Joanna Briggs Institute Qualitative Assessment And Review Instrument Research Articles

The Quality of Husserlian Phenomenological Research in the Health Sciences: A Methodological Systematic Review.

Review question/objective The objective of this systematic review is to provide a narrative summary synthesis of the quality of existing Husserlian phenomenological research studies in the health sciences. As a methodological systematic review, only studies that focus on adult patients’ experiences of preventive, screening, diagnosis, treatment or rehabilitation interventions/procedures will be considered to serve as a paradigm “case” of the use of the Husserlian phenomenological approach within the broad field of health. The review question is: What is the quality of existing Husserlian phenomenological research studies in the health sciences? The motivation for this systematic review is not to fault authors of existing Husserlian phenomenological research, but to explore the problems encountered in existing research literature, if any, and to provide guidance to authors for future health research guided by this specific philosophical perspective. In order to avoid repetition, the term ‘Husserlian phenomenological approach’ as used in the text refers to the approach described by Edmund Husserl in English translations of his own published work; or as described in English language commentaries by internationally recognized scholars; or from Husserlian phenomenological scholars including the structured framework presented by Spiegelberg. Each time the ‘content of Husserlian phenomenological research studies’ is used in the text it should be understood to mean ‘content of Husserlian phenomenological research studies as reflected in the stated philosophical perspective, research methodology, data collection methods, data analysis methods, presentation and interpretation of the results, and the conclusions’. Definition of terms: 1. Husserlian phenomenological research studies refers to primary qualitative research studies that are explicitly grounded in the work of Husserl reflected in explicit statements or descriptions by the authors. 2. Quality refers to the extent to which there is congruence between the Husserlian phenomenological approach and the content of Husserlian phenomenological research studies. These stipulative definitions are intended to preclude the need to cite the scientific literature as there is no need to demonstrate their ‘validity’ or ‘acceptability’ by the communities of scholars. TRUNCATED AT 350 WORDS.

A comprehensive systematic review on lateral/horizontal violence in the profession of nursing.

Review Questions/Objective The overall aim of this comprehensive systematic review is to synthesise the best available evidence on the experience of lateral/horizontal violence in the profession of nursing and the effectiveness of programs/strategies meant to decrease its prevalence or mitigate its negative effects. Specifically, this review will seek to answer the following questions: •What is the experience of being a licensed nurse who is a victim of lateral/horizontal violence? •What is the experience of being a student nurse who is a victim of lateral/horizontal violence? •What is the impact of experiencing lateral/horizontal violence on job retention and job satisfaction? •What are the most effective interventions/strategies for decreasing the prevalence or mitigating the negative effects of lateral/horizontal violence on licensed nurses? Inclusion Criteria Types of Participants This review will consider studies with a focus on licensed nurses and student nurses. For purposes of this review ‘licensed nurse’ refers to a nurse who holds a license to practice nursing at any level. Due to the ambiguity of nomenclature, different titles for licensed nurse will be considered, including but not limited to registered nurse, practical nurse, vocational nurse.) Types of Interventions/Phenomena of Interest The qualitative component of this review will consider as phenomena of interest the actual experience of horizontal/lateral violence by licensed nurses and student nurses. The quantitative component of this review will examine interventions/strategies meant to decrease the prevalence or mitigate the effects of lateral/horizontal violence on licensed or student nurses. Some examples of programs or strategies reported in the literature are intense education programs, cognitive rehearsal strategies, zero tolerance policies and workshops. Context This review will consider research on the experience of lateral/horizontal violence in the profession of nursing and the efficacy/effectiveness of programs/strategies that are designed to decrease its prevalence or mitigate its negative effects in any setting where licensed or student nurses practise. Types of Outcomes The qualitative component of this review will include experiential accounts of being a nurse or student nurse who has experienced lateral/horizontal violence. The quantitative component of this review will consider studies that report outcomes such as but not limited to: •types and intensity/severity of effects of lateral/horizontal violence on licensed or student nurses •number of lateral/horizontal violence episodes/ prevalence of lateral/horizontal violence. •job satisfaction •job retention.

Family-centred care for hospitalized children aged 0-12 Years: A systematic review of qualitative studies.

