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Long-term conditions are the leading cause of mortality in the UK and represent a major public health challenge. While such illnesses primarily affect adults, there are various long-term conditions affecting significant numbers of children, such as asthma and diabetes. The health promotion role of health visitors means they are well placed to help prevent the development of long-term conditions in children and the wider community, in collaboration with colleagues in primary care. This paper discusses the existing and potential role of health visitors in preventing, screening for and helping children and families to live well with long-term conditions.

This article presents the qualitative findings of a mixed-methods study that explored factors influencing lesbians' breast health-care behavior and intentions. A total of 37 semi-structured face-to-face interviews were conducted among women who self-identified as lesbians or women who partnered with the same gender who were aged 20 years or above in four areas of Taiwan (North, Central, South, and East Taiwan) between August 2012 and October 2012. Interviews were audio recorded with participants' consent. The interviews were analyzed using constant comparative analysis with Nvivo audio-coding support. Four themes were identified to be strongly associated with the lesbians' breast health-care behavior and their intentions, namely, gender identity, gender role expression, partners' support, and concerns about health-care providers' reactions. Important barriers to the women's breast health-care behavior and intentions were masculine identity ("T-identity" in Taiwan), masculine appearance, concerns about health-care providers' lack of knowledge of multiple gender diversity, and their attitudes toward lesbians. Conversely, their partners' support was a factor facilitating the women's breast health-care behavior and intentions, particularly for the T-identity lesbians. These findings suggest the significance of and need for culturally competent care and are important for improving Taiwanese lesbians' breast health.

Background: Many palliative cancer patients spend much of their last year at home. In the UK, district nurses make frequent support visits to patients and carers at this time, yet surprisingly little is known about their supportive role in palliative care. Current studies are limited to district nurses’ reports of practice, which offer limited insight into their content. Patients’ and carers’ views on district nurse support visits are largely unknown. Aim: To present findings of a multi-perspective study that explored how district nurse early support visits are both described and carried out. Design: Focus groups with district nurses to explore views on the purpose of early support visits. Observation of support visits to identify how they are conducted. Patient and carer interviews to elucidate and verify district nurse data. Setting and participants: Participants included 58 district nurses, 10 palliative care patients and nine carers from four Primary Care Trusts in contrasting urban and rural locations. Results: District nurses had difficulty articulating early support visits. Observations however revealed a complex role comprising extensive physical and practical assessments, practical interventions, information giving, liaison, facilitation and referral. Patients and carers confirmed that they felt valued, reassured and supported by district nurses. Conclusions: A multi-perspective approach provided new insights into district nurse support visits. Monitoring work described appears to have additional psycho-social benefits for patients and carers. The supportive role of district nurses needs to be clearly articulated and recognised so that colleagues, patients and carers access this valuable resource for palliative care patients.

Background: Observational research methods are important for understanding people’s actions, roles and behaviour. However, these techniques are underused generally in healthcare research, including research in the palliative care field. Aim: The aim in this paper is to place qualitative observational data collection methods in their methodological context and provide an overview of issues to consider when using observation as a method of data collection. This paper discusses practical considerations when conducting palliative care research using observation. Findings: Observational data collection methods span research paradigms, and qualitative approaches contribute by their focus on ‘natural’ settings which allow the explanation of social processes and phenomena. In particular, they can facilitate understanding of what people do and how these can alter in response to situations and over time, especially where people find their own practice difficult to articulate. Observational studies can be challenging to carry out: we focus on the potentially problematic areas of sampling, consent and ethics, data collection and recording, data management and analysis. Conclusion: Qualitative observational data collection methods can contribute to theoretical and conceptual development and the explanation of social processes in palliative care. In particular this contribution to understanding care structures and processes should improve understanding of patients’ experiences of their care journey and thus impact on care outcomes.

