College of Health, Psychology and Social Care, University of Derby, Kedleston Road, Derby DE22 1GB, United Kingdom.
Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, United Kingdom.
Int J Nurs Stud. 2021 Nov;123:104043. doi: 10.1016/j.ijnurstu.2021.104043. Epub 2021 Jul 21.
Traumatic brain injury has a significant effect on uninjured family members. Typically, this has been examined with a focus on psychopathological outcomes including stress, depression and anxiety. However, in recent years there has been increasing interest in the subjective experiences of families post-injury leading to a plethora of qualitative studies. Therefore, an in-depth examination and synthesis of this literature is now relevant and timely.
To examine the subjective experiences of families following traumatic brain injury in adult populations in the sub/post-acute period through the synthesis of original qualitative research.
This paper presents a meta-synthesis using Thomas and Harden's framework of 'thematic synthesis' rooted in a critical realist philosophy.
In July 2019 five electronic databases, were searched for the terms 'traumatic brain injury', 'family' and 'qualitative'. Studies were included if the primary research reported qualitative data about the subjective experiences of family members of adults with traumatic brain injury and had been published in a peer reviewed journal. Studies with mixed brain injury samples, child or adolescent traumatic brain injury or disorders of consciousness were excluded. Hand searching and citation searches were also completed.
Two reviewers screened titles, abstracts and full text and reached consensus through critical discussion. Thirty papers were finally agreed for inclusion in this review. Each study was then assessed for relevance, resonance and rigour using the Critical Appraisal Skills Programme (CASP) tool. Line by line coding of the findings in each paper was conducted as the basis for a thematic analysis and synthesis.
Descriptive themes were identified followed later by analytical themes. This final stage was informed by a narrative lens and from these, eight narrative functions belonging to four dimensions were identified from the subjective experiences of families post-traumatic brain injury. Specifically, these were: (1) Displacing and Anchoring; (2) Rupturing and Stabilising; (3) Isolating and Connecting; (4) Harming and Healing.
The interpretation of the narrative functions revealed the substantial existential work involved in negotiating lives, maintaining family system equilibrium and moving forward. As such, family members have their own unique narrative needs. Despite contemporary service models built around the injured person, service providers are well placed to support families in this everyday narrative work through actively attending to narrative structures and understanding the implications of these for family experience. The study protocol was registered with PROSPERO (International prospective register of systematic reviews) in July 2018 (Registration number: CRD42018085824). Tweetable abstract: This synthesis showed the immense and invisible work required for family members to maintain family system equilibrium and negotiate their lives post-TBI.
创伤性脑损伤对未受伤的家庭成员有重大影响。通常，这是通过检查包括压力、抑郁和焦虑在内的心理病理结果来进行的。然而，近年来，人们对受伤后家庭的主观体验越来越感兴趣，导致了大量的定性研究。因此，现在对这些文献进行深入的检查和综合是及时和相关的。
通过综合原始定性研究，检查成年创伤性脑损伤患者亚/急性期家庭的主观体验。
本文采用托马斯和哈登（Thomas and Harden）基于批判实在论哲学的“主题综合”框架进行元综合。
2019 年 7 月，通过搜索五个电子数据库中的“创伤性脑损伤”、“家庭”和“定性”这三个术语，来查找相关文献。如果主要研究报告了关于成年创伤性脑损伤患者家庭成员的主观体验的定性数据，且该研究已在同行评审期刊上发表，则将其纳入研究。纳入研究的标准为：混合性脑损伤样本、儿童或青少年创伤性脑损伤或意识障碍的研究则被排除在外。还进行了手工搜索和引文搜索。
两位审查员通过批判性讨论对标题、摘要和全文进行筛选，并达成共识。最终有 30 篇论文被认为与本综述相关。然后，使用批判性评估技能计划（Critical Appraisal Skills Programme，CASP）工具评估每篇论文的相关性、共鸣和严谨性。对每篇论文的发现进行逐行编码，作为主题分析和综合的基础。
确定了描述性主题，然后是分析性主题。这最后一个阶段受到叙事视角的启发，并从这些主题中，确定了四个维度的八个叙事功能，这些功能来自创伤性脑损伤后家庭的主观体验。具体来说，这些是：（1）移位和锚定；（2）破裂和稳定；（3）隔离和连接；（4）伤害和治愈。
对叙事功能的解释揭示了在协商生活、维持家庭系统平衡和向前发展的过程中所涉及的大量存在主义工作。因此，家庭成员有自己独特的叙事需求。尽管当代的服务模式是围绕受伤者建立的，但服务提供者可以通过积极关注叙事结构并理解这些结构对家庭体验的影响，来支持家庭的这种日常叙事工作。该研究方案于 2018 年 7 月在 PROSPERO（国际系统评价注册中心）注册（注册号：CRD42018085824）。可推文摘要：这项综合研究表明，家庭成员为维持家庭系统平衡和协商他们的生活，需要付出巨大的、无形的努力。
