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Anthony SJ, Nicholas DB, Regehr C, West LJ. 'My Transplanted Self': Adolescent recipients' experience of post-traumatic growth following thoracic transplantation. J Heart Lung Transplant 2023; 42:327-334. [PMID: 36543705 DOI: 10.1016/j.healun.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 11/24/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Despite heart and lung transplantation being life-saving therapies for children and adolescents, little research has focused on recipients' lived experience post-transplant. This study captures the subjective experiences of adolescent thoracic transplant recipients, providing insight into the impact of life changes following transplantation in this population. METHODS A grounded theory approach guided an iterative process of data collection and data analysis. Adolescent heart and lung transplant recipients were recruited from a large Canadian pediatric teaching hospital to participate in one-on-one semi-structured interviews. Analysis using line-by-line coding and constant comparison methods facilitated reflection and agreement on categories and emergent themes. RESULTS A total of 27 heart and 5 lung transplant recipients (66% female) participated at a median age of 15.9 years and a median time post-transplant of 2.7 years. Participant narratives illuminated three themes describing (1) personal growth - an awareness of personal strengths and coping abilities, (2) relationship growth - a greater appreciation for family and friends, and (3) introspective growth - a developing life philosophy. Findings suggest that adolescents experience an emergent 'transplanted self', positioning thoracic transplantation as a potential catalyst for positive growth and personal change. CONCLUSIONS The study findings describe pediatric thoracic transplantation as potentially transformative in nature and sheds light on the application of post-traumatic growth theory. Practitioners and researchers are encouraged to acknowledge the possibility of growth, transformation, and positive change that may be possible within the adolescent thoracic transplant experience and leverage such strengths in clinical care.
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Affiliation(s)
- Samantha J Anthony
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.
| | - David B Nicholas
- Department of Social Work, University of Calgary, Edmonton, Alberta, Canada
| | - Cheryl Regehr
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Lori J West
- Departments of Pediatrics, Surgery, Medical Microbiology/Immunology and Laboratory Medicine/Pathology, Alberta Transplant Institute, University of Alberta, Edmonton, Alberta, Canada
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Velleca A, Shullo MA, Dhital K, Azeka E, Colvin M, DePasquale E, Farrero M, García-Guereta L, Jamero G, Khush K, Lavee J, Pouch S, Patel J, Michaud CJ, Shullo M, Schubert S, Angelini A, Carlos L, Mirabet S, Patel J, Pham M, Urschel S, Kim KH, Miyamoto S, Chih S, Daly K, Grossi P, Jennings D, Kim IC, Lim HS, Miller T, Potena L, Velleca A, Eisen H, Bellumkonda L, Danziger-Isakov L, Dobbels F, Harkess M, Kim D, Lyster H, Peled Y, Reinhardt Z. The International Society for Heart and Lung Transplantation (ISHLT) Guidelines for the Care of Heart Transplant Recipients. J Heart Lung Transplant 2022; 42:e1-e141. [PMID: 37080658 DOI: 10.1016/j.healun.2022.10.015] [Citation(s) in RCA: 99] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Velleca A, Shullo MA, Dhital K, Azeka E, Colvin M, DePasquale E, Farrero M, García-Guereta L, Jamero G, Khush K, Lavee J, Pouch S, Patel J, Michaud CJ, Shullo M, Schubert S, Angelini A, Carlos L, Mirabet S, Patel J, Pham M, Urschel S, Kim KH, Miyamoto S, Chih S, Daly K, Grossi P, Jennings D, Kim IC, Lim HS, Miller T, Potena L, Velleca A, Eisen H, Bellumkonda L, Danziger-Isakov L, Dobbels F, Harkess M, Kim D, Lyster H, Peled Y, Reinhardt Z. The International Society for Heart and Lung Transplantation (ISHLT) Guidelines for the Care of Heart Transplant Recipients. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Emotional Wellbeing in Adolescents Living With Chronic Conditions: A Metasynthesis of the Qualitative Literature. J Adolesc Health 2022; 70:864-876. [PMID: 35168883 DOI: 10.1016/j.jadohealth.2021.12.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 11/22/2022]
Abstract
Adolescents living with chronic conditions (ALWCCs) are at a higher risk of suicide (odds ratio: 4.3) than their peers. No consensus exists in the scientific community on a definition or conceptual elements of emotional well-being in this vulnerable population, hindering informed interventional research. This study investigated the meaning of emotional well-being in ALWCCs. A systematic metasynthesis of the qualitative literature was performed and structured using ENTREQ guidelines for reporting qualitative metasynthesis. A final sample of 11 primary qualitative studies met inclusion criteria and was critically analyzed using a team-based thematic synthesis and reciprocal translation approach. The meaning of emotional well-being in ALWCCs is having positive relationships that ease loss, foster hope and resilience, and promote self-efficacy and self-actualization. The role of healthcare providers as a safe, stable nurturing relationship which promotes hope and positive body image emerges an area for future research. Spirituality as it relates to emotional well-being in this population is scarce in the qualitative literature and should be further explored.