Background Patients are living longer with incurable cancer, and for most of the time, they are at home. Psychological morbidity is high and increases with advanced disease and poor prognosis, and evidence suggests that patients' psychological needs at this time are not met. District nurses provide support visits to patients for long periods before they die. Little is known about district nurses' skills in detecting patients' concerns and meeting psychological needs. Objective The aim of the study was to explore how UK district nurses describe and conduct early support visits with palliative patients and patients' perceptions of visits. We report 1 aspect of the findings: psychological assessment and support provided during early support visits at home. Methods Six focus group were conducted with 53 district nurses. Interactions between 10 patients, their carers, and district nurses were observed and audio recorded during home visits. Patients and carers were also interviewed before and after the observation visits. Data were analyzed using a thematic approach. Results District nurses described assessing and meeting patients' psychological needs informally through "chatting." Observation of practice, however, revealed avoidance behaviors when faced with patients' psychological concerns, exemplified by the statement "moving swiftly on," which was 1 district nurse's response to a patient's overt distress. Implications for practice District nurses have a potentially important role in assessing and meeting cancer patients' psychological needs, but appear to lack confidence and skills. District nurses need to be taught a simple intervention based on active listening and problem solving to assess and manage mild psychological morbidity.

Although John Skelton has recently been the subject of renewed critical interest, this attention has not extended to the verse form to which he gave his name: the Skeltonic. This article revisits the vexed question of its origins, arguing that there are strong (and previously unremarked) resemblances between the Skeltonic and the Middle English lyric, specifically that form of the lyric which deploys long rhyme leashes within a containing stanza form. The article compares Skelton's own lyrics with his Skeltonics, and both with the lyrics of BL MS Additional 5465, a manuscript with which Skelton is closely associated. Having demonstrated that all three share a number of formal features, it then traces a persistent lyric influence in a number of Skelton's later works, focusing in particular on what is apparently one of his most unruly poems, Why Come Ye Nat to Court? Finally, it argues that the form of a number of poems of the later sixteenth century (notably William Barnes’ ‘Treatyse answerynge the boke of Berdes’ and the anonymous The Passyon of the Fantasy of the Foxe) reveals that Skelton's immediate successors viewed lyric and Skeltonic as closely related. Thus, although the Skeltonic remains a highly idiosyncratic verse form, the article demonstrates that it is more closely linked to the development of mainstream English poetry than has generally been suggested.

Poor reading ability is associated with numerous negative consequences. School psychologists should provide teachers with resources and support to improve student reading ability and prevent these negative outcomes. This paper offers a guide for school psychologists to use in the consultation process when working with teachers to address students’ reading difficulties. The paper delineates the important facets of instructional consultation and considerations to take into account including: entering the consultation relationship, effectively identifying the problem and underlying cause, identification of the appropriate intervention, monitoring implementation integrity, and the termination of the consultation relationship. Specific intervention strategies and resources are also provided to offer the school psychologist potential resources.

The aim of this study was to examine UK district nurses' perceptions of their role in supporting palliative care cancer patients. Patients with cancer are living longer with the disease. District nurses are the largest UK workforce caring for people with cancer at home, the preferred place of care. Meeting patients' supportive and palliative care needs is complex. Little is known about district nurses' supportive role in the early phase of palliative care. Semistructured interviews were conducted with 34 district nurses. Data were analyzed thematically, with assistance from Atlas/ti. A dominant theme emerging from the interviews was ambiguity in the district nurses' supportive role in early palliative care. District nurses discussed the importance of making contact early on to support cancer patients and their families but had difficulty articulating this "support." Ambiguity, lack of confidence, and perceived skill deficits presented district nurses with dilemmas that were difficult to resolve. District nurses have great potential for meeting cancer patients' supportive and palliative care needs, a potential not currently realized. Education alone is unlikely to improve practice without an understanding of the tensions faced by district nurses in their work. Recognizing and addressing dilemmas in the everyday work of district nurses is central to moving practice forward.

