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Bakgrund: Den basala processen för nyblivna föräldrar är att ta kontroll över sin situation vilket innebär hårt arbete för att organisera sina behov och ta till sig råd och stöd för att kunna tillgodese barnets behov. Föräldrars upplevda behov är relaterade till osäkerhet i föräldraskapet och stöd behövs för att stärka dem i föräldrarollen. Effekterna av stöd kan vara att föräldrars mentala hälsa förbättras och barnens behov blir tillgodosedda. Sjuksköterskan på BVC har till uppgift att stödja föräldrar, men hur stödet ser ut finns inte klart beskrivet i tidigare forskning. Syfte: Syftet med studien var att få en ökad förståelse för betydelsen av sjuksköterskans stöd till nyblivna föräldrar för att stödja dem i föräldrarollen. Metod: Metasyntes valdes till metod med en hermeneutisk ansats i analysen. Resultat: Resultatet visade att föräldrar behövde vägledning på föräldraskapets hinderbana för att öka självförtroendet och självtilliten med underrubrikerna: ser sjuksköterskans om en symbol för stöd, att ha ett gemensamt perspektiv på föräldraskapet, att tillit skapas – en förutsättning för att kunna ta emot stöd och att växa i självtillit i sitt föräldraskap. Föräldrarnas vandring på föräldraskapets hinderbana var vägen fram till ökad självtillit i föräldraskapet.  Konklusion: Den ömsesidiga tilliten var essentiell för att föräldrarna skulle kunna ta till sig sjusköterskans stöd och kunna växa i självtillit i föräldraskapet. Implikationer för praxis är att sjuksköterskan ger föräldrarna det utrymme de behöver för att de ska kunna bedöma om hon/han har tillit till dem. / Background: Parents with a newborn baby need to take control over their new situation, which means hard work to organize their needs and to assimilate advice and support. Parents’ needs are related to insecurity in parenthood and support is needed to strengthen them. Support can improve parents’ mental health and the child’s needs be fulfilled. The nurse at the child health clinic role is to support parents with small children, but has not been clearly described in earlier research. Aim: The aim of the study was to get a wider comprehension of the meaning of the nurse’s support to parents with a newborn baby to strengthen them in parenting. Method: Qualitative meta-synthesis was chosen with a hermeneutic approach in the analysis. Results: The result revealed that the parents needed guidance on the parenting trail to enhance their self confidence and trust to themself with the categories: see the nurse as a symbol of support, a mutual perspective of parenthood, creating trust – a condition to be able to receive support and growth in self confidence in parenthood. Parents walk on the parenting trail was the path to an enhanced trust in themselves in their parenthood.  Conclusion Mutual trust was essential for the parents to be able to assimilate the support from the nurse and grow in their parenthood. The walk on the parenting trail was the path to improvement in confidence in parenthood. Implications are that the nurses have to give parents space to judge if the nurses have trust in them.

The purpose of this study was to synthesize the counter-narratives of mathematically successful African American students. The gap in educational achievement between African American and White students is well documented in the United States, especially in mathematics education. Although Florida Comprehensive Assessment Test scores have increased for both groups at Seminole High School, the gap has remained over 30% for nearly a decade. Most research on this topic has focused on the reasons why African American students fail to achieve. Various individual, social, and organizational factors have been suggested. However, a growing body of research has highlighted the stories of mathematically successful African American students. Using best evidence review methods, an exhaustive review of the literature identified 22 research articles published between 2004 and 2013. All studies collected interview data with mathematically successful African American middle school, high school, and higher education students in the United States. Meta-synthesis was used to synthesize findings across studies. Among the 151 participants across 22 studies, six common experiences were identified as contributing to students' mathematical success: supportive teachers, supportive family, supportive peers, a strong mathematics identity, ability to deal with racial stereotype, and supportive organizations. Most importantly, this meta-synthesis highlights the tendency of prior research to focus on de-contextualized factors rather than understanding students holistically within their broader social and community environment. Insights from this study lead to several recommendations for improving mathematics education for African American students at Seminole High School and for suggested future research on this topic.

