Experiences of family caregivers of persons living with mental illness: A meta-synthesis.

BACKGROUND: Meta-synthesis is used to generate and understand new insights from a qualitative perspective. Caregiving is associated with a range of physical and psychological symptoms. Caregivers bear the brunt of caregiving and this has become worse since the inception of de-institutionalisation, as more patients are discharged into the community under the care of their families. OBJECTIVES: The purpose of this study was to synthesise phenomenological qualitative studies and create a comprehensive chronicle of phenomena of family caregivers' experiences of caring for relatives living with mental illness. METHOD: Google Scholar and different electronic databases, which included CINAHL, MEDLINE, EBSCO and PubMed, were searched using keywords for relevant studies published from 1994 to 2014. To obtain an in-depth view of caregivers' lived experiences, a qualitative meta-synthesis was employed to review the findings of 10 studies. RESULTS: A total of 10 studies were included in the meta-synthesis. The family caregivers described their caregiving experiences under four themes: perceived responsibility of caregiving, experiences of emotional effect, experiences of support needs and experiences of changed perspective. CONCLUSION: The meta-synthesis revealed a lack of emotional coping among the family caregivers. This calls for robust family caregiver interventions to facilitate their mental health.

A qualitative description of service providers' experiences of ethical issues in HIV care.

BACKGROUND: Managing HIV treatment is a complex multi-dimensional task because of a combination of factors such as stigma and discrimination of some populations who frequently get infected with HIV. In addition, patient-provider encounters have become increasingly multicultural, making effective communication and provision of ethically sound care a challenge. PURPOSE: This article explores ethical issues that health service providers in the United States and Botswana encountered in their interaction with patients in HIV care. RESEARCH DESIGN: A descriptive qualitative design was used to collect data from health service providers and patients using focused group discussions. This article is based on responses from health service providers only. PARTICIPANTS AND CONTEXT: This article is based on 11 focused group discussions with a total sample of 71 service providers in seven US sites and one Botswana site. ETHICAL CONSIDERATIONS: Ethical review boards at all the study sites reviewed the study protocol and approved it. Ethical review boards of the study's coordinating centers, Rutgers University and the University of California at San Francisco, also approved it. The study participants provided a written informed consent to participate. FINDINGS: HIV service providers encountered ethical challenges in all the four Beauchamp and Childress' biomedical ethics of respect for patients' autonomy, beneficence, justice, and nonmaleficence. DISCUSSION: The finding that HIV service providers encounter ethical challenges in their interaction with patients is supported by prior studies. The ethical challenges are particularly prominent in multicultural care and resource-constrained care environments. CONCLUSION: Provision of HIV care is fraught with ethical challenges that tend to pose different issues depending on a given care environment. It is important that strong partnerships are developed among key stakeholders in HIV care. In addition, health service providers need to be provided with resources so they can provide quality and ethically sound care.

Experiences of family caregivers of persons living with mental illness: A meta-synthesis

Background: Meta-synthesis is used to generate and understand new insights from a qualitative perspective. Caregiving is associated with a range of physical and psychological symptoms. Caregivers bear the brunt of caregiving and this has become worse since the inception of de-institutionalisation, as more patients are discharged into the community under the care of their families.Objectives: The purpose of this study was to synthesise phenomenological qualitative studies and create a comprehensive chronicle of phenomena of family caregivers' experiences of caring for relatives living with mental illness.Method: Google Scholar and different electronic databases, which included CINAHL, MEDLINE, EBSCO and PubMed, were searched using keywords for relevant studies published from 1994 to 2014. To obtain an in-depth view of caregivers' lived experiences, a qualitative meta-synthesis was employed to review the findings of 10 studies.Results: A total of 10 studies were included in the meta-synthesis. The family caregivers described their caregiving experiences under four themes: perceived responsibility of caregiving, experiences of emotional effect, experiences of support needs and experiences of changed perspective.Conclusion: The meta-synthesis revealed a lack of emotional coping among the family caregivers. This calls for robust family caregiver interventions to facilitate their mental health

Building Trust and Relationships Between Patients and Providers: An Essential Complement to Health Literacy in HIV Care.

Health literacy is important for access to and quality of HIV care. While most models of health literacy acknowledge the importance of the patient-provider relationship to disease management, a more nuanced understanding of this relationship is needed. Thematic analysis from 28 focus groups with HIV-experienced patients (n = 135) and providers (n = 71) identified a long-term and trusting relationship as an essential part of HIV treatment over the continuum of HIV care. We found that trust and relationship building over time were important for patients with HIV as well as for their providers. An expanded definition of health literacy that includes gaining a patient's trust and engaging in a process of health education and information sharing over time could improve HIV care. Expanding clinical perspectives to include trust and the importance of the patient-provider relationship to a shared understanding of health literacy may improve patient experiences and engagement in care.