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Integration Process With a Donated Heart: A Grounded Theory Study. Dimens Crit Care Nurs 2021; 41:10-17. [PMID: 34817955 DOI: 10.1097/dcc.0000000000000500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In the posttransplant period, recipients face a complex phenomenon called the new heart, which is a symbol of physical and emotional life. They use different methods to get used to the new heart. OBJECTIVE The aim of this study was to explore the integration process with a donated heart in heart transplant patients. METHODS A qualitative study design with a grounded theory approach following Corbin and Strauss was used. Purposive and then theoretical sampling led to the inclusion of 15 heart transplant patients with diverse characteristics. Observations and semistructured interviews were conducted during a 1-year period in 2019 to 2020. Data collection and analysis occurred simultaneously. RESULTS The process of integration with the new heart in the transplant patients or the core category in this study was "rebirth." The process involved thre3 sequential and overlapping phases, which over time led to toleration and management of the situation. Religious issues, emotional chaos, additional worries, and sense of duality in the early stages after transplantation form a cycle, and the person is moving in this cycle. DISCUSSION The results of this study indicated that the patients experienced several emotional and psychological changes after heart transplantation. It was also shown that the participants experienced a change in the emotions and feelings over time. On the basis of the findings of this study, it can be suggested that health care providers need to improve their knowledge about posttransplant changes, recipients' feelings, and adaptation strategies.
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Anthony SJ, Young K, Pol SJ, Selkirk EK, Blydt-Hansen T, Boucher S, Goldberg A, Hamiwka L, Haverman L, Mitchell J, Urschel S, Santana M, Stinson J, Sutherland K, West LJ. Patient-reported outcome measures in pediatric solid organ transplantation: Exploring stakeholder perspectives on clinical implementation through qualitative description. Qual Life Res 2021; 30:1355-1364. [PMID: 33447959 PMCID: PMC8068689 DOI: 10.1007/s11136-020-02743-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 12/05/2022]
Abstract
PURPOSE Patient-reported outcome measures (PROMs) are standardized instruments used to collect data about the subjective assessment of medical care from the patient perspective. Implementing PROMs within pediatric clinical settings has gained increasing importance as health services prioritize patient-centred pediatric care. This study explores the perspectives of pediatric solid organ transplant patients, caregivers, and healthcare practitioners (HCPs) on implementing PROMs into clinical practice. METHODS Qualitative description methods were used to elicit stakeholder perspectives. Semi-structured interviews were conducted across five Canadian transplant centres. Purposive sampling was used to obtain maximum variation across age, gender, and transplant program for all participants, as well as discipline for HCPs. RESULTS The study included a total of 63 participants [patients (n = 20), caregivers (n = 22) and HCPs (n = 21)]. Nearly all participants endorsed the implementation of PROMs to enhance pediatric transplant clinical care. Three primary roles for PROMs emerged: (1) to bring a transplant patient's overall well-being into the clinical care conversation; (2) to improve patient communication and engagement; and, (3) to inform the practice of clinical pediatric transplant care. Insights for effective implementation included completing electronic PROMs remotely and prior to clinical appointments by patients who are eight to 10 years of age or older. CONCLUSIONS This study contributes to current research that supports the use of PROMs in clinical pediatric care and guides their effective implementation into practice. Future directions include the development, usability testing, and evaluation of a proposed electronic PROM platform that will inform future research initiatives.