Water heating in the United States has the largest energy consumption of any residential related use. It uses more energy than all other home appliances combined. They have also been implicated as the source of waterborne disease outbreaks. With such high stakes, it is recommended that a Decision Support Tool (DST) be used prior to selection of a water heater for new construction or replacement. Although there are numerous tools available, it is challenging to find a tool that takes into account all factors critical to the selection of water heaters, addresses gaps and barriers, provides adequate information to all stakeholders and finally, assists in rational decision making towards more sustainable choices. The purpose of this research is threefold: (a) to inventory, organize and characterize web-based existing water heater Decision Support Tools (eDSTs) to highlight gaps and/or shortcomings; (b) to develop a Decision Support Tool Skeleton (DSTS) containing a comprehensive list of sustainability capital, criteria and indicators based on Multi-Attribute Decision Making (MADM) approach; (c) to create a stakeholder map comprising supply chain, stakeholder system, decision making process during water heater selections as well as other market factors, using metasynthesis of collected documents. The findings of this research indicate that considerable gaps and shortcomings exist in the current pool of water heater DSTs. To address these barriers, information was captured from various documents in a process of qualitative data analysis called coding. The coding process generated attributes which were used to generate a comprehensive set of capital, criteria, subcriteria and indicators using MADM approach. This organizing structure developed on lines of sustainability assessment will serve as a starting point towards achieving global sustainability in real life. Importantly, information asymmetry between various stakeholders is evidence of the fact that the existing tools are not addressed in an equitable manner. This study will help determine the stakeholder system and the decision making process for selection of water heaters in the residential sector, so as to effectively implement new tools being created. / Master of Science

Meta-synthesis is an approach to synthesize qualitative research results. Originally proposed in the medical field and in education, this approach helps to advance current knowledge by generating a new interpretive synthesis. Since current research practices and knowledge development in emergency management is excessively divergent, there has been a need for a synthesis of knowledge from practice and research. One of the main arguments of this study is that the need is met by this study of a meta-synthesis. In this research, I suggested that many research results dealing with the issue of how to improve the performance of emergency management can be integrated into strategies for network management in emergencies. I used the term strategies in a much more generalized way to capture the idea of managerial/behavioral skills, plans, and insights for emergency management. The meta-synthesis was conducted from a keyword search, surveys, and expert interviews, which identified representative studies in emergency response. The review process of the representative studies is captured in a two-by-two matrix (intervention point axis and planning-improvisation axis) as a way of presenting the meta-synthesis results. This study then, turned to an analysis of reports of the Hurricane Katrina response using the meta-synthesis results. Qualitative content analysis was used as a method for the analysis. Reports from the White House, the House of Representatives, and the Senate are the target documents of the analysis. While conducting the analysis, I argued that the attempt of interpreting the failures of Katrina response into the failures of network management strategies provides clearer understandings regarding what went wrong and what was lacking. Furthermore, I argued that the way of thinking attempted in the analysis is a constructive one in that it provides an instructive action agenda for future disasters by connecting lessons learned to the strategies for emergency management. / Ph. D.

A tradição do uso da fotografia na pesquisa social remonta ao século XIX, com os primeiros trabalhos da Antropologia que usaram-na para registrar costumes e tradições de povos considerados exóticos. A seguir, a Sociologia, a História e a Psicologia, dentre outras disciplinas se interessaram pelo uso da foto para o registro do real e, também, como auxiliar na obtenção de dados subjetivos. Os objetivos do presente trabalho foram identificar o uso que vem sendo feito da fotografia na pesquisa qualitativa na enfermagem e sintetizar as potencialidades e limites desse uso. Procedeu-se a uma Revisão Sistemática de Literatura e Metassíntese de estudos primários que fossem pesquisas qualitativas, feitas por enfermeiras ou que tivessem a Enfermagem como objeto e que registrassem o uso da fotografia em algum momento de seu método. Os termos para a busca foram: Fotografia, Pesquisa Qualitativa e Enfermagem. As bases de dados pesquisadas incluíram: PubMed, CINAHL, EMBASE, PsycInfo, Scopus, ISI, BVS, Scielo. Não houve limite de tempo de publicação. A amostra final incluiu 31 artigos. Os resultados apontaram o uso da fotografia nos métodos: Photovoice, Foto-Elicitação, Etnografias e Mistos. As potencialidades foram: Emancipação dos sujeitos; Dar voz a grupos vulneráveis; Melhor compreensão da situação do sujeito; Registro detalhado do real, Maior riqueza dos dados obtidos; Permite ao sujeito rever suas experiências de vida; Efeito terapêutico para os sujeitos; Mais proximidade entre o entrevistador e o sujeito; Conferir protagonismo aos sujeitos; Divulgação de acervos e Aceitação do Método. As limitações foram: Habilidade no manuseio da câmara fotográfica; Censura dos familiares às fotografias; Invasão da privacidade individual e familiar; Risco de manipulação dos dados; Disponibilidade de equipamento; Custo e necessidade de pessoal especializado; Dados oriundos de fontes secundárias. Com esses resultados, especialmente ao se considerar as potencialidades, conclui-se que a fotografia é um recurso útil na pesquisa qualitativa que permite ao enfermeiro, enquanto pesquisador, dar conta das peculiaridades da enfermagem como uma prática social, contribuindo para emancipação de pessoas em situação de vulnerabilidade. / The tradition of using photography in social research goes back to the nineteenth century to the early work of anthropology, which used it to record habits and traditions of exotic populations. Then, sociology, history and psychology, among other disciplines became interested in using photos to register reality and also as a tool to obtain subjective data. The aims of the present study were to identify what is being done using photography in qualitative research in nursing and summarize the potentialities and limitations of such use. A Systematic Literature Review and Meta-Synthesis of primary studies has been done. It included qualitative research studies done by nurses or about nurses that had used photography on their Method. The terms defined to guide the search were: Photography, Qualitative Research and Nursing. The databases searched included PubMed, CINAHL, EMBASE, PsycInfo, Scopus, ISI, BVS e SciELO. There was no time limit for publication. The final sample included 31 articles. The results showed the use of photography in the following methods: Photovoice, Photo-Elicitation, Ethnographies and Mixed Methods. The potentialities identified for photography usage were: Emancipation of subjects; Giving voice to vulnerable groups; Better understanding of subjects situation; Detailed recording of reality; Richness of data obtained; Allowing the subject to review their life experiences; Therapeutic effect in subjects; Proximity between the interviewer and the subject; Giving prominence to the subject; Dissemination of collections and the method acceptance. The limitations identified were: Skill in handling the camera; Family censorship; Invasion of individual and familiar privacy; Risk of data manipulation; Equipment availability; Cost and need for specialized personnel; and Data from secondary sources. With these results, especially when considering the potentialities presented, it is concluded that photography is a useful resource for qualitative research that allows nurses as researchers, to account for the peculiarities of nursing as a social practice, contributing to the empowerment of vulnerable population.