In 2009-2010, the postgraduate residency training program at the Department of Family Medicine, Queen's University, wrestled with the practicalities of competency-based medical education (CBME) implementation when its accrediting body, the College of Family Physicians of Canada, introduced the competency-based Triple C curriculum.The authors used a stepwise approach to implement CMBE; the steps were to (1) identify objectives, (2) identify competencies, (3) map objectives and competencies to learning experiences and assessment processes, (4) plan learning experiences, (5) develop an assessment system, (6) collect and interpret data, (7) adjust individual residents' training programs, and (8) distribute decisions to stakeholders. The authors also note overarching processes, costs, and facil itating factors and processes or steps that would have been helpful for CBME implementation.Early outcomes are encouraging. Residents are being directly observed more often with increased documented feedback about performance based on explicit competency standards (24,000 data points for 150 residents from 2013 to 2015). These multiple observations are being collated in a way that is allowing the identification of patterns of performance, red flags, and competency development trajectory. Outliers are being identified earlier, resulting in earlier individualized modification of their residency training program.The authors will continue to provide and refine faculty development, are developing an entrustable professional activity field note app for handheld devices, and are undertaking research to explore what facilitates learners' competency development, what increases assessors' confidence in making competence decisions, and whether residents are better trained as a result of CBME implementation.

Several approaches to response to intervention (RTI) described in the literature could be blended into an RTI model that would be effective in the schools. An effective RTI model should employ three fundamental variables: (a) systematic data collection to identify students in need, (b) effective implementation of interventions for adequate durations, and (c) review of student progress data to determine when and/or if more intensive services are warranted. Research regarding RTI elements such as intervention time, intervention duration, treatment efficacy, intervention group size, measurement of student progress, and decision analyses is reviewed. Recommendations for future research include further defining the element of intervention time with regard to frequency and duration, determining the effect of the individual delivering the intervention, and specifying a reliable decision-making rule for determining student responsiveness/nonresponsiveness to interventions.

This paper presents a section of the findings of a case study of a newly established community rehabilitation team (CRT) comprising physiotherapists, occupational therapists and nurses. The findings reported here address issues of interdisciplinary teamwork that arose during the project. All eight members of the team were interviewed as well as three ex-team members. The data were collected by semi-structured interviews and analysed using thematic content analysis (Strauss and Corbin 19990). The findings suggest that when recognised barriers to teamwork are eradicated, such as geographical separation and different employers, teams such as the CRT can achieve high levels of teamwork. A problem that took longer for the CRT to resolve, however, was that of flexible working across traditional professional and hierarchical role boundaries. The paper concludes that the difficulties that need to be overcome when a new team and new service are established con-currently, should not be underestimated.

This paper tests the commonplace that John Skelton's late poem A Replycacion (1527– 8) contains the first English formulation of the Platonic theory of divine inspiration. It argues first that Skelton's use of the term ‘effecte energiall’ suggests the influence of Aristotle as well as of Plato, second that Skelton's ‘divine inspiration’ can be read as a metaphor for the activity of the poet's own mind. In asserting the poet's originary power at a time when his authority was still widely thought to be derivative, the poem thus anticipates late sixteenth-century views of poetic authority. (pp. 55–68)

The study identified barriers to research implementation experienced by nurses, midwives and health visitors in five trusts and one health authority in Yorkshire, UK. Funk et al. (Appl. Nurs. Res. 4(1) (1991a) 39, Appl. Nurs. Res. 4(2) (1999b) 90) developed the BARRIERS to research utilisation questionnaire over 10 years ago, but no replication, in size (n = 1989) and extent, of that study appeared to have occurred. The staff population (n = 4501) were sent the BARRIERS questionnaire. 44.6% (n = 2009) were returned. Findings suggested nurses need time to read and apply research; authority to change practice; critical appraisal skills, an understanding of statistics and support of managers and peers (particularly doctors) to achieve successful practice change.