Review question/objective The objective of the review is to synthesise the existing evidence on family and/or health providers’ experience of family-centred models of care for hospitalised children aged 0-12 years (excluding premature neonates). (*Some sections of this protocol are adopted or adapted from the Cochrane Systematic Review of family-centred care in hospitalised children 0-12 years (2007)1 and its update (2012)2 and are published here with permission from Wiley. A more detailed discussion of the development of the concept of family-centred care is available in these publications.) This review will consider studies that include hospitalised children aged 0-12 years (but excluding premature neonates), their family and/or health providers. Definitions Child/children: throughout this review, the term 'child' or 'children' is used to include all newborn infants, babies and children up to the age of 12 years being cared for in hospital; and all parts of hospitals that provide a service to children. The definitions of childhood can vary, and age limits are arbitrary. For the purpose of this review the National Library of Medicine's medical subject headings were used to define the age cut off of 12 years. However, we have excluded neonates born prematurely and who are patients in a neonatal intensive or special care nursery, as their requirements for family-centred care, and the ethics and philosophies of care around this particular group, are different to those in a ward/unit where full term infants and children are nursed.40 We have excluded studies about adolescents for similar reasons. Families: throughout the review the following definition of the family will be applied: The family is a basic social unit having as its nucleus two or more persons, irrespective of age, in which each of the following conditions are present: the members are related by blood, or marriage, or adoption, or by a contract which is either explicit or implied;the members communicate with each other in terms of defined social roles such as mother, father, wife, husband, daughter, son, brother, sister, grandfather, grandmother, uncle, aunt; and they adopt or create and maintain common customs and traditions. TRUNCATED AT 350 WORDS

The experience of men who have sex with men in responding to and coping with HIV in the first year following a diagnosis: a systematic review of qualitative evidence.

Review Objective/Questions: The objective of this systematic review is to identify and synthesise the best available qualitative evidence on how men who have sex with men respond to and cope with HIV in the first year following diagnosis. The specific questions to be addressed are: How do men who have sex with men respond to HIV in the first year following diagnosis? How do men who have sex with men cope with HIV in the first year following diagnosis? Inclusion Criteria: Population This review will consider studies that include a focus on men who have sex with men who have been diagnosed with HIV. ‘Men who have sex with men’ is a behavioural definition to include those men who do not identify as homosexual or bisexual but who have sexual encounters with men. Any studies referring to gay, homosexual or bisexual men specifically will be included, as well as those that refer to men who have sex with men in general. Phenomena of interest This review will consider studies that include a focus on the experience of men who have sex with men in responding to and coping with HIV in the first year following a diagnosis. Studies exploring the experience of men who have sex with men with HIV after their first year following diagnosis will not be considered.

Choosing to have an illegal abortion in southern Africa: a comprehensive systematic review of the qualitative and text and opinion evidence.

Review Objective/Questions The overall objective of this systematic review is to critically appraise, synthesize and present the best available evidence in relation to why women choose to undergo an “illegal or unsafe” abortion when abortion is legal and readily available in South Africa. Review question: Why do pregnant women choose “illegal or unsafe” abortions when legal abortions are freely available in South Africa? Inclusion Criteria Types of participants This systematic review will consider any qualitative study where the focus is on pregnant women of childbearing age who have had an illegal abortion and who live in Southern Africa. Phenomena of interest The phenomena of interest of this review are the reasons why women choose illegal abortions in situations where abortion is freely available; social and demographic data of participants in studies. For the purpose of this systematic review, studies that use terms such as “unsafe” abortion, or abortions conducted in “non-medical settings” will be considered to be illegal abortions and will be considered for inclusion in the study. Context This review will consider any qualitative study for inclusion that was conducted in South Africa. Studies that have been conducted in public or private health care settings will be considered for inclusion in the review. Health care settings may include hospitals, clinics and non-governmental organizations that offer supportive services to women who have had an abortion

Communication for Development Interventions in Fragile States: a systematic review.

Communication for Development Interventions in Fragile States: a systematic review.

Factors affecting and strategies to improve pain management in emergency departments: a comprehensive systematic review.

Factors affecting and strategies to improve pain management in emergency departments: a comprehensive systematic review.

Venous Thromboembolism Risk Assessment and Prophylaxis: A Comprehensive Systematic Review of the Facilitators and Barriers to Healthcare Worker Compliance with Clinical Practice Guidelines in the acute care setting.