Chronic kidney disease (CKD) is frequently described as a chronic illness. It is also a life-threatening illness, although this is rarely discussed. When people with CKD face declining kidney function, they need technological assistance to extend life. Many people receiving treatment will also die within 5 years. The experience of living with CKD is often difficult to articulate, and little is known about the aspects of this illness that are often ineffable, difficult to discuss, or beyond words. The purpose of this dissertation is to present four papers in which I investigate the concept of the unsayable and illuminate how this concept may be helpful in exploring individuals’ stories of living with CKD. Located in social constructionism, this narrative research explores the unsayable aspects of experience for people living with CKD as portrayed through their stories and symbols. In the first paper, I present a concept analysis of the unsayable and I define the unsayable as that which is not expressed yet alluded to through language and may be conscious or unconscious. Although the unsayable is intertwined with language, it also transcends articulation. In the second paper, I offer a qualitative meta-synthesis and I show how people with kidney failure have experienced restricted freedom that brings about distant connection, dependent autonomy, abnormal normalcy, and uncertain hope. In the third paper, I present a narrative inquiry using secondary analysis of 46 interviews conducted over 3 years with 14 people living with CKD. Narrative expressions of the unsayable include the following: living with death, embodied experiences that were difficult to language, that which was unthinkable, unknowable mystery, and that which was untold / unheard. Lastly, I offer a narrative visual analysis of symbols that represent living with CKD for 13 participants. Descriptive themes of the symbols include hopes and inspirations, reflections on “who I am,” and confrontations of illness. Participants’ expressions through symbols are described through stories of memories, emotions, and poetic devices. Consideration of the unsayable may offer insights for nurses who work to support individuals and promote quality of life for those living with this chronic and life-threatening illness. / Graduate