Assessing entrustable professional activities (EPAs), or carefully chosen units of work that define a profession and are entrusted to a resident to complete unsupervised once she or he has obtained adequate competence, is a novel and innovative approach to competency-based assessment (CBA). What is currently not well described in the literature is the application of EPAs within a CBA system. In this article, the authors describe the development of 35 EPAs for a Canadian family medicine residency program, including the work by an expert panel of family physician and medical education experts from four universities in three Canadian provinces to identify the relevant EPAs for family medicine in nine curriculum domains. The authors outline how they used these EPAs and the corresponding templates that describe competence at different levels of supervision to create electronic EPA field notes, which has allowed educators to use the EPAs as a formative tool to structure day-to-day assessment and feedback and a summative tool to ground competency declarations about residents. They then describe the system to compile, collate, and use the EPA field notes to make competency declarations and how this system aligns with van der Vleuten's utility index for assessment (valid, reliable, of educational value, acceptable, cost-effective). Early outcomes indicate that preceptors are using the EPA field notes more often than they used the generic field notes. EPAs enable educators to evaluate multiple objectives and important but unwieldy competencies by providing practical, manageable, measurable activities that can be used to assess competency development.

The Green Card Project is a small randomized controlled trial (RCT) designed to test the effectiveness of an intervention to aid diabetes self-management carried out in a general practice setting in rural New South Wales. Participants were given a card with four key predictors of long term diabetes health and offered incentives for positive changes in these indicators. Controls received standard care. Fifty four participants and 68 controls completed the project. There was an average decline of 0.20 (se 0.15) in HbA1c for males in the intervention group compared to an average increase of 0.23 (se 0.13) in the control group. For women, the opposite occurred, with the intervention women exhibiting an average increase of 0.24 (se 0.13) and the controls an average reduction of 0.12 (se 0.127). For lipids, there was a significant reduction in both intervention and control. Both males and females in the intervention group demonstrated a significant reduction in waist circumference, whereas the control group had a non-significant increase in waist circumference. Male participants saw the program in a competitive light, while women were focused on the discount voucher. Education strategies for diabetes may benefit from research into gender specific information delivery systems. The trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) as ACTRN12613000414718.

Introduction 1. Material Processes: The Glossing of Lydgate's Siege of Thebes and Fall of Princes 2. Authors, Translators and Commentators: Glossing Practices in Bodleian MS Fairfax 16 3. Exhortations to the Reader: The Double Glossing of Douglas's Eneados 4. Glossing the Spoken Word: Erasmus's Moriae Encomium and Thomas Chaloner's Praise of Folie 5. 'A Broil of Voices': The Printed Word in Baldwin's Beware the Cat and Bullein's Dialogue against the Fever Pestilence 6. 'Masking naked in a net': George Gascoigne and Sir John Harington 7. 'Playing the Dolt in Print': The Extemporary Glossing of Nashe's Pierce Penilesse Afterword

Background : the BARRIERS to research utilization scale was developed in the US almost a decade ago (Funk et al. 1991). Since then it has been used in several countries with different, relatively small groups of nurses in different settings. The work reported here is a sub-section of a larger survey of more than 2000 nurses working in acute and community settings in Yorkshire. Results for the hospital-based nurses only are presented here. Aim : the aim of the study was to produce a general picture of the main barriers to the implementation of research findings as reported by hospital nurses and to explore sub-samples in order to identify similarities and differences between them. Method : a census survey of nurses from two hospital trusts was undertaken. The BARRIERS questionnaire was sent by mail to 1984 nurses, with a response rate of 36% ( n =712). Results : the greatest area of concern focused on resources. This included time and facilities for implementation and cooperation from colleagues, in particular medical colleagues. Inadequate authority to make changes and incomprehensible statistical analyses were also major barriers. Night nurses and older nurses reported greater difficulties with the accessibility of research and had more negative views of the benefits of research for practice. Conclusions : the provision of time, facilities and peer support appeared to be needed, in keeping with other UK-based studies of hospital nurses using the BARRIERS scale. Nurses needed authority to make changes to practice. Furthermore, there was a need for training to improve nurses’ understanding of statistics, as well as statistics being presented more clearly and with greater explanation. The current drive for evidence-based practice makes the use of an instrument such as the BARRIERS scale to measure the progress of nurses with research implementation highly desirable.