Review question/objective The objective of this review is to identify, appraise and synthesise the best available evidence on the facilitators and barriers to compliance with Venous Thromboembolism (VTE) risk assessment and prophylaxis clinical practice guidelines in the acute care setting. More specifically, the review question is: To what extent are clinical practice guidelines for risk assessment and prophylaxis of VTE adhered to in the acute care setting, and what are the facilitators and barriers? Inclusion criteria Types of participants This review will consider any studies that include all health care professionals regardless of their designated involvement with venous thromboembolism risk assessment and prophylaxis in the acute care setting. Phenomena of interest This review will consider studies that evaluated the facilitators and barriers to venous thromboembolism compliance with clinical practice guidelines in the acute care setting. The qualitative component of the review will consider as phenomena of interest any studies that identify facilitators and/or barriers to compliance with clinical practice guidelines in relation to venous thromboembolism risk assessment and prophylaxis in the acute care setting. The quantitative component of the review will consider any studies that report on the barriers and facilitators to compliance with clinical practice guidelines in relation to venous thromboembolism risk assessment and prophylaxis in the acute care setting. The textual component of the review will consider any paper that discusses the facilitators and/or barriers to compliance with clinical practice guidelines in relation to venous thromboembolism risk assessment and prophylaxis in the acute care setting. Types of outcomes This review will consider studies that include measures of compliance as their outcome measures. The qualitative component of the review will consider any studies that identify facilitators and/or barriers to compliance with clinical practice guidelines in relation to venous thromboembolism risk assessment and prophylaxis in the acute care setting. The quantitative component of the review will consider any studies that report on the barriers and facilitators to compliance with clinical practice guidelines in relation to venous thromboembolism risk assessment and prophylaxis in the acute care setting. The textual component of the review will consider any paper TRUNCATED AT 350 WORDS

The uptake of research evidence: a systematic review of nurses' experiences of using research evidence in their practice.

Review question/objective The objective of this systematic review is to critically appraise and synthesise the best available evidence regarding the uptake of research evidence in clinical practice as experienced by nurses. This review seeks to answer the following questions: 1. What are the experiences of nurses in relation to the uptake of research into clinical practice? 2. What factors do nurses report as helpful in the uptake of research evidence into clinical practice? 3. What factors do nurses report as limiting the uptake of research evidence into clinical practice? Inclusion criteria Types of participants This review will consider qualitative studies that include all nurses working in any type of health care setting, including acute (hospitals), primary (community health), mental health and aged care. For the purpose of this review, the generic term ‘nurses’ will include registered nurses, enrolled nurses and assistants in nursing. The aim is to be as inclusive as possible and allow for global variations of nurse positions. Types of intervention(s)/phenomena of interest This review will consider studies that investigate the experience of nurses regarding the uptake of research evidence into clinical practice, including clinical decision making or clinical judgement. The term ‘clinical decision making’ for this review will describe any organisational aspects that influence decision making. The term ‘clinical judgement’ will describe the ‘different grounds for making judgements’. 20 (p. 1506) Additionally, for this review the terms research uptake or utilisations and evidence-based practice will be used interchangeably as they all represent the aspect of incorporating research evidence into clinical practice. Types of outcomes This review will consider any subjective accounts by nurses describing their experiences, either positive or negative, in relation to the uptake of research evidence into clinical practice.

A systematic review of qualitative evidence on the perceptions, knowledge and beliefs of Asian Indians regarding Coronary Artery Disease and its prevention.

