Five common pitfalls in mixed methods systematic reviews: lessons learned.

OBJECTIVES: Mixed methods systematic reviews (MMSRs) combine quantitative and qualitative evidence within a single review. Since the revision of the JBI methodology for MMSRs in 2020, there has been an increasing number of reviews published that claim to follow this approach. A preliminary examination of these indicated that authors frequently deviated from the methodology. This article outlines five common 'pitfalls' associated with undertaking MMSR and provides direction for future reviewers attempting MMSR. METHODS: Forward citation tracking identified 17 reviews published since the revision of the JBI mixed methods methodological guidance. Methods used in these reviews were then examined against the JBI methodology to identify deviations. RESULTS: The issues identified related to the rationale for choosing the methodological approach, an incorrect synthesis and integration approach chosen to answer the review question/s posed, the exclusion of primary mixed methods studies in the review, the lack of detail regarding the process of data transformation, and a lack of 'mixing' of the quantitative and qualitative components. CONCLUSION: This exercise was undertaken to assist systematic reviewers considering conducting an MMSR and MMSR users to identify potential areas where authors tend to deviate from the methodological approach. Based on these findings a series of recommendations are provided.

Health technologies for the prevention and detection of falls in adult hospital inpatients: a scoping review.

OBJECTIVE: The objective of this scoping review was to examine and map the evidence relating to the reporting and evaluation of technologies for the prevention and detection of falls in adult hospital inpatients. INTRODUCTION: Falls are a common cause of accidental injury, leading to significant safety issues in hospitals globally, and resulting in substantial human and economic costs. Previous research has focused on community settings with less emphasis on hospital settings. INCLUSION CRITERIA: Participants included adult inpatients, aged 18 years and over; the concept included the use of fall-prevention or fall-detection technologies; the context included any hospital ward setting. METHODS: This scoping review was conducted according to JBI methodology for scoping reviews, guided by an a priori protocol. A wide selection of databases including MEDLINE, CINAHL, AMED, Embase, PEDro, Epistimonikos, and Science Direct were searched for records from inception to October 2019. Other sources included gray literature, trial registers, government health department websites, and websites of professional bodies. Only studies in the English language were included. A three-step search strategy was employed, with all records exported for subsequent title and abstract screening prior to full-text screening. Screening was performed by two independent reviewers and data extraction by one reviewer following agreement checks. Data are presented in narrative and tabular form. RESULTS: Over 13,000 records were identified with 404 included in the scoping review: 336 reported on fall-prevention technologies, 51 targeted detection, and 17 concerned both. The largest contributions of studies came from the USA (n=185), Australia (n=65), the UK (n=36), and Canada (n=18). There was a variety of study designs including 77 prospective cohort studies, 33 before-after studies, and 35 systematic reviews; however, relatively few randomized controlled trials were conducted (n = 25). The majority of records reported on multifactorial and multicomponent technologies (n = 178), followed by fall detection devices (n = 86). Few studies reported on the following interventions in isolation: fall risk assessment (n = 6), environment design (n = 8), sitters (n = 5), rounding (n = 3), exercise (n = 3), medical/pharmaceutical (n = 2), physiotherapy (n = 1), and nutritional (n = 1). The majority (57%) of studies reported clinical effectiveness outcomes, with smaller numbers (14%) reporting feasibility and/or acceptability outcomes, or cost-effectiveness outcomes (5%). CONCLUSIONS: This review has mapped the literature on fall-prevention and fall-detection technology and outcomes for adults in the hospital setting. Despite the volume of available literature, there remains a need for further high-quality research on fall-prevention and fall-detection technologies.

Methodological guidance for the conduct of mixed methods systematic reviews.