A tradição do uso da fotografia na pesquisa social remonta ao século XIX, com os primeiros trabalhos da Antropologia que usaram-na para registrar costumes e tradições de povos considerados exóticos. A seguir, a Sociologia, a História e a Psicologia, dentre outras disciplinas se interessaram pelo uso da foto para o registro do real e, também, como auxiliar na obtenção de dados subjetivos. Os objetivos do presente trabalho foram identificar o uso que vem sendo feito da fotografia na pesquisa qualitativa na enfermagem e sintetizar as potencialidades e limites desse uso. Procedeu-se a uma Revisão Sistemática de Literatura e Metassíntese de estudos primários que fossem pesquisas qualitativas, feitas por enfermeiras ou que tivessem a Enfermagem como objeto e que registrassem o uso da fotografia em algum momento de seu método. Os termos para a busca foram: Fotografia, Pesquisa Qualitativa e Enfermagem. As bases de dados pesquisadas incluíram: PubMed, CINAHL, EMBASE, PsycInfo, Scopus, ISI, BVS, Scielo. Não houve limite de tempo de publicação. A amostra final incluiu 31 artigos. Os resultados apontaram o uso da fotografia nos métodos: Photovoice, Foto-Elicitação, Etnografias e Mistos. As potencialidades foram: Emancipação dos sujeitos; Dar voz a grupos vulneráveis; Melhor compreensão da situação do sujeito; Registro detalhado do real, Maior riqueza dos dados obtidos; Permite ao sujeito rever suas experiências de vida; Efeito terapêutico para os sujeitos; Mais proximidade entre o entrevistador e o sujeito; Conferir protagonismo aos sujeitos; Divulgação de acervos e Aceitação do Método. As limitações foram: Habilidade no manuseio da câmara fotográfica; Censura dos familiares às fotografias; Invasão da privacidade individual e familiar; Risco de manipulação dos dados; Disponibilidade de equipamento; Custo e necessidade de pessoal especializado; Dados oriundos de fontes secundárias. Com esses resultados, especialmente ao se considerar as potencialidades, conclui-se que a fotografia é um recurso útil na pesquisa qualitativa que permite ao enfermeiro, enquanto pesquisador, dar conta das peculiaridades da enfermagem como uma prática social, contribuindo para emancipação de pessoas em situação de vulnerabilidade. / The tradition of using photography in social research goes back to the nineteenth century to the early work of anthropology, which used it to record habits and traditions of exotic populations. Then, sociology, history and psychology, among other disciplines became interested in using photos to register reality and also as a tool to obtain subjective data. The aims of the present study were to identify what is being done using photography in qualitative research in nursing and summarize the potentialities and limitations of such use. A Systematic Literature Review and Meta-Synthesis of primary studies has been done. It included qualitative research studies done by nurses or about nurses that had used photography on their Method. The terms defined to guide the search were: Photography, Qualitative Research and Nursing. The databases searched included PubMed, CINAHL, EMBASE, PsycInfo, Scopus, ISI, BVS e SciELO. There was no time limit for publication. The final sample included 31 articles. The results showed the use of photography in the following methods: Photovoice, Photo-Elicitation, Ethnographies and Mixed Methods. The potentialities identified for photography usage were: Emancipation of subjects; Giving voice to vulnerable groups; Better understanding of subjects situation; Detailed recording of reality; Richness of data obtained; Allowing the subject to review their life experiences; Therapeutic effect in subjects; Proximity between the interviewer and the subject; Giving prominence to the subject; Dissemination of collections and the method acceptance. The limitations identified were: Skill in handling the camera; Family censorship; Invasion of individual and familiar privacy; Risk of data manipulation; Equipment availability; Cost and need for specialized personnel; and Data from secondary sources. With these results, especially when considering the potentialities presented, it is concluded that photography is a useful resource for qualitative research that allows nurses as researchers, to account for the peculiarities of nursing as a social practice, contributing to the empowerment of vulnerable population.

Type 2 diabetes is a life-threatening condition, and it is rapidly growing in the world. If patients receive adequate education and support, they can manage their diabetes-related tasks effectively and reduce the severe complications of this disease. However, traditional self-management education and practices were not very effective in stimulating behaviour change and addressing patients’ diversified needs and expectations. Mobile text messaging is a promising method for type 2 diabetes self-management as it can provide continuous and customized support to these patients. However, there is a lack of knowledge about the optimal approach to designing and delivering mobile text messages. Hence, this dissertation aimed to define effective message strategies for mobile text messaging interventions targeting type 2 diabetes self-management. This manuscript-based dissertation consists of three complementary studies. The first manuscript includes a systematic review and a meta-analysis of tailored mobile text messaging interventions on type 2 diabetes self-management. It examines the tailoring strategies, message content, and structure and identifies the moderators of effectiveness in these interventions. The second manuscript includes a systematic review and a meta-synthesis of qualitative evidence on patients’ experiences and perspectives of mobile text messaging studies. The third manuscript consists of a prospective qualitative study to explore the text messaging design and delivery preferences of patients. In the first and second studies, the comprehensive search strategy included major electronic databases, key journal searches, and hand searches of the reference lists of related systematic reviews and meta-analyses. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Cochrane Collaboration's guidelines and recommended tools were used for data extraction, risk of bias and critical appraisal assessments, data analysis and reporting. Within a social marketing framework, the third study included semi-structured interviews and a thematic analysis of the main findings. In the first manuscript, 13 eligible trials were included for the systematic review and 11 eligible trials were further analyzed in the meta-analysis. This study concluded that tailored mobile text messaging interventions could improve glycemic control in patients with type 2 diabetes. The subgroup analyses revealed the importance of some moderators such as message delivery, message direction, message frequency, and using multi-modalities. In the second manuscript, the systematic review included 14 eligible studies, and the thematic synthesis included 13 eligible studies. Patients emphasized the importance of tailored text message design and delivery. They felt “supported” by using text messaging and improved their communication with family/friends and care providers. Mobile text messaging increased patients’ self-awareness, knowledge and control of diabetes. The third study explored that mobile text messages could be more effective if they are gain-framed and written in a standard format. Patients favoured the text messages that included simple and direct tone and provided statistical evidence. The findings demonstrated patients’ needs and expectations for advanced tailoring strategies in both message content and delivery. Together, the manuscripts fill a significant gap and inform research and practice for the development of more effective message strategies that could lead to reducing the spread of type 2 diabetes worldwide. / Graduate / 2022-05-12