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Colonnello V, La Manna G, Cangini G, Russo PM. Post-Donation Evaluation: Emotional Needs for Social Connection and Social Support among Living Kidney Donors-A Systematic Review. Healthcare (Basel) 2024; 12:1216. [PMID: 38921330 PMCID: PMC11203999 DOI: 10.3390/healthcare12121216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/09/2024] [Accepted: 06/13/2024] [Indexed: 06/27/2024] Open
Abstract
INTRODUCTION Evaluation of post-nephrectomy social health in living kidney donors is essential. This systematic review examines their emotional need for social relatedness post-donation. METHODS Following the PRISMA guidelines, we systematically searched Scopus, CINAHL, and PsycINFO. RESULTS Among the screened records, 32 quantitative and 16 qualitative papers met the inclusion criteria. Quantitative research predominantly utilized questionnaires featuring generic items on social functioning. However, a minority delved into emotional and social dimensions, aligning with qualitative studies emphasizing the importance of social connection and perceived social support post-donation. Specifically, post-donation changes in connecting with others encompass a sense of belongingness, heightened autonomy, shifts in concern for the recipient's health, and continued care by shielding the recipient from personal health issues. Social acknowledgment and social support from both close and extended networks are reported as relevant for recovery after nephrectomy. DISCUSSION These findings underscore the necessity for targeted measures of emotional needs and social functioning to effectively assess post-donation adjustment. They also inform the identification of key health themes for kidney donor Patient-Reported Outcome Measures (PROMs) and Patient-Reported Experience Measures (PREMs) questions.
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Affiliation(s)
- Valentina Colonnello
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy; (G.L.M.); (G.C.)
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2
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Gad MM, Rasmussen MK, Ladefoged HB, Mathiesen LL, Finderup J. The phenomenon of urinary tract infection experienced by women with a kidney transplant. J Ren Care 2024; 50:159-167. [PMID: 37076761 DOI: 10.1111/jorc.12467] [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: 08/22/2022] [Revised: 02/19/2023] [Accepted: 04/02/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Urinary tract infection is the most common infection among people with a kidney transplant and increases the risk of graft rejection. Women have a higher risk. A literature search did not identify any description of the phenomenon of urinary tract infection experienced by women with a kidney transplant. OBJECTIVE To examine how women with a kidney transplant experienced the phenomenon of a urinary tract infection. DESIGN A qualitative study with a phenomenological approach. APPROACH Eight individual semistructured interviews based on van Manen's four lifeworld existentials and analysed using systematic text condensation. PARTICIPANTS Women with a kidney transplant and recently been admitted to the hospital due to a urinary tract infection. FINDINGS We identified four themes: (1) Feeling both typical and atypical symptoms; (2) Becoming aware of the body and trying her best to prevent urinary tract infection; (3) Having a urinary tract infection is a dual experience, both good and bad; (4) Support from relatives. CONCLUSION The urinary tract infection symptoms pathway varied between participants but also between individual episodes of incidents among each participant. Participants felt secure when they experienced a common symptom pattern, but a new symptom pattern made them insecure. Together with their relatives, they experienced a urinary tract infection as a disruption of their everyday life and it decreased their experiences of happiness. They experienced to be supported by relatives but also by healthcare professionals, but needed more information on how to prevent, observe and react to a urinary tract infection in the future.