OBJECTIVE: The objective of this paper is to outline the updated methodological approach for conducting a JBI mixed methods systematic review with a focus on data synthesis, specifically, methods related to how data are combined and the overall integration of the quantitative and qualitative evidence. INTRODUCTION: Mixed methods systematic reviews provide a more complete basis for complex decision-making than that currently offered by single method reviews, thereby maximizing their usefulness to clinical and policy decision-makers. Although mixed methods systematic reviews are gaining traction, guidance regarding the methodology of combining quantitative and qualitative data is limited. In 2014, the JBI Mixed Methods Review Methodology Group developed guidance for mixed methods systematic reviews; however, since the introduction of this guidance, there have been significant developments in mixed methods synthesis. As such, the methodology group recognized the need to revise the guidance to align it with the current state of knowledge on evidence synthesis methodology. METHODS: Between 2015 and 2019, the JBI Mixed Methods Review Methodology Group undertook an extensive review of the literature, held annual face-to-face meetings (which were supplemented by teleconferences and regular email correspondence), sought advice from experts in the field, and presented at scientific conferences. This process led to the development of guidance in the form of a chapter in the JBI Manual for Evidence Synthesis, the official guidance for conducting JBI systematic reviews. In 2019, the guidance was ratified by the JBI International Scientific Committee. RESULTS: The updated JBI methodological guidance for conducting a mixed methods systematic review recommends that reviewers take a convergent approach to synthesis and integration whereby the specific method utilized is dependent on the nature/type of questions that are posed in the systematic review. The JBI guidance is primarily based on Hong et al. and Sandelowski's typology on mixed methods systematic reviews. If the review question can be addressed by both quantitative and qualitative research designs, the convergent integrated approach should be followed, which involves data transformation and allows reviewers to combine quantitative and qualitative data. If the focus of the review is on different aspects or dimensions of a particular phenomenon of interest, the convergent segregated approach is undertaken, which involves independent synthesis of quantitative and qualitative data leading to the generation of quantitative and qualitative evidence, which are then integrated together. CONCLUSIONS: The updated guidance on JBI mixed methods systematic reviews provides foundational work to a rapidly evolving methodology and aligns with other seminal work undertaken in the field of mixed methods synthesis. Limitations to the current guidance are acknowledged, and a series of methodological projects identified by the JBI Mixed Methods Review Methodology Group to further refine the methodology are proposed. Mixed methods reviews offer an innovative framework for generating unique insights related to the complexities associated with health care quality and safety.

Impact of canine-assisted interventions on the health and well-being of older people residing in long-term care: a mixed methods systematic review protocol.

OBJECTIVE: The objective of this review is to synthesize and integrate the best available evidence on the impact of canine-assisted interventions on the health and well-being of older people residing in long-term care. INTRODUCTION: Canine-assisted interventions are commonly used as an adjunct therapy to enhance health and well-being, and are often implemented in long-term care facilities. The number of studies undertaken in this area has increased substantially over the previous five years; therefore, an update of two previous systematic reviews is warranted. INCLUSION CRITERIA: This review will consider older people who reside in long-term care facilities and who receive canine-assisted interventions. For the quantitative component, canine-assisted interventions will be compared to usual care, alternative therapeutic interventions, or no interventions, and outcomes will be grouped under the following headings: biological, psychological, and social. For the qualitative component, the experiences of older people receiving canine-assisted interventions, as well as the views of people directly or indirectly involved in delivering canine-assisted interventions, will be explored. Quantitative, qualitative, and mixed methods studies published from 2009 to the present will be considered. METHODS: A search of 10 bibliographic databases and other resources for published and unpublished English language studies will be undertaken. Study selection, critical appraisal, data extraction, and data synthesis will be undertaken by two independent reviewers following the segregated JBI approach to mixed methods reviews. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020161235.

Methodological guidance for the conduct of mixed methods systematic reviews.