There is growing evidence that clinical supervision is a useful means of developing practice in nursing (Butterworth et al, 1997). There is, however, little in the way of research evidence to support various approaches to supervision for district nurses. This article reports a practice development initiative in which clinical supervision was implemented in a community trust. The rationale which underpinned the decision to implement group supervision is explored and the supervision techniques described. Recommendations are made for further work in this area, most notably in relation to evaluation.

This article describes how the results of an audit of district nursing care plan documentation have been used to inform practice development in a community trust. The principle aim of the audit was to discover whether the evaluation of patient care was being adequately recorded in nursing care plans. To establish this, four commonly occurring areas of district nursing work were selected and an ideal assessment of care developed from the available evidence. The areas were: the management of leg ulceration, bath care, pressure area care and catheter care. Data capture forms were developed to record whether the features of an ideal assessment of these four areas of care were reflected in the written evaluation of that care. The results of the audit demonstrated that the evaluation of care was often inadequately recorded, which reflected poor written documentation of the initial nursing assessment. The implications of the findings of the audit for practice development in the four areas of care are discussed.

Holistic care is the aspiration of the nursing profession yet in district nursing, it is becoming increasingly difficult to attain. Developments such as skill or grade mix and the employment of the social services carer, have carved up traditional district nursing into tasks that are allocated to a variety of nursing and related personnel, in a manner that is as cost-effective as possible. The traditional district nurse who was allowed the scope to attend to any patient need is an increasingly rare entity; some would argue rightly so. There is an exception to this, however, in the acute ‘holistic’ care of patients who are terminally ill. This paper discusses the changes to district nursing practice that have taken place in recent years and using supportive data from an ethnographic research study of district nursing work, explores why terminal care is so highly valued by the district nursing service.

This prospective questionnaire-based study evaluated the effectiveness of “The Responsible Sexuality Program” in changing knowledge and attitudes and leading to safer sex behavior. In a brief sexual health intervention, coeducational medical student pairs used role-plays to facilitate small group discussion concerning communication and safer sex issues, including abstinence. Sixty-four grade 9 students, including students who received the program intervention and controls, completed the pretest and posttest questionnaires and participated in the study Compared to the control group, significant changes in knowledge, attitudes, and behavioral intentions of the intervention group were evident at posttest, predominantly among female participants. The intervention was rated good or excellent by more than 95% of participants. This program could be part of a comprehensive series of preventive sexual health interventions integrated into classroom learning.

Objectives the following paper addresses the etique tte of district nursing, which, it is argued, is a manifestation of the profession's non-challenging occupational culture and a barrier to clinical effectiveness. Etiquette describes courtesy rules that are applied, often unthinkingly, to facilitate smooth social interaction. Although good working relationships are essential to ‘teamwork’, there are circumstances under which patient care can suffer if politeness becomes an overriding aim. Design the data for this paper are taken from a larger ethnographic study of district nursing work. Participant observation spanned 13 days, and 50 semi-structured interviews were conducted. Setting three community trusts in North West England. Participants 37 district nurses, grades G, H and one F, were observed and interviewed. Analysis the data were analysed by constant comparative analysis until no new themes arose. Findings the findings presented here address the problem faced by the nurses of perceiving that a colleague's care was out of date, or otherwise inappropriate, and of how they dealt with this. In such circumstances, the rule of etiquette was usually that the patient's care would not be challenged, although whether the issue would be subsequently raised with the nurse concerned was attributed to a number of factors. The implications of etiquette in the workplace are addressed. Conclusions the paper concludes by suggesting that a more formal set up for clinical peer review may be a useful platform to move discussion about patient care onto a more professional footing.