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Affiliation(s)
- Mette Marie Gad
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- ResCenPI-Research Centre for Patient Involvement, Aarhus University & The Central Denmark Region, Aarhus, Denmark
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3
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Loban K, Milland T, Hales L, Lam NN, Dipchand C, Sandal S. Understanding the Healthcare Needs of Living Kidney Donors Using the Picker Principles of Patient-centered Care: A Scoping Review. Transplantation 2024:00007890-990000000-00770. [PMID: 38773835 DOI: 10.1097/tp.0000000000005080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
Living kidney donors (LKDs) undertake a complex and multifaceted journey when pursuing donation and have several unmet healthcare needs. A comprehensive understanding of these needs across their entire donation trajectory can help develop a patient-centered care model. We conducted a scoping review to synthesize empirical evidence, published since 2000, on LKDs' experiences with healthcare from when they decided to pursue donation to postdonation care, and what they reported as their care needs. We categorized them according to the 8 Picker principles of patient-centered care. Of the 4514 articles screened, 47 were included. Ample literature highlighted the need for (1) holistic, adaptable, and linguistically appropriate approaches to education and information; (2) systematic, consistent, and proactive coordination and integration of care; and (3) self-management and preparation to optimize perioperative physical comfort. Some literature highlighted the need for (4) better continuity and transition of care postdonation. Two key unmet needs were the lack of (5) a holistic psychosocial evaluation predonation and predischarge to provide emotional support and alleviation of fear and anxiety; and (6) access to specialty and psychosocial services postdonation especially when adverse events occurred. Limited literature explored the principles of (7) respect for patients' values, preferences, and expressed needs; and (8) involvement of family and friends as caregivers. We summarize several unmet healthcare needs of LKDs throughout their donation journey and highlight knowledge gaps. Addressing them can improve their well-being and experiences, and potentially address inequities in living kidney donation and increase living donor kidney transplantation.
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Affiliation(s)
- Katya Loban
- MEDIC, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Division of Experimental Medicine, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Thea Milland
- MEDIC, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Lindsay Hales
- Library Services, McGill University Health Centre, Montreal, QC, Canada
| | - Ngan N Lam
- Division of Nephrology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christine Dipchand
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Shaifali Sandal
- MEDIC, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Division of Experimental Medicine, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
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4
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Bourkas S, Achille M. The psychosocial adjustment of kidney recipients across donation contexts. J Health Psychol 2023; 28:1011-1023. [PMID: 36688379 PMCID: PMC10492421 DOI: 10.1177/13591053221149780] [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] [Indexed: 01/24/2023] Open
Abstract
The objective of this study was to investigate kidney recipients' experiences within deceased and living donation contexts and, in the latter, by donor relationship type, to identify differences by context and mechanisms by which the relationship with the donor may impact recipients' psychosocial well-being. Individual interviews were conducted with 12 participants and analyzed using Interpretative Phenomenological Analysis. Three themes emerged: (a) salience of and sensitivity toward sacrifice and loss, (b) honoring the sacrifice by honoring the gift, and (c) relational imbalance mirroring perceived burden of donation. Findings were contextualized in relation to the transplantation literature, and their clinical implications discussed.
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5
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Ranieri J, Guerra F, Ferri C, Di Giacomo D. Chronic non-communicable diseases and health awareness of patients: An observational study analysing the health adaptive behaviours through self-care skills. J Psychiatr Res 2022; 155:596-603. [PMID: 36209561 DOI: 10.1016/j.jpsychires.2022.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 07/23/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022]
Abstract
The incidence of chronic non-communicable diseases (CNCDs) increases with age, thus placing a burden on individuals and healthcare systems; furthermore, CNCDs are associated with lower quality of life (QoL) in the elderly. This study aimed to evaluate the behavioural management of CNCDs by comparing different diseases under its ambit exhibiting various side effects, as well as vascular, gastrointestinal, and other chronic diseases, simultaneously analysing self-care efficacy and emotional dimensions (i.e. anxiety, stress, and depression). A total of 122 outpatients aged >18 years (mean age, 50.0 years; standard deviation, ±13.8) participated in the study, and 59% of the participants were women. The psychological battery was composed of three standardised self-assessments measuring the relevant emotional dimensions, QoL, and self-care indices. Analysis of the emotional dimensions of depression, anxiety, and stress indices resulted in significant differences. Furthermore, post-hoc analyses (Tukey test) showed that patients with gastrointestinal disease (GD) experienced depression more than patients with vascular disease (VD) (p = 0.002). In addition, there were no differences between the VD and Oth and between the GD and Oth groups; however, the Oth group appeared to experience more anxiety than the VD group (p = 0.04); there were no differences between the GD and VD groups, as well the Oth group. The ANCOVA test compared the chronic disease groups, the disease stage (early and long-term), self-care indices, and sex. They were covariated by age, showing a significant effect on the management index only in chronic disease groups (p = 0.007). Our study suggests that the following specific factors need to be considered in health decision-making processes to enhance the compliance of patients to the clinically expected results: (1) tailored clinical therapies; (2) side effects of disease; (3) comorbidity; (4) mental health. The harmonisation of these internal and external factors could offer a powered perspective for personalized medicine.