OBJECTIVE: The objective of this paper is to outline the updated methodological approach for conducting a JBI mixed methods systematic review with a focus on data synthesis; specifically, methods related to how data are combined and the overall integration of the quantitative and qualitative evidence. INTRODUCTION: Mixed methods systematic reviews provide a more complete basis for complex decision-making than that currently offered by single method reviews, thereby maximizing their usefulness to clinical and policy decision-makers. Although mixed methods systematic reviews are gaining traction, guidance regarding the methodology of combining quantitative and qualitative data is limited. In 2014, the JBI Mixed Methods Review Methodology Group developed guidance for mixed methods systematic reviews; however, since the introduction of this guidance, there have been significant developments in mixed methods synthesis. As such, the methodology group recognized the need to revise the guidance to align it with the current state of knowledge on evidence synthesis methodology METHODS:: Between 2015 and 2019, the JBI Mixed Methods Review Methodology Group undertook an extensive review of the literature, held annual face-to-face meetings (which were supplemented by teleconferences and regular email correspondence), sought advice from experts in the field, and presented at scientific conferences. This process led to the development of guidance in the form of a chapter in the JBI Manual for Evidence Synthesis, the official guidance for conducting JBI systematic reviews. In 2019, the guidance was ratified by the JBI International Scientific Committee. RESULTS: The updated JBI methodological guidance for conducting a mixed methods systematic review recommends that reviewers take a convergent approach to synthesis and integration whereby the specific method utilized is dependent on the nature/type of questions that are posed in the systematic review. The JBI guidance is primarily based on Hong et al. and Sandelowski's typology on mixed methods systematic reviews. If the review question can be addressed by both quantitative and qualitative research designs, the convergent integrated approach should be followed, which involves data transformation and allows reviewers to combine quantitative and qualitative data. If the focus of the review is on different aspects or dimensions of a particular phenomenon of interest, the convergent segregated approach is undertaken, which involves independent synthesis of quantitative and qualitative data leading to the generation of quantitative and qualitative evidence, which are then integrated together. CONCLUSIONS: The updated guidance on JBI mixed methods systematic reviews provides foundational work to a rapidly evolving methodology and aligns with other seminal work undertaken in the field of mixed methods synthesis. Limitations to the current guidance are acknowledged, and a series of methodological projects identified by the JBI Mixed Methods Review Methodology Group to further refine the methodology are proposed. Mixed methods reviews offer an innovative framework for generating unique insights related to the complexities associated with health care quality and safety.

Barriers and enablers to implementation of pressure injury prevention in hospitalized adults: a mixed methods systematic review protocol.

OBJECTIVE: The objective of the proposed systematic review is to determine the barriers and enablers (or facilitators) to the implementation of pressure injury prevention among adults receiving care in the hospital setting. INTRODUCTION: Hospital-acquired pressure injuries are preventable; however, they remain an ongoing safety and quality health care concern in many countries. There are various evidence-based preventative interventions for pressure injuries, but their implementation in clinical practice is limited. An understanding of the different factors that support (enablers or facilitators) and inhibit (barriers) the implementation of these interventions from different perspectives is important, so that targeted strategies can be incorporated into implementation plans. INCLUSION CRITERIA: This review will include quantitative, qualitative, and mixed methods studies that investigate barriers and/or enablers in relation to hospital-acquired pressure injury prevention in hospitalized adults. Only English publications will be considered, with no publication date restrictions. METHODS: The systematic review will be conducted in accordance with the JBI methodology for mixed methods systematic review. Published studies will be searched in PubMed, CINAHL, Embase, PsycINFO and Scopus. Gray literature will also be considered. Critical appraisal and data extraction will be performed using standardized tools, followed by data transformation. Data synthesis will follow the convergent integrated approach.

Discussing sudden unexpected death in epilepsy with children and young people with epilepsy and their parents/carers: A mixed methods systematic review.