Singapore Institute of Technology (SIT) in partnership with University of Manchester (UoM) deliver a post registration Degree Programme that incrementally supports Registered Nurses(RNs) in developing the skills to lead changes in Singapore health care. An important aspect of this programme is to prepare RNs to manage the increasing number of people living with Long Term Conditions (LTCs) in Singapore. The aim of the module (Long Term Care Pathways) is to equip students with the knowledge and skills in promoting self-management enabling them to critically examine how integrated care influences interventions for people with LTCs. This is achieved by working in partnership with the Agency of Integrated Care (AIC) who support voluntary organizations in the Intermediate and Long-Term Care (ILTC) sector providing clinical placements for students. In these placements, students explore the range of care options available in the voluntary organizations in the Intermediate and Long-Term Care (ILTC) sector as people with LTCs journey from acute to community care. In this way, the students incorporate knowledge about the Singapore health financing and service delivery systems as well as community resources and policies into specific nursing competencies in self-management, clinical reasoning and interventions for people with LTCs. This overarching approach is in agreement with Wagner’s Chronic Care Model. Post-module quantitative and qualitative feedback from students and practitioners from the ILTC organizations is positive and encouraging. With the assistance from AIC, the module has also stimulated greater interest from the ILTC sector to support students in practice.

Background In the United Kingdom, district nurses (DNs) support patients with advanced cancer in their homes. Although evidence suggests that DNs emphasize the distinctiveness of home rather than hospital settings, little is known about the specific challenges of delivering care in family-home settings. Objective The objective of this study was to explore DNs' experiences of supporting patients within families. Methods Focus groups were conducted with 40 DNs from 4 areas in the United Kingdom. The groups were digitally recorded and facilitated by researchers using a flexible topic guide. Analysis Verbatim transcripts were analyzed using thematic content analysis. Results Case-load complexity (household volatility) and family dynamics posed distinct challenges for nurses supporting patients. Many family members struggled with accepting the patients' prognosis and were complicit in withholding information. At times, this foreclosed a consideration of palliative options. Conclusions Carers provide a great deal of positive supportive care within the home. However, for some, the home is characterized by conflict rather than consensus. Complexities surrounding family relationships pose a distinctive and challenging environment for DNs. Implications for practice Education and training of DNs should be designed to address the challenges of supporting patients within the family-home setting.

This paper considers the needs of Polish managers in order to make recommendations for the design of training programmes. The experience of Polish managers is first considered through a comparison of theoretical and actual organizational situations. We find that, as a result of political competition, Polish managers should have developed some managerial skills. Exploratory research in managerial skills, based on Katz's (1955) model, is then reviewed, and we find that Polish managers do possess and use a wide range of skills. National business culture and the effects of relatively high power distance, thought to exist in Poland, on training are then discussed. Research into preferred learning styles, based on Honey and Mumford (1986), is then compared to research conducted in the UK, US and Canada; the preferred learning style of Polish managers is found to be contemplative. Based on these findings, specific recommendations are made for the content and delivery of managerial training programmes. Above all, trainers must be prepared to be flexible and to listen to what their trainees tell them is needed for management in the transition economy. A consultative rather than prescriptive approach is recommended.

Background and aims The rising incidence of inflammatory bowel disease (IBD) in adults and children has implications for the lifelong burden of disease and the provision of specialist services. Patients with IBD should have access to specialist care which is delivered according to their values and needs. Few studies have examined patients' views of follow-up care. The aim of this qualitative study was to explore patients' needs, preferences and views of follow-up care. Methods IBD patients were selected from a gastroenterology clinic in a UK Hospital and invited to participate in interviews which focused on needs, preferences and role of follow-up, their experience of follow-up, service delivery, and other models of follow-up care. Results 24 patients were recruited, 18 patients had Crohn's Disease, and 6 ulcerative colitis. Median age was 48.5 years (range was 27–72 years) and median disease duration 11.5 years (range 2–40 years). Four main themes emerged: (1) experiences of current follow-up care; (2) attitudes to new models of care, including self-management, role of general practitioner, patient-initiated consultations and ‘virtual’ follow-up; (3) the personal value of follow-up care; and (4) the ‘ideal’ consultation. Conclusion The main finding was that patients prefer a more flexible follow-up care system. ‘Virtual’ care as an adjunct to patient-initiated consultations and self-management, was identified as optimal approaches to meet the patients' needs of follow-up care. New models of follow-up care could improve the patients' experience of care, offer potential cost savings with reduction in face-to-face consultations and allow targeted care to those who need it.