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Affiliation(s)
- Samantha J Anthony
- Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada.
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.
- Canadian Donation and Transplantation Research Program, Edmonton, Canada.
| | - Katarina Young
- Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
| | - Sarah J Pol
- Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
| | - Enid K Selkirk
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Tom Blydt-Hansen
- Canadian Donation and Transplantation Research Program, Edmonton, Canada
- British Columbia Children's Hospital, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Suzanne Boucher
- Canadian Donation and Transplantation Research Program, Edmonton, Canada
| | - Aviva Goldberg
- Canadian Donation and Transplantation Research Program, Edmonton, Canada
- Health Science Centre Winnipeg, Winnipeg, Canada
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Lorraine Hamiwka
- Canadian Donation and Transplantation Research Program, Edmonton, Canada
- Alberta Children's Hospital, Calgary, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Lotte Haverman
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Psychosocial, Amsterdam, The Netherlands
| | - Joanna Mitchell
- Canadian Donation and Transplantation Research Program, Edmonton, Canada
| | - Simon Urschel
- Canadian Donation and Transplantation Research Program, Edmonton, Canada
- Stollery Children's Hospital, Edmonton, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Maria Santana
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Jennifer Stinson
- Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Katie Sutherland
- Canadian Donation and Transplantation Research Program, Edmonton, Canada
| | - Lori J West
- Canadian Donation and Transplantation Research Program, Edmonton, Canada
- Stollery Children's Hospital, Edmonton, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Canada
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Asgari P, Jackson AC, Bahramnezhad F. Adjustment to a New Heart: Concept Analysis Using a Hybrid Model. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:89-96. [PMID: 34036054 PMCID: PMC8132861 DOI: 10.4103/ijnmr.ijnmr_9_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/29/2020] [Accepted: 12/29/2020] [Indexed: 11/04/2022]
Abstract
Background Although the phenomenon of adjustment to a new heart in transplant recipients is very complex, very few studies have been conducted on this important issue. Therefore, no careful and clear definition exists for this concept. Materials and Methods This concept analysis was conducted in Iran in 2018 on 13 patients undergoing heart transplantation. In the theoretical phase, a conceptual framework was created according to the existing data in the literature about the phenomenon. In this study, 13 participants were selected using purposive sampling with maximum diversity.-Ž In the fieldwork phase, 20 deep and semistructured interviews were conducted with patients undergoing heart transplantation over 4 months. After data saturation, interviews were analyzed using the qualitative content analysis method proposed by Granheim and Lundman (2009). At the final analytical phase, the results of the two previous phases were integrated using a hybrid model. Results Adjustment to a new heart is a unique multiphase process in patients undergoing heart transplantation. The antecedents include the transplantation time, physical conditions, social and family support, relationship with congeners, and spiritual beliefs. The desirable consequences of adjustment to a new heart may include a new life, inner peace, and spiritual excellence, and the undesirable consequences may include psychological abuse and emotional stagnation. Conclusions According to the results, the health-care team should consider the patient as a unique client and initiate discussions before and following heart transplantation that address patients' adjustment to a new heart in all their physical, sexual, and emotional aspects.