PURPOSE: To synthesise the quantitative and qualitative evidence on the views and experiences of children and young people with epilepsy (CYPwE), their family members/caregivers and healthcare professionals on conversations between healthcare professionals and CYPwE/caregivers about the possibility of sudden unexplained death in epilepsy (SUDEP). METHODS: Mixed methods systematic review in accordance with Joanna Briggs Institute methodology, PRISMA guidelines and guided by an a-priori protocol. RESULTS: 656 potentially relevant studies were identified, 11 of which fulfilled the inclusion criteria for the review: 6 quantitative studies, 4 qualitative studies and 1 opinion/text article. Data synthesis resulted in the following 2 integrated findings: (i) Caregivers, and where appropriate CYPwE, should be provided with information on SUDEP and how it relates to them; (ii) Information on SUDEP should be delivered face-to-face, with supporting written information, by a suitably knowledgeable healthcare professional whom the caregiver/CYPwE feels comfortable with, at an appropriate time at or close to diagnosis. CONCLUSION: This review confirms that healthcare professionals should discus SUDEP with CYPwE and/or their caregivers at or around the time of diagnosis and that the discussion should include prevalence of SUDEP, risk factors and risk reduction methods relative to the individual concerned. Apart from delivering SUDEP information face-to-face, with written or online information provided to reinforce messages, there is a lack of evidence on "how" to impart this sensitive information. Further research exploring the most acceptable and effective methods of discussing SUDEP with CYPwE and their caregivers is therefore indicated.

Incorporating qualitative evidence in clinical practice guidelines: a Scottish perspective.

The current article provides an overview of an approach to incorporating a range of evidence, including qualitative research findings, which the authors piloted when developing a clinical guideline on epilepsies in children and young people. We describe methods used for incorporating literature types not usually included in Scottish Intercollegiate Guidelines Network guidelines, including critical appraisal, and establishing dependability and credibility of qualitative findings. We highlight limitations encountered and make suggestions for future work.

Health technologies for falls prevention and detection in adult hospital in-patients: a scoping review protocol.

REVIEW OBJECTIVE/QUESTIONS: The objective of this scoping review is to map the evidence relating to the reporting and evaluation of health technologies for the prevention and detection of falls in adult hospital in-patients. The following questions will guide this scoping review.

Absolute clinical skill decay in the medical, nursing and allied health professions: a scoping review protocol.

REVIEW QUESTIONS/OBJECTIVES: The objective of this scoping review is to examine and map absolute clinical skill decay in the medical, nursing and allied health professions and to map the range of approaches used to address decay of clinical skills in these professions.Specifically, the review questions are: which clinical skills, performed by which professional groups, are reported to be most susceptible to absolute clinical skill decay, and what approaches have been reported for addressing absolute clinical skill decay in the medical, nursing and allied health professions?In addressing the review questions, the following sub-questions will also be addressed:It is anticipated that this scoping review will inform further systematic review/s on the topic of addressing clinical skill decay in the medical, nursing and allied health professions, as well as identify gaps in the research knowledge base that will inform further primary research.

Diagnostic test accuracy of nutritional tools used to identify undernutrition in patients with colorectal cancer: a systematic review.

