK medical schools

Background: Standards for undergraduate medical education in the UK, published in Tomorrow’s Doctors, include the criterion ‘everyone involved in educating medical students will be appropriately selected, trained, supported and appraised’. Aims: To establish how new general practice (GP) community teachers of medical students are selected, initially trained and assessed by UK medical schools and establish the extent to which Tomorrow’s Doctors standards are being met. Method: A mixed-methods study with questionnaire data collected from 24 lead GPs at UK medical schools, 23 new GP teachers from two medical schools plus a semi-structured telephone interview with two GP leads. Quantitative data were analysed descriptively and qualitative data were analysed informed by framework analysis. Results: GP teachers’ selection is non-standardised. One hundred per cent of GP leads provide initial training courses for new GP teachers; 50% are mandatory. The content and length of courses varies. All GP leads use student feedback to assess teaching, but other required methods (peer review and patient feedback) are not universally used. Conclusions: To meet General Medical Council standards, medical schools need to include equality and diversity in initial training and use more than one method to assess new GP teachers. Wider debate about the selection, training and assessment of new GP teachers is needed to agree minimum standards.

Social exclusion of Australian childless women in their reproductive years

Research suggests Australian childless women are at risk of pronatalism-driven social exclusion. This exploratory, mixed methods, cross-sectional study described and explored the social exclusion of Australian childless women aged 25 to 44 years, and asked: what are the nature and extent of social exclusion of childless women; and do the nature and extent of exclusion vary for different types of childless women? A total of 776 childless female Australian residents aged 25 to 44 years completed a self-administered questionnaire. Quantitative data were collected on childlessness types, indicators of exclusion and perceived stigmatisation and exclusion due to being childless. Data were analysed using descriptive statistics, One Way ANOVAs and Kruskal Wallis Analysis of Ranks. Qualitative data on childless women’s experiences were inductively thematically analysed. Findings suggest societal-level pronatalism drives exclusion of Australian childless women. While exclusion occurs in all domains of life, childless women experience more exclusion, and perceive more exclusion due to being childless, in the social and civic domains than the service and economic domains. Circumstantially and involuntarily childless women, followed by voluntarily childless women, perceive more exclusion due to being childless than undecided and future childed women. Experiences are influenced by the nature of women’s ‘deviance’ from pronatalism.

Responsabilidade corporativa: entre o social e o regulado estudo de um setor da siderurgia brasileira

Este trabalho teve como objetivo analisar as dimensões de responsabilidade corporativa "regulada" e a responsabilidade corporativa "social", explorando o conceito de responsabilidade social em relação às práticas de responsabilidade social e regulada, bem como sua aplicação no ramo siderúrgico brasileiro, especificamente nas seguintes empresas: Companhia Siderúrgica Nacional, CSN e Companhia Siderúrgica Paulista, COSIP A. Em linhas gerais, os resultados chamaram a atenção para o fato de que, em grande parte, o que se vem chamando de responsabilidade social, não passa do cumprimento às determinações legais. Dessa forma, entender a responsabilidade que as empresas têm para o desenvolvimento de uma sociedade requer verificar em que medida as organizações estão contribuindo para um desenvolvimento econômico e social, que leve em conta noções de sustentabilidade e que vão além das determinações pautadas pela legislação vigente. No tratamento dos dados coletados nas entrevistas utilizou-se análise do discurso como uma forma de entender as relações intertextuais e interdiscursivas, ou seja, compreender as disfuncionalidades entre o que se diz e o que se faz. Além disso, serviram de suporte para análise pesquisas documental e bibliográfica do tema em questão.

O desafio de reconhecimento do sujeito cego em espaços públicos de representação

This work is funded based on the uneasiness with the concept of State as a public machine for development. Of State as a public machine to deliberate valid practices for valid methods and to limit valid subjects in valid spaces. In midst of this specific context, this work dedicates itself to investigate the following research problem: the mistaken recognition of the blind subject in public spaces of representation. For this reason, it was addressed the following question: how the blind subject is recognized in public spaces of representation? To answer the question, it was necessary to contextualize how the blind subject is being recognized in various public spaces of representation. In the international scope, the human rights debate held between the National States was analyzed (BRAND, 2005; KOERNER, 2002; UN, 2006). In the national arena, constitutional rights, federal laws, public policies and institutions representing the blind subject were examined (CABRAL, 2008; SARAVIA, 2006). Finally, in a local context, the fundaments of the concept of citizen for the subject recognition were investigated (AGAMBEN, 2002; RORTY, 1999, DELEUZE AND GUATTARI, 1996). The methodology included reports of national and international representatives in the Lusophone Countries Meeting for Dissemination and Implementation of the Convention on the Rights of Persons with Disabilities and, mainly, interviews with blind subjects. The data was processed by content analysis and was discussed based on the following categories: representation spaces; representation modes; representation amplitude; representation premises. The results show, regarding such spaces of representation, the growing importance of thinking the rights of persons with disabilities ¿ group in which belongs the blind subject ¿ as of the international and national scenario. However, the blind subjects announced alternative local spaces for representation: church, internet, radio, etc. Regarding the representation modes, the role of law and standards has been advocated specially in the human rights field. The importance of the cooperation between the States and the civil society to ensure, in practice, the rights achieved was also emphasized. But other forms of representation, directly linked to each interviewee¿ history, was important. Regarding the representation amplitude, there were arguments in defense of a conception of human dignity and freedom to all inhabitants of the globe. The lusophone event highlighted the concern of the cultural peculiarities of those involved in the meeting. The blind interviewees argued for citizenship as construction of instruments for freedom and autonomy, but recognized that this is not a clear desire between the blind people in general, and even less in society as a whole. With respect to the representation premises, the fundaments for the recognition of the blind subject were based on the primacy of reason at the expense of personal experimentation. Experimentation that serves as the foundation of a new form of recognition of the blind subject in public spaces of representation, one more interested in singularities, impenetrable by reason, unmovable to another, and which are irreducible to each subject. The final considerations suggest that if the State has a reason to be, this is not another than to offer instruments to manifest as many as the existential possibilities of the subject. This is the concept of State for development.