Review Question/Objectives The objective of this systematic review is to examine the best available qualitative evidence about the influences on, and perceptions toward, coronary artery disease (CAD) prevention strategies in Asian Indians (AI). Additionally this review will help in identifying barriers to preventive measures, such as deeply- held cultural beliefs. The anticipated outcome is an in-depth understanding of Asian Indians’ perceptions and knowledge of CAD, which can be used to develop more effective, culturally sensitive health promotion services for AI communities. Specifically, the review seeks answers to the following questions: 1. What are the perceptions of AI about CAD? 2. What are the beliefs of AI regarding CAD? 3. What are the barriers or challenges to improving lifestyle for prevention of CAD among AI? 4. What is the knowledge of AI regarding risk factors of CAD? 5. What is the knowledge of AI regarding preventive strategies for CAD? 6. What is the AI attitude towards overcoming the risk factors? Inclusion Criteria Types of Participants This review will consider studies that include Asian Indians who have CAD and their family members or who are at risk of developing CAD. For this review “Asian Indians” will include people who trace their origin to the country of India. The participants to be studied are both AI male and female adults, 18 years or older. Studies with a primary focus only on participants from other countries in South Asia (Pakistan, Bangladesh and Srilanka) other than India would be excluded. Studies on AI children would not be included for this review. Studies on cerebrovascular disease such as stroke, transient ischemic attack (TIA) and peripheral vascular disease (PVD) will be excluded. Studies on AIs with congestive heart failure (CHF) and cardiac arrhythmias such as atrial fibrillation will be excluded. . Studies on AIs with ischemic heart disease, angina and myocardial infarction will be included. Types of Interventions/Phenomenon of interest The review will consider studies that have examined perceptions, attitudes, beliefs, knowledge, and meaning of CAD and its prevention among Asian Indians. TRUNCATED AT 350 WORDS

Nurses' experiences of responding to a health care disaster or adventitious crisis: a systematic review of qualitative evidence.

Review Question/Objectives The purpose of this systematic review is to systematically review and synthesise research literature reporting nurses’ experiences of responding to a health care disaster or adventitious crisis. This review aims to answer the following specific question: What are nurses’ experiences of responding to a health care disaster or adventitious crisis? Inclusion criteria Types of participants The review will consider publications that include registered nurses who have worked in a disaster, healthcare disaster, or adventitious crisis (e.g. flood, hurricane, earthquake, tsunami, volcanic eruption, terrorist attack) in the years 1945 through 2011. 5 Nurses that will be included in this study are licensed practical nurses, professional registered nurses, and advanced practice registered nurses. Phenomena of interest This review will examine the experiences of nurses in responding to a disaster, health care disaster, or adventitious crisis. Consideration will be given to, but not be limited to, the following challenges: • reporting to work • personal and family safety • dwelling in uncertainty • providing front line clinical care • changing standards of care in health care disasters or adventitious crisis • functioning with severely limited resources, communication • triaging and providing care in a range of settings • maintaining infection control • crisis debriefing • mental health sequelae Context Context will include a consideration of the cultural factors, including, but not limited to, geographic location, specific racial or ethnic considerations, gender based interests, detail about the setting (for example, acute care, primary health care, or the community) as they relate to the experiences reported in the studies.

Venous Thromboembolism Risk Assessment and Prophylaxis: A Comprehensive Systematic Review of the Facilitators and Barriers to Healthcare Worker Compliance with Clinical Practice Guidelines in the acute care setting.

Venous Thromboembolism Risk Assessment and Prophylaxis: A Comprehensive Systematic Review of the Facilitators and Barriers to Healthcare Worker Compliance with Clinical Practice Guidelines in the acute care setting.

The experience and role of the companion during normal labor and childbirth: a systematic review of qualitative evidence

The experience and role of the companion during normal labor and childbirth: a systematic review of qualitative evidence

The Experience of Hypoglycaemia and Strategies Used For Its Management by Community-Dwelling Adults with Diabetes Mellitus: A Systematic Review.