BACKGROUND: Effective nutritional screening, nutritional care planning and nutritional support are essential in all settings, and there is no doubt that a health service seeking to increase safety and clinical effectiveness must take nutritional care seriously. Screening and early detection of malnutrition is crucial in identifying patients at nutritional risk. There is a high prevalence of malnutrition in hospitalized patients undergoing treatment for colorectal cancer. OBJECTIVES: To synthesize the best available evidence regarding the diagnostic test accuracy of nutritional tools (sensitivity and specificity) used to identify malnutrition (specifically undernutrition) in patients with colorectal cancer (such as the Malnutrition Screening Tool and Nutritional Risk Index) compared to reference tests (such as the Subjective Global Assessment or Patient Generated Subjective Global Assessment). TYPES OF PARTICIPANTS: Patients with colorectal cancer requiring either (or all) surgery, chemotherapy and/or radiotherapy in secondary care. Focus of the review: The diagnostic test accuracy of validated assessment tools/instruments (such as the Malnutrition Screening Tool and Nutritional Risk Index) in the diagnosis of malnutrition (specifically under-nutrition) in patients with colorectal cancer, relative to reference tests (Subjective Global Assessment or Patient Generated Subjective Global Assessment). Types of studies: Diagnostic test accuracy studies regardless of study design. SEARCH STRATEGY: Studies published in English, German, Danish, Swedish and Norwegian were considered for inclusion in this review. Databases were searched from their inception to April 2014. METHODOLOGICAL QUALITY: Methodological quality was determined using the Quality Assessment of Diagnostic Accuracy Studies checklist. DATA COLLECTION: Data was collected using the data extraction form: the Standards for Reporting Studies of Diagnostic Accuracy checklist for the reporting of studies of diagnostic accuracy. DATA SYNTHESIS: The accuracy of diagnostic tests is presented in terms of sensitivity, specificity, positive and negative predictive values. In addition, the positive likelihood ratio (sensitivity/ [1 - specificity]) and negative likelihood ratio (1 - sensitivity)/ specificity), were also calculated and presented in this review to provide information about the likelihood that a given test result would be expected when the target condition is present compared with the likelihood that the same result would be expected when the condition is absent. Not all trials reported true positive, true negative, false positive and false negative rates, therefore these rates were calculated based on the data in the published papers. A two-by-two truth table was reconstructed for each study, and sensitivity, specificity, positive predictive value, negative predictive value positive likelihood ratio and negative likelihood ratio were calculated for each study. A summary receiver operator characteristics curve was constructed to determine the relationship between sensitivity and specificity, and the area under the summary receiver operator characteristics curve which measured the usefulness of a test was calculated. Meta-analysis was not considered appropriate, therefore data was synthesized in a narrative summary. RESULTS: 1. One study evaluated the Malnutrition Screening Tool against the reference standard Patient-Generated Subjective Global Assessment. The sensitivity was 56% and the specificity 84%. The positive likelihood ratio was 3.100, negative likelihood ratio was 0.59, the diagnostic odds ratio (CI 95%) was 5.20 (1.09-24.90) and the Area Under the Curve (AUC) represents only a poor to fair diagnostic test accuracy. A total of two studies evaluated the diagnostic accuracy of Malnutrition Universal Screening Tool (MUST) (index test) compared to both Subjective Global Assessment (SGA) (reference standard) and PG-SGA (reference standard) in patients with colorectal cancer. In MUST vs SGA the sensitivity of the tool was 96%, specificity was 75%, LR+ 3.826, LR- 0.058, diagnostic OR (CI 95%) 66.00 (6.61-659.24) and AUC represented excellent diagnostic accuracy. In MUST vs PG-SGA the sensitivity of the tool was 72%, specificity 48.9%, LR+ 1.382, LR- 0.579, diagnostic OR (CI 95%) 2.39 (0.87-6.58) and AUC indicated that the tool failed as a diagnostic test to identify patients with colorectal cancer at nutritional risk,. The Nutrition Risk Index (NRI) was compared to SGA representing a sensitivity of 95.2%, specificity of 62.5%, LR+ 2.521, LR- 0.087, diagnostic OR (CI 95%) 28.89 (6.93-120.40) and AUC represented good diagnostic accuracy. In regard to NRI vs PG-SGA the sensitivity of the tool was 68%, specificity 64%, LR+ 1.947, LR- 0.487, diagnostic OR (CI 95%) 4.00 (1.23-13.01) and AUC indicated poor diagnostic test accuracy. CONCLUSIONS: There are no single, specific tools used to screen or assess the nutritional status of colorectal cancer patients. All tools showed varied diagnostic accuracies when compared to the reference standards SGA and PG-SGA. Hence clinical judgment combined with perhaps the SGA or PG-SGA should play a major role. IMPLICATIONS FOR PRACTICE: The PG-SGA offers several advantages over the SGA tool: 1) the patient completes the medical history component, thereby decreasing the amount of time involved; 2) it contains more nutrition impact symptoms, which are important to the patient with cancer; and 3) it has a scoring system that allows patients to be triaged for nutritional intervention. Therefore, the PG-SGA could be used as a nutrition assessment tool as it allows quick identification and prioritization of colorectal cancer patients with malnutrition in combination with other parameters. IMPLICATIONS FOR RESEARCH: This systematic review highlights the need for the following: Further studies needs to investigate the diagnostic accuracy of already existing nutritional screening tools in the context of colorectal cancer patients. If new screenings tools are developed, they should be developed and validated in the specific clinical context within the same patient population (colorectal cancer patients).