Política de desenvolvimento e o setor de mineração: análise de discursos do governo do Peru no período de 1990 a 2009

Os estudos sobre desenvolvimento, sem dúvida, se mantiveram como um dos últimos bastiões do modernismo nas ciências sociais (Rapley, 2004). Muitos dos dilemas chave em estudos contemporâneos sobre desenvolvimento se centraram nas disjuntivas entre inovação teórica, política e prática (Simon, 2003). No entanto, a discussão que envolve a relação entre desenvolvimento e mineração, que interessa neste estudo, ainda permanece acrítica dentro da literatura dominante. Segundo Graulau (2008), o tema de mineração encontra-se num vaivém entre o favoritismo e a oposição. O estudo sob o ponto de vista normativo da mineração no campo de desenvolvimento mostra a mentalidade econômica de longa data que prevalece nesse campo. No Peru as reformas neoliberais implantadas desde a década 1990 têm promovido fortemente o setor de mineração. Os investimentos nacionais e estrangeiros, o volume das exportações e impostos certamente têm influenciado favoravelmente na economia em termos macroeconômicos, obtendo quantidades consideráveis de divisas (UNCTAD, 2008). Não obstante, a grande mineração parece não ter beneficiado as comunidades envolvidas com a extração de minérios (Barrantes, 2005; Glave e Kuramoto, 2007; Zegarra; Orihuela e Paredes, 2007). A quantidade e gravidade dos conflitos que vem acontecendo evidenciam a resistência ao setor, frente à ação discursiva do Estado peruano sobre o “desenvolvimento” que assegura o que a mineração traz. Neste contexto este estudo tem como objetivo analisar as práticas discursivas das políticas de mineração peruana em relação a construção do discurso de desenvolvimento no período compreendido entre 1990-2009. Com esse objetivo, foi necessário abordar primeiramente as principais teorias sobre desenvolvimento, mineração e mineração no Peru. No que diz respeito à metodologia o presente estudo utilizou duas técnicas de análise: a Análise Crítica de Discurso, baseado no método tridimensional proposto por Fairclough (2001), para realizar a análise de três discursos de representantes da política de mineração peruana, a segunda abordagem utiliza a Análise de Conteúdo de Bardin (2009), para examinar os artigos relacionados à política de mineração entre as principais revistas especializadas do setor–Mineria e Desde Adentro. Foram utilizadas também categorias de análise constantes e convergentes ao conceito de desenvolvimento para orientar a presente pesquisa. Finalmente as conclusões sugerem que as políticas de mineração reproduzidas pelas autoridades do Estado peruano introduziram práticas discursivas sobre desenvolvimento sustentável e que essas se mantêm relacionadas com as novas ordens de discurso: Responsabilidade Social, Minerção Sustentável, Mineração moderna, Gestão ambiental.

Crimes financeiros e política criminal : estudo de acórdãos do TRF da 3ª Região sobre os crimes de gestão fraudulenta e gestão temerária no período de 2001 a 2010

Este trabalho visa produzir conhecimento sobre como o Tribunal Regional Federal da 3ª Região tem decidido sobre dois dos principais crimes afetos à administração das instituições financeiras: gestão fraudulenta e gestão temerária. Trata-se de delitos criticados pela doutrina em razão das falhas de definição dos tipos, desde a edição da Lei 7.492, em 1986. Além disso, a sua previsão legislativa possui características que os aproximam do paradigma do direito penal do risco, ou seja: são crimes de perigo abstrato, que tutelam bem jurídico supra-individual, praticados por administradores detentores do dever de probidade na condução das instituições frente aos riscos inerentes à dinâmica do sistema financeiro. A adoção desse paradigma é controversa na doutrina penal por implicar a flexibilização de garantias do Estado Democrático de Direito sob a perspectiva do paradigma do direito penal tradicional. Diante disso, adota-se a metodologia de análise de conteúdo de decisões para se responder a dois problemas de pesquisa: (1) Quais os critérios adotados pelo Tribunal para a configuração dos crimes? (2) As decisões aproximam-se de algum paradigma de direito penal? As hipóteses objeto de teste são: (1) que o Tribunal considera principalmente a prática da conduta sem analisar a sua potencialidade lesiva sob uma perspectiva ex ante; e, (2) que esse discurso de imputação de responsabilidade aproxima as decisões do paradigma do direito penal do risco, considerados, em contexto, outros elementos presentes nas decisões. Na primeira parte, é feita uma introdução metodológica; na segunda, estabelece-se o referencial teórico; na terceira e na quarta, realizam-se as análises dos resultados quantitativos e qualitativos obtidos com a sua discussão; por fim, procede-se à conclusão, levantando-se novo problema a ser investigado.