The first line nurse managers’ opportunities to lead nursing care seem to be diminishing. The aim of this study was, therefore, to gain an understanding of the first line nurse managers in their experiences in the development of nursing care as part of a wider research programme. Finnish nurse managers wrote narratives at the beginning of five different leadership courses in this grounded theory study. ‘Preparing the Air for Nursing Care’ emerged as a core category. It was formed by two major categories. ‘Being Concerned about Nursing Care’ describes the nurse managers’ focus on the development of nursing care, the nursing caregivers’ health and knowledge and a concern for the whole organisation. The second major category ‘Creating the Direction and Content of Nursing Care’ describes the nurse manager working together with the staff to create individual and family-centred best practice, initiating relationships and dialogues for nursing care, and a culture of caring. A typology was created that explained the four main modalities to emerge from the data: ‘the Active Developer’, ‘the Passive Thinker’, ‘the Impulsive Creator’ and ‘the Routine Manager’.

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.

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 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.

The suffering patient is thrown into a strange and unfamiliar environment of different technological devices in an Intensive care unit. The intensive room is a place for care and treatment, for rest and recovery, a visiting room, and a working place for the staff. In this context patients and relatives are very vulnerable and are in a need of support. Patients may suffer from unreal experiences, often very traumatic during their stay in ICU and many patients also suffer from unpleasant memories, and some develop post traumatic stress after their discharge. In order to design optimal rooms in ICU it would be important to identify factors which are meaningful for the patients and relatives. The aim of this study, as part of a larger research project, is to illuminate patients’ and relatives’ experiences of the physical room, the design and the interior in the ICU. Photographs combined with interviews are used as data collection methods within the ICU-context. Relatives and former patients are asked to photograph different aspects of the room that they remember or associate with a feeling. The pictures were used later during an interview with the informants. In total the researcher meets the informants three times, first time to inform, the second time to take the photos and a third time for the interview. This method gives the researcher opportunity to deepen the understanding and capture aspects of the room that otherwise might have been hidden. The presentation will focus on photography as a research method.

In a direct and somewhat provocative editorial in IJNS (43) pp. 923–927, Hallberg (2006) raises several challenges for nursing research if it is to provide useful evidence for health-care practice in both the short and the long term. We wish to offer a response to Hallberg’s challenges and to add support to her general call. In particular we wish to consider the challenges she poses in the wider context of caring science rather than the more limited perspective of nursing science. In the spirit of constructive debate we counter some of the claims made and indicate some areas for future direction which embrace a more epistemologically sound view of knowledge generation, which is methodologically sensitive to different research questions. This direction we believe is at the heart of what caring and nursing science is about.

The experience of childbirth is an important life experience for women. However, in-depth knowledge about long-term experiences is limited. The aim of the study was to describe women’s experiences two to 20 years after birth. This study is a part of a meta-synthesis project about childbearing in the Nordic countries. Methodologically, the study was a secondary analysis performed on original data from three selected qualitative studies by the authors, in three Nordic countries, Finland, Iceland and Sweden, and in two different forms of care, birth centre care and standard maternity care. There were 29 participants, both primipara and multiparous women. The result from this study shows that women, in a long-term perspective describe childbirth as an encounter with different participants and the most important is with the midwife. The midwife is also important in connection to the atmosphere experienced during birth. The childbirth experience has a potential to strengthen self-confidence and trust in others or, on the contrary, it can mean failure or distrust. Impersonal encounters linger feelings of being abandoned and alone. This dimension is in particular demonstrated in the description of the woman who had given birth at standard maternity care. The conclusion of this study is that childbirth experience has a potential to strengthen self-confidence and trust in others or on the contrary failure or distrust. Maternity care should be organized in a way that emphasis this aspects of care.

OBJECTIVE: To describe the meaning of previous experiences of childbirth in pregnant women who have exhibited intense fear of childbirth such that it has an impact on their daily lives. DESIGN: A descriptive phenomenological study. SETTING: A maternity clinic for women with fear of childbirth in the western part of Sweden. PARTICIPANTS: Nine women with intense fear of childbirth who were pregnant with their second child and considered their previous birth experiences negative. METHODS: Interviews that were transcribed verbatim and analyzed with a reflective life-world approach. RESULTS: The essential meanings that emerged were a sense of not being present in the delivery room and an incomplete childbirth experience. The women felt as if they had no place there, that they were unable to take their place, and that even if the midwife was present, she did not provide support. The experience remained etched in the women's minds and gave rise to feelings of fear, loneliness, and lack of faith in their ability to give birth and diminished trust in maternity care. These experiences contrasted with brief moments that made sense. CONCLUSIONS: Previous childbirth experiences for pregnant women with intense fear of childbirth have a deep influence and can be related to suffering and birth trauma. The implication is to provide maternity care where the nurse/midwife is present and supports women during birth in a way that enables them to be present and take their place during birth.

Abstract The aim of this study is to explore and describe a patient perspective in research on intercultural caring in maternity care. In total, 40 studies are synthesized using Noblit and Hare’s meta-ethnography method. The following opposite metaphors were found: caring versus non-caring; language and communication problems versus information and choice; access to medical and technological care versus incompetence; acculturation: preserving the original culture versus adapting to a new culture; professional caring relationship versus family and community involvement; caring is important for well-being and health versus conflicts cause interrupted care; vulnerable women with painful memories versus racism. Alice in Wonderland emerged as an overarching metaphor to describe intercultural caring in maternity care. Furthermore, intercultural caring is seen in different dimensions of uniqueness, context, culture, and universality. There are specific cultural and maternity care features in intercultural caring. There is an inner core of caring consisting of respect, presence, and listening as well as external factors such as economy and organization that impact on intercultural caring. Moreover, legal status of the patient, as well as power relationships and racism, influences intercultural caring. Further meta-syntheses about well-documented intercultural phenomena and ethnic groups, as well as empirical studies about current phenomena, are suggested.