Supporting Breastfeeding Establishment among Socially Disadvantaged Women: A Meta-Synthesis.

BACKGROUND: Many women from socially disadvantaged groups discontinue breastfeeding in the early postnatal period before lactation is fully established. This suggests that existing health service practices do not adequately meet the breastfeeding support needs of this population. The aim of this meta-synthesis is to review the literature exploring how women from socioeconomically deprived backgrounds experience breastfeeding establishment and to identify factors associated with supportive practice. METHODS: The meta-synthesis includes qualitative studies exploring the perception of women from disadvantaged groups of in-hospital and professionally led interventions to support the establishment of breastfeeding. Searches were conducted for studies published between 1992 and 2013; after critical appraisal, eight studies were retained. RESULTS: Three overarching themes of the influences on maternal perception of the efficacy of breastfeeding support were identified. These included practical skill and knowledge of the breastfeeding process, the influence of psychological factors on perceived breastfeeding ability, and the provision of a person-centered approach to infant feeding support. CONCLUSIONS: The findings illustrate that the factors associated with supportive breastfeeding practice are extensive, complex, and interrelated. Strategies which enable mothers to gain confidence in their ability to successfully breastfeed by acquiring technical expertise, which offer positive encouragement, and which are culturally specific are more likely to be perceived as supportive by women from socially disadvantaged groups.

A mixed-methods approach to systematic reviews.

There are an increasing number of published single-method systematic reviews that focus on different types of evidence related to a particular topic. As policy makers and practitioners seek clear directions for decision-making from systematic reviews, it is likely that it will be increasingly difficult for them to identify 'what to do' if they are required to find and understand a plethora of syntheses related to a particular topic.Mixed-methods systematic reviews are designed to address this issue and have the potential to produce systematic reviews of direct relevance to policy makers and practitioners.On the basis of the recommendations of the Joanna Briggs Institute International Mixed Methods Reviews Methodology Group in 2012, the Institute adopted a segregated approach to mixed-methods synthesis as described by Sandelowski et al., which consists of separate syntheses of each component method of the review. Joanna Briggs Institute's mixed-methods synthesis of the findings of the separate syntheses uses a Bayesian approach to translate the findings of the initial quantitative synthesis into qualitative themes and pooling these with the findings of the initial qualitative synthesis.

Research to support evidence-based practice in COPD community nursing.

Evidence-based practice (EBP) is a requirement of nurses through the generation of evidence to implementing it, in a bid to to improve clinical practice. However, EBP is difficult to achieve. This paper highlights an approach to generating evidence for enhancing community nursing services for patients with chronic obstructive pulmonary disease (COPD) through a collaborative partnership. A district nurse and two nursing lecturers formed a partnership to devise a systematic review protocol and perform a systematic review to enhance COPD practice. This paper illustrates the Joanna Briggs Institute (JBI) systematic review process, the review outcomes and the practitioner learning. Collaborative partnerships between academics, researchers and clinicians are a potentially useful model to facilitate enhanced outcomes in evidence-based practice and evidence application.

Exploring clinical wisdom in nursing education.

