ObjectivesLittle research has explored the full extent of the impact of self-harm on the family. This study aimed to explore the emotional, physical and practical effects of a young person's self-harm on parents and family.Design and participantsWe used qualitative methods to explore the emotional, physical and practical effects of a young person's self-harm on their parents and family. We conducted a thematic analysis of thirty-seven semistructured narrative interviews with parents of young people who had self-harmed.ResultsAfter the discovery of self-harm, parents described initial feelings of shock, anger and disbelief. Later reactions included stress, anxiety, feelings of guilt and in some cases the onset or worsening of clinical depression. Social isolation was reported, as parents withdrew from social contact due to the perceived stigma associated with self-harm. Parents also described significant impacts on siblings, ranging from upset and stress to feelings of responsibility and worries about stigma at school. Siblings had mixed responses, but were often supportive. Practically speaking, parents found the necessity of being available to their child often conflicted with the demands of full-time work. This, along with costs of, for example, travel and private care, affected family finances. However, parents generally viewed the future as positive and hoped that with help, their child would develop better coping mechanisms.ConclusionsSelf-harm by young people has major impacts on parents and other family members. Clinicians and staff who work with young people who self-harm should be sensitive to these issues and offer appropriate support and guidance for families.

Informal caregiving continues to be a crucial part of health and social care provision in the developed world, but the processes by which the identity of informal caregiver is conferred, or assumed, remain unclear. In this article we draw on data from a qualitative research study which examined the experiences of family members and friends of people with multiple sclerosis (pwMS) to explore how they interpret the label ‘carer’. We conducted narrative interviews with forty people throughout the United Kingdom between June 2011 and January 2012. Participants were spouses, partners, parents, children, siblings or friends of people who have had multiple sclerosis between 6 months and fifty years. We carried out thematic analysis of the interviews, informed by identity theory. Identity theory illuminated variation in peoples' perceptions of themselves as carers, suggesting that self-identification with the role and label of carer is nuanced, shifting and variable. We propose a taxonomy of caring activity including emotional support, personal care, physical care, household tasks, advocacy and activism and describe four categories, with fluid and overlapping boundaries, in which the identity of carer was apparently embraced, enforced, absorbed or rejected. Variability and fluidity in self-identification as a carer are related to apparent expectations about whether one should assume a caring role. Those who were caring from the more tangential (and less taken for granted) relationship of sibling or ex-partner were among those who apparently embraced the role. Those who were expected to assume the caring role (typically spouses) were not always comfortable with doing so. It may be difficult to gain acknowledgement from family members and others that they occupy the role of carer if people resist the label as a bureaucratisation of their personal relationships.

Aims and objectives: This UK study aimed to generate new ideas about training strategies for healthcare staff caring for people with dementia in the acute hospital setting. Background: A review of related literature exposed topical debate regarding current educational deficits, yet revealed few examples of the implementation of training initiatives for practising healthcare professionals. Design: A descriptive qualitative approach was used. Methods: Data were generated using two focus groups comprised of Staff Nurses (four) and Healthcare Assistants (three) working in a mixed gender acute elderly care unit in the North of England. Dialogues explored individuals’ experiences of delivering care to people with dementia hospitalised with physical illnesses and, usefully, their thoughts about learning in the workplace. Results: Four broad categories emerged from transcript-based analysis: learning about dementia; learning about the person; learning from each other; learning from specialists. Specific recommendations included the improvement of staff preparedness through fundamental training, improved flow of information about individuals, dementia-specialist input for situation-based advice, and structured opportunities to reflect on practice. Conclusion: The National Dementia Strategy for England emphasises the pressing need to improve care for people with dementia when they are admitted to hospital with physical illness, and highlights the importance of staff education in contributing to improved care. This study provides an insider view from a potential target population of such healthcare providers regarding their perceived educational needs. Relevance to clinical practice: The results of this study point the way forward to practical and achievable ways of increasing and improving knowledge about dementia, and enhancing skills in caring for people who are cognitively impaired, among general hospital staff.

Our purpose in this study was to find, report, and interpret the results of qualitative studies which investigated the experiences of older people living with cancer. We conducted systematic literature searches, identified and extracted the findings from 11 studies, and analyzed them systematically. We interpreted the findings to suggest that living with cancer in old age is to live in a perpetual state of ambiguity. The experience is characterized by a sense of disintegration, diminished identity, suffering, and social retraction. These experiences are balanced by sources of comfort and strength found within the self and among diverse relationships. The results of our study illuminate the complex, multidimensional character of living with cancer in old age. They show that older people living with cancer are resilient as well as vulnerable. We argue for changes in attitudes and behavior that will enable health care professionals to foster older peoples' resilience. In this article we report the purpose, design, conduct, and findings of a systematic search and review of qualitative research literature that investigated older peoples' experiences of living with cancer.Cancer has its highest incidence in older populations. There is extensive literature reporting the incidence and prevalence of cancers in older age groups, along with approaches to treatment and the effects and management of comorbidity (Bennahum, Forman, Vellas, & Albarede, 1997;Extermann, Overcash, Lyman, Parr, & Balducci, 1998;Satariano & Silliman, 2003). However, the subjective perceptions of older individuals undergoing the experience of cancer remain largely unknown. This review provides a basis for developing clinical health services that are based on older peoples' perceived and expressed needs.To make the most effective use of research findings, approaches to synthesizing the results of many studies on the same topic have increasingly found favor and, in quantitative research, sophisticated methods of meta-analysis have been developed which aim to produce a definitive set of findings from a wide range of work. In qualitative research, also, such an approach is deemed to be an essential part of increasing the usefulness and relevance of findings (Sandelowski, Docherty, & Emden, 1997), though the methodology is at an earlier stage of development (Dixon-Woods, Booth, & Sutton, 2007;Popay & Roën, 2003) and there has been debate about whether the approach is epistemologically appropriate (Campbell et al., 2003;McDermott, Graham, & Hamilton, 2004;Sandelowski et al., 1997). This approach is termed variously "metastudy," "metasynthesis," and "research integration." It is an approach to the literature that is more than a critical review: it is an attempt to integrate findings across studies to arrive at new understandings.Our reading of methodological literature in the field of qualitative reviewing and synthesis (Barbour, 2001;Booth, 2001;Britten et al., 2002;Campbell et al., 2003;Noblit & Hare, 1988;Paterson, Thorne, Canam, & Jillings, 2001...

BackgroundWhen faced with the discovery of their child’s self-harm, mothers and fathers may re-evaluate their parenting strategies. This can include changes to the amount of support they provide their child and changes to the degree to which they control and monitor their child.MethodsWe conducted an in-depth qualitative study with 37 parents of young people who had self-harmed in which we explored how and why their parenting changed after the discovery of self-harm.ResultsEarly on, parents often found themselves “walking on eggshells” so as not to upset their child, but later they felt more able to take some control. Parents’ reactions to the self-harm often depended on how they conceptualised it: as part of adolescence, as a mental health issue or as “naughty behaviour”. Parenting of other children in the family could also be affected, with parents worrying about less of their time being available for siblings. Many parents developed specific strategies they felt helped them to be more effective parents, such as learning to avoid blaming themselves or their child for the self-harm and developing new ways to communicate with their child. Parents were generally eager to pass their knowledge on to other people in the same situation.ConclusionsParents reported changes in their parenting behaviours after the discovery of a child’s self-harm. Professionals involved in the care of young people who self-harm might use this information in supporting and advising parents.