Background A small body of evidence demonstrates the challenges faced by migrant communities living with HIV but has yet to consider in-depth the experience of asylum seekers whose residency status is undetermined. The overall aim of our study was to explore the experiences of those who are both living with HIV and seeking asylum. This paper focuses on the stressors precipitated by the HIV diagnosis and by going through the asylum system; as well as participants’ resilience in responding to these stressors and the consequences for their health and wellbeing. Methods We conducted an ethnographic study. Fieldwork took place in the UK between 2008–2009 and included: 350 hours of observation at voluntary services providing support to black and minority ethnic groups living with HIV; 29 interviews and four focus group discussions with those who were seeking asylum and living with HIV; and 15 interviews with their health and social care providers. Data were analysed using the constant comparative method. Results There were three main stressors that threatened participants’ resilience. First, migration caused them to leave behind many resources (including social support). Second, stigmatising attitudes led their HIV diagnosis to be a taboo subject furthering their isolation. Third, they found themselves trapped in the asylum system, unable to influence the outcome of their case and reliant on HIV treatment to stay alive. Participants were, however, very resourceful in dealing with these experiences. Resilience processes included: staying busy, drawing on personal faith, and the support received through HIV care providers and voluntary organisations. Even so, their isolated existence meant participants had limited access to social resources, and their treatment in the asylum system had a profound impact on perceived health and wellbeing. Conclusions Asylum seekers living with HIV in the UK show immense resilience. However, their isolation means they are often unable to deal with their treatment in the asylum system, with negative consequences for their perceived health and wellbeing.

AIM: To undertake a metasynthesis of qualitative studies to understand the health and social needs of people living with inflammatory bowel disease (IBD). METHODS: A systematic search strategy identified qualitative studies exploring the phenomenon of living with inflammatory bowel disease. Databases included MEDLINE, PsychInfo, EMBASE, CINAHL and the British Nursing Index via the OVID platform. Qualitative search filters were adapted from Hedges database (http://www.urmc.rochester.edu/hslt/miner/ digital_library/tip_sheets/Cinahl_eb_filters.pdf). Qualitative empirical studies exploring the health and social needs of people living with inflammatory bowel disease were selected. Study eligibility and data extraction were independently completed using the Critical Appraisal Skills Programme for qualitative studies. The studies were analysed and synthesised using metasynthesis methodology. The themes from the studies allowed for common translations into a new interpretation of the impact of living with inflammatory bowel disease. RESULTS: Of 1395 studies, six published studies and one unpublished thesis fulfilled the inclusion criteria. First iteration of synthesis identified 16 themes, 2nd iteration synthesised these into three main 2nd order constructs: "detained by the disease"; "living in a world of disease" and "wrestling with life". "Detained by the disease" is the fear of incontinence, the behaviour the patients display due to the fear, and the impact this has on the individual, such as social isolation and missing out on life events. All of these serve to "pull" the patient back from normal living. "Living in a world of disease" is the long term effects of living with a long term condition and the fear of these effects. "Wrestling with life" is the continued fight to thrive, the "push" to continue normal living. CONCLUSION: The metasynthesis provides a comprehensive representation of living with IBD. The unmistakeable burden of incontinence is exposed and its ongoing effects are demonstrated. The combined overall impact of living with IBD is the tension these patients live with: "Pushed and pulled: a compromised life", people living with IBD experience a constant conflict throughout their lives, they push to be normal but IBD pulls them back. The impact of the fear of incontinence and behaviour of the individual as a result, requires further qualitative enquiry. © 2012 Baishideng. All rights reserved.