Hypoglycaemia, a common complication of diabetes drug therapy, has been reported to influence therapy adherence and the quality of life of people with diabetes mellitus. No systematic reviews on the experience of hypoglycaemia have been undertaken. The extant literature has taken a medical model perspective focusing on the causes, prevalence, and impact of hypoglycaemia. To understand the meaningfulness of hypoglycaemia and how this condition impacts on a person with diabetes mellitus, a systematic review was undertaken exploring the experiences of hypoglycaemia in community-dwelling people with diabetes mellitus. This review aimed to synthesise evidence on the experience of hypoglycaemia, and the strategies used to control it in community-dwelling adults with type 1 and type 2 diabetes mellitus. Type of Participants - Community-dwelling adults (18 years of age and over) who had experienced hypoglycaemia from type 1 or type 2 diabetes mellitus and/or who had used self-management strategies for hypoglycaemia were included.Phenomena of Interest - The experiences of hypoglycaemia in community-dwelling adults with diabetes mellitus and the strategies they used to self-manage hypoglycaemia were included.Type of Studies - Qualitative studies including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research were included. Published and unpublished studies in English from January 2000 to August 2010 were gathered using a three-step search strategy. An initial limited search was conducted in MEDLINE and CINAHL to identify keywords and index terms, which were then used in a second search across the CINAHL, PUBMED, SCOPUS, PsycINFO, PsycARTICLES, Web of Science, JSTOR, EMBASE and MEDNAR databases. Additionally, the reference list of all studies was hand-searched for additional studies. Two reviewers independently assessed the retrieved studies for methodological validity, using standardised Joanna Briggs Institute-Qualitative Assessment and Review Instrument (JBI-QARI) critical appraisal instruments. Disagreements that arose between the two reviewers were resolved with the help of a third reviewer. Data, in terms of research findings, were extracted from included studies using the standardised JBI-QARI data extraction tool. These findings were then pooled and assembled into level 1 findings, then level 2 findings (categories), and lastly meta-synthesised to form one level 3 synthesised finding. Meta-aggregation was carried out using JBI-QARI. Six studies were included in the review. Participants who lived independently in the community and attended primary care or outpatient clinics were included. In total, twenty findings were grouped into three categories, which were synthesised into one overall finding - i.e., "People with diabetes mellitus can self-manage their diabetes and thus prevent hypoglycaemic episodes more effectively when health professionals provide psychological, physiological and spiritual support, and an individually targeted education programme". The review findings revealed patient-identified priorities to maintain normality in blood glucose self-management. There is also evidence that some people lack the knowledge to identify and self-manage hypoglycaemia.To enable community-dwelling adults with diabetes mellitus to self-manage hypoglycaemia, healthcare professionals should provide individualised information and emotional support, and regularly discuss and assess the person's level of knowledge, awareness of hypoglycaemia, and their ability to self-manage.There is a lack of data that capture the person's experience and awareness of hypoglycaemia and how they self-manage the condition, particularly in varying cultural contexts. A mixed-method study could be designed to explore the experiences of hypoglycaemia, and to develop and validate a reliable tool that assesses the level of knowledge and awareness of hypoglycaemia, and the ability to self-manage. This study should include people with diabetes mellitus from different cultures and/or geographical locations.

Patients' experiences towards the donation of their residual biological samples and the impact of these experiences on the type of consent given for secondary use: A systematic review.

Background Residual or leftover clinical tissues are valuable resources for biomedical research. There is on-going discussion about the methodological, legal, and ethical issues on the collection, storage and use of these tissues for future research. This systematic review will consider qualitative studies previously conducted, which report on patients' preferences, experiences and willingness to donate their tissues.Objectives The aim of this review was to critically appraise, synthesize and present the best available evidence related to the experiences of patients toward consent when donating their leftover tissue for research.Search strategy The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilized. An initial limited search of MEDLINE and CINAHL was undertaken, followed by analysis of text words contained in the title and abstract, and of the index terms used to describe the article. A second search using all identified keywords and index terms was then undertaken across all included databases. Thirdly, the reference lists of all identified reports and articles were searched for additional studies.Data collection & analysis The standardised data extraction tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) was used to extract data from each paper. The qualitative research findings were presented as thematic pooling using the JBI-QARI approach in a narrative form. During the analysis, 131 study findings from 18 publications were aggregated into 19 categories to form four synthesized findings.Main results The synthesized findings generated were: (1) Healthcare professionals should be aware that patients' consent to the use of their left-over tissues are influenced by many and varied factors. Primarily these factors included: benefits to self and other and trust in research and researchers; (2) Healthcare institutions and regulatory authorities must provide strict safeguards and controls in order to maintain privacy and confidentiality of the patients; (3) Healthcare professionals should be aware that the views on ownership and rights to the tissues will vary between individual patients; (4) Healthcare professionals, institutions and regulatory authorities should be aware that patients have different views on the commercial use of their tissues.Discussion Patients would prefer that institutions requesting donation of leftover tissues establish a good governance system for the collection and storage of tissues, as well as a system for protecting the rights and confidentiality of patients. Most patients prefer to have an ethical and effective system, which decides the future use of their tissues, especially when a full informed consent is not obtained from the patients at time of donation and subsequent use.Implications for Practice The results from this review can assist researchers and policy makers to understand the experiences of patients and their attitudes and preferences on the collection, storage, distribution and use of their leftover tissue for research. This is especially so when designing a prospective model of consent regimen, to respect patients' needs and make recommendations for the use of existing and previously collected biological samples with no consent taken.Implications for Research Further qualitative research can be undertaken to ascertain patients' expectations when they donate their tissues; the type of consent model to be used; the perceived risks of genetic and stem cells research; and the effects of culture, religion and age on patients' willingness to donate their leftover tissues for future research.