The recent interest in wisdom in professional health care practice is explored in this article. Key features of wisdom are identified via consideration of certain classical, ancient and modern sources. Common themes are discussed in terms of their contribution to 'clinical wisdom' itself and this is reviewed against the nature of contemporary nursing education. The distinctive features of wisdom (recognition of contextual factors, the place of the person and timeliness) may enable their significance for practice to be promoted in more coherent ways in nursing education. Wisdom as practical knowledge (phronesis) is offered as a complementary perspective within the educational preparation and practice of students of nursing. Certain limitations within contemporary UK nursing education are identified that may inhibit development of clinical wisdom. These are: the modularization of programmes in higher education institutions, the division of pastoral and academic support and the relationship between theory and practice.

Factors influencing adherence to antiretroviral treatment in Asian developing countries: a systematic review.

OBJECTIVE: To systematically review the literature of factors affecting adherence to Antiretroviral treatment (ART) in Asian developing countries. METHODS: Database searches in Medline/Ovid, Cochrane library, CINAHL, Scopus and PsychINFO for studies published between 1996 and December 2010. The reference lists of included papers were also checked, with citation searching on key papers. RESULTS: A total of 437 studies were identified, and 18 articles met the inclusion criteria and were extracted and critically appraised, representing in 12 quantitative, four qualitative and two mixed-method studies. Twenty-two individual themes, including financial difficulties, side effects, access, stigma and discrimination, simply forgetting and being too busy, impeded adherence to ART, and 11 themes, including family support, self-efficacy and desire to live longer, facilitated adherence. CONCLUSION: Adherence to ART varies between individuals and over time. We need to redress impeding factors while promoting factors that reinforce adherence through financial support, better accessible points for medicine refills, consulting doctors for help with side effects, social support and trusting relationships with care providers.

Support for Older People with COPD in Community Settings: A Systematic Review of Qualitative Research.

BACKGROUND: There are an estimated three million people affected by Chronic Obstructive Pulmonary Disease (COPD) in the UK with only about 900,000 of these being diagnosed according to the Healthcare Commission, and prevalence is increasing. Significant progress has been made in respect of treatment and management of the disease. However, there is limited evidence related to the perspective of those with COPD despite an acknowledgement that lung function, as determined by spirometry, does not necessarily equate with pulmonary disease and subsequent functional level or disability. The impact of COPD on patients, their family, carers and healthcare services demands that better ill health prevention and disease maintenance strategies be employed. OBJECTIVE: The objective was to explore the common and shared experiences of those in caring partnership for patients with COPD receiving care and support in their community. CONCEPT OF SUPPORT: For this review, the definition of support takes the view that support relates to 'any activity or intervention aimed at improving or maintaining the health status of a patient with COPD'. INCLUSION CRITERIA: The review focused on the experiences of patients, carers, family members, nurses and doctors involved in providing support to patients with COPD in their own home. Patients aged 65 years and over were included.The review considered studies that represented patient, carer, nursing and medical staff experiences and perceptions of support relating to COPD.The review considered evidence from qualitative research including phenomenology, grounded theory, and descriptive studies, where support for COPD in a community context was the focus. SEARCH STRATEGY: The search set out to find published studies in English from 1990-2010. METHODOLOGICAL QUALITY: The studies were appraised and findings extracted using the JBI critical appraisal tool for qualitative research. Three reviewers appraised the studies independently. 72 studies were critically appraised and 39 met the inclusion criteria. DATA SYNTHESIS: Findings from included papers were aggregated, categorised and synthesised. RESULTS: If those with COPD received more consistent support in relation to information, rehabilitation, end of life care and other service provision then their quality of life could be enhanced.Better planned and more integrated support for home based care around self-care/management and in managing exacerbations can reduce patient and carer anxiety and distress related to COPD.Individualisation of care, which is not based on the patient's 'disease state' (i.e. physical parameters) but on assessed need, is a necessary part of care for those with COPD.

Using solution-focused communication to support patients.

Nurses want to help patients; it is one of their main roles and a key source of job satisfaction. However, finding the time despite low staffing levels and a heavy workload is a constant challenge. This article provides an overview of solution-focused communication -an approach valued by an increasing number of nurses because of its brevity and effectiveness in empowering patients to find the solutions that will help them to deal with their health challenges.