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Affiliation(s)
- Parvaneh Asgari
- PhD Candidate in Nursing Education, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Alun C Jackson
- Australian Centre for Heart Health, Melbourne, Australia.,Faculty of Health, Deakin University, Geelong, Australia.,Honorary Professor, Centre on Behavioural Health, Hong Kong University, Hong Kong, PRC
| | - Fatemeh Bahramnezhad
- Departments of Critical Care Nursing, Nursing and Midwifery Care Research Center, Spiritual Health Group, Research Center of Quran, Hadith and Medicine, Tehran University of Medical Sciences, Tehran, Iran
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McIntyre HF. Pump, person and Parfit: why the constitutive heart matters. MEDICAL HUMANITIES 2020; 46:384-393. [PMID: 33172911 DOI: 10.1136/medhum-2020-011849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/30/2020] [Indexed: 06/11/2023]
Abstract
The historical view of the heart as a source and repository of characteristics of individual persons remains prevalent in speech and literature. A more recent scientific view regards the heart as just a replaceable mechanical device, supporting a hydraulic system (the pump-view). To accept the pump-view is to reduce the historical view of the heart, and reference to it, to metaphor. To address whether this conclusion is justified, this paper investigates what constitutes an individual person over time and whether the heart has any role in that constitution. While some physical continuity may be necessary, most philosophers agree that our 'personal identity' is conferred through the persistence of 'psychological' characteristics predominantly through memory. Memory is constituted through the interplay of external and internal sensory experience-to which the heart is a major contributor. On scientific grounds alone this sensory role for the heart makes the pump-view incomplete. If our persistence as a person reflects the totality of experience codified through memory, and the heart is a central source of the internal component of that experience, then the pump-view is also misleading since the heart plays some constitutive role. More widely, if what fundamentally matters for our survival as persons is just psychological continuity, then the pump-view is irrelevant. While a 'supportive heart' may be necessary for continued embodiment, it is on the constitutive role of the heart, as part of a unique internal experience, that our individuation as persons depends.
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Lindberg C, Almgren M, Lennerling A, Forsberg A. The Meaning of Surviving Three Years after a Heart Transplant-A Transition from Uncertainty to Acceptance through Adaptation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155434. [PMID: 32731539 PMCID: PMC7432631 DOI: 10.3390/ijerph17155434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/25/2020] [Accepted: 07/26/2020] [Indexed: 01/10/2023]
Abstract
The rationale was to longitudinally follow-up interviews performed with heart recipients at their one-year examination in order to deepen the understanding of the meaning of surviving a heart transplant. The aim was to explore the meaning of surviving three years after a heart transplant compared to one year and to identify what constitutes the change process. A phenomenological–hermeneutic method was used. This multicenter study was carried out at the two hospitals in Sweden where heart transplants are performed. A total of 13 heart recipients who survived three years after a heart transplant were invited to participate in this three-year follow-up study and 12 accepted, 3 women and 9 men, with a mean age of 51.25 years. The naïve understanding revealed that the heart recipients strongly accepted their life situation and that time had enabled this acceptance of limitations through adaptation. The thematic structural analyses cover six themes illustrating the meaning of acceptance and adaptation, i.e., accepting life as it is, adapting to post-transplant limitations, adapting to a changed body, social adaptation, showing gratitude and trusting oneself and others. In conclusion, achieving acceptance and a solid sense of self-efficacy after heart transplantation is a time-consuming process that involves courage to face and accept the reality and adapt in every life dimension.
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Affiliation(s)
- Catharina Lindberg
- Department of Health Sciences, Blekinge Institute of Technology, 374 35 Karlskrona, Sweden;
| | - Matilda Almgren
- Care in High Tech Environments, Institute of Health Sciences at Lund University, 221 00 Lund, Sweden;
| | - Annette Lennerling
- The Transplant Centre, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden;
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Anna Forsberg
- Care in High Tech Environments, Institute of Health Sciences at Lund University, 221 00 Lund, Sweden;
- Department of Thoracic Surgery, Skåne University Hospital, 222 42 Lund, Sweden
- Correspondence:
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