Background

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.

Objective

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.

Design

This paper presents a meta-synthesis using Thomas and Harden's framework of ‘thematic synthesis’ rooted in a critical realist philosophy.

Data sources

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.

Review methods

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.

Results

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.

Conclusions

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.

中文翻译：

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成人创伤性脑损伤后家庭的经历：叙事结构的综合

背景

创伤性脑损伤对未受伤的家庭成员有显着影响。通常情况下，这一点已经过检查，重点是精神病理学结果，包括压力、抑郁和焦虑。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研究和综合是相关和及时的。

客观的

通过原始定性研究的综合，检查成人人群在亚急性期/急性期后创伤性脑损伤后家庭的主观体验。

设计

本文使用托马斯和哈登的“主题综合”框架提出了一个元综合，该框架植根于批判现实主义哲学。

数据源

2019 年 7 月，在五个电子数据库中搜索了“创伤性脑损伤”、“家庭”和“定性”等术语。如果主要研究报告了有关患有创伤性脑损伤的成年人的家庭成员的主观经历的定性数据并且已在同行评审的期刊上发表，则纳入研究。混合脑损伤样本、儿童或青少年创伤性脑损伤或意识障碍的研究被排除在外。手动搜索和引文搜索也完成了。

审查方法

两名审稿人对标题、摘要和全文进行筛选，并通过批判性讨论达成共识。最终同意将 30 篇论文纳入本次审查。然后使用批判性评估技能计划 (CASP) 工具评估每项研究的相关性、共鸣和严谨性。对每篇论文中的发现进行逐行编码，作为主题分析和综合的基础。

结果

描述性主题被确定，随后是分析性主题。这个最后阶段是由一个叙述镜头通知的，从这些镜头中，从创伤后脑损伤后家庭的主观经历中确定了属于四个维度的八个叙述功能。具体来说，这些是：（1）置换和锚定；(2) 破裂和稳定；(3) 隔离和连接；(4) 伤害和治疗。

结论

对叙事功能的解读揭示了协商生活、维持家庭系统平衡和前进的实质性存在工作。因此，家庭成员有自己独特的叙事需求。尽管围绕伤者建立了当代服务模式，但服务提供者通过积极关注叙事结构并了解这些结构对家庭经历的影响，可以很好地支持家庭进行日常叙事工作。

研究方案于 2018 年 7 月在 PROSPERO（国际前瞻性系统评价注册库）注册（注册号：CRD42018085824）。

推文摘要：这一综合表明，家庭成员在 TBI 后维持家庭系统平衡和协商他们的生活所需的巨大而无形的工作。