Childrenʼs experiences of their postoperative pain management: a qualitative systematic review

Childrenʼs experiences of their postoperative pain management: a qualitative systematic review

Meaningfulness and the experience of support initiatives for the family of a child in a critical care context: A systematic review.

Meaningfulness and the experience of support initiatives for the family of a child in a critical care context: A systematic review.

The experience of body image of children and adolescents with cancer: A meta-synthesis.

The experience of body image of children and adolescents with cancer: A meta-synthesis.

The meaningfulness and appropriateness of using human patient simulation manikins as a teaching and learning strategy in undergraduate nursing education: a systematic review.

Review question/objective Objective The aim of this review is to identify the best available evidence on the meaningfulness and appropriateness of integrating human patient simulation manikins (HPSMs) into undergraduate nursing education. Review Questions This review will systematically examine the evidence to answer the following questions: 1. What are the perspectives and experiences of students and academics on the appropriateness and meaningfulness of the use of HPSMs in undergraduate nursing education? 2. What teaching and learning practices with HPSM are considered appropriate and meaningful by students and academics? Inclusion criteria Types of participants The review will consider studies that include undergraduate nursing students and academics who are involved in undergraduate education. Studies that consider other allied health care professionals will be excluded unless data for undergraduate nursing students are included and analysed separately. Types of intervention(s)/phenomena of interest The review will consider as phenomena of interest the experiences, values, opinions, beliefs and interpretations of undergraduate nursing students and academics using HPSM for teaching and learning purposes.

The experience of living with chronic manifestations of Lymphatic Filariasis among patients 15 years and older in developing countries: a systematic review

Lymphatic filariasis is considered a disease of the poor with painful and profoundly disfiguring consequences. It is transmitted by the mosquito. Lymphatic filariasis is found among persons residing in rural areas and at the periphery of communities predominantly in developing countries in the tropics.To present the best evidence regarding the experiences of persons living with chronic manifestations of lymphatic filariasis, their experiences of treatment strategies and how the condition influences their social relationships within the context of developing countries.Study subjects were persons 15 years and older with chronic lymphatic filariasis living in developing countries.Phenomena of interest Publications that were selected considered the experiences of persons living with chronic lymphatic filariasis, their experiences of treatment measures and their social relationships.Types of studies Qualitative research papers (including but not limited to: phenomenology, grounded theory, action research, narrative studies, descriptive studies, ethnographies, cultural studies, behavioral studies, case studies and feminist research) exploring the experiences of persons living with chronic manifestations of lymphatic filariasis within the context of developing countries SEARCH STRATEGY: A three-step search strategy was utilised to search for published and unpublished studies over the period of 1980-2007. MEDLINE and CINAHL were initially searched for keywords and index terms that were then used to search across all the other data bases and finally the reference list of identified studies.Eligible publications were assessed by two independent reviewers for methodological validity using the standardised critical appraisal tools of the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) DATA EXTRACTION: Data extraction was conducted using the standardised data extraction tools of the JBI-QARI. Extracted information consisted of details on relevant aspects of the identified studies.Study findings were categorised according to the JBI-QARI degrees of credibility scale, and placed in categories of similar meaning. Categories were finally meta-synthesised.Six (6) included studies yielded 41 findings that were placed in 8 categories and finally meta-synthesised into 3 synthesised findings: CONCLUSION: Policy guidelines on chronic lymphatic filariasis management need to provide a holistic approach with the involvement of communities.Much more research into elephantiasis management should be encouraged; so should qualitative research with rigorous methodological approaches into all aspects of lymphatic filariasis.Interventions should address in concert with other needs the psycho-emotional health of patients. Counseling should be incorporated into surgical management of hydroceles to allay fears of death.