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Affiliation(s)
- Jessica Ranieri
- Laboratory of Clinical Psychology and Psychoncology, Mesva Department, University of L'Aquila, Italy
| | - Federica Guerra
- Laboratory of Clinical Psychology and Psychoncology, Mesva Department, University of L'Aquila, Italy
| | - Claudio Ferri
- Mesva Department, University of L'Aquila, Italy; S. Salvatore Hospital, ASL1 AQ Abruzzo, Italy
| | - Dina Di Giacomo
- Laboratory of Clinical Psychology and Psychoncology, Mesva Department, University of L'Aquila, Italy.
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6
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McKeaveney C, Noble H, Courtney AE, Griffin S, Gill P, Johnston W, Maxwell AP, Teasdale F, Reid J. Dialysis, Distress, and Difficult Conversations: Living with a Kidney Transplant. Healthcare (Basel) 2022; 10:healthcare10071177. [PMID: 35885704 PMCID: PMC9321787 DOI: 10.3390/healthcare10071177] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 11/19/2022] Open
Abstract
Background: Providing holistic care to kidney patients is important; however, without full consideration of the perspectives of people living with a kidney transplant, the provision of truly ‘holistic healthcare’ cannot be possible. It is imperative to understand patient experiences by including kidney patients in key strategies and future renal service planning. Ignoring these important patient views means that there is a significant risk of inappropriate renal service provision and lack of adequate support, impacting overall health. The aim of this study was to develop an in-depth understanding of the lived experiences of kidney transplant recipients. Methods: A total of 23 participants were recruited between two regional nephrology units within the United Kingdom via clinical gatekeepers. In-depth interviews were undertaken. Interviews were digitally recorded, transcribed verbatim, and subjected to interpretative phenomenological analysis. Results: Two themes emerged: “managing ongoing fears of dialysis, distress, and COVID-19” and “dealing with difficult conversations”. Conclusions: Renal healthcare professionals need to understand more than the biological impact of receiving a kidney transplant. Understanding the holistic and multidomain experiences that these participants experience will help healthcare professionals to recognize the needs of this group and ensure more responsive psychosocial care.
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Affiliation(s)
- Clare McKeaveney
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (C.M.); (H.N.)
| | - Helen Noble
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (C.M.); (H.N.)
| | | | - Sian Griffin
- Department of Nephrology and Transplantation, Cardiff & Vale University Health Board, Cardiff CF14 4XW, UK;
| | - Paul Gill
- School of Healthcare Sciences, Cardiff University, Cardiff CF24 0AB, UK;
| | - William Johnston
- Northern Ireland Kidney Patients Association, Belfast BT9 7AB, UK;
| | | | | | - Joanne Reid
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (C.M.); (H.N.)
- Correspondence:
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7
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Mckie AL, Gaida F. A scoping review of spirituality and religiosity in people who have had a kidney transplant. Nurs Open 2022; 9:2277-2288. [PMID: 35670228 PMCID: PMC9374409 DOI: 10.1002/nop2.1271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 05/11/2022] [Accepted: 05/17/2022] [Indexed: 11/10/2022] Open
Abstract
Aim To conduct a scoping review to discover what is known about the presence of spirituality and religiosity in people who have received a kidney transplant. Design Using Arksey and O'Malley's five‐stage framework, a scoping review of seven key databases was performed in June 2020. The scoping review follows the PRISMA extension for scoping review process. Methods CINAHL, MEDLINE, Embase, OvidPsychINFO, JBI, Scopus and Cochrane databases were searched to identify original research, from which seven studies were identified with only four meeting the criteria. The search strategy focused on studies that were published between January 2000‐May 2020. Results In synthesizing the available research, two key areas of interest were identified within the included studies, (1) clinical outcomes (medical adherence, renal function and transplant‐related outcomes) and (2) well‐being outcomes (locus of control and coping).
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Affiliation(s)
- Amanda L Mckie
- School of Nursing, Midwifery and Public Health, University of Canberra, Canberra, Australian Capital Territory, Australia.,School of Nursing, Griffith University, Gold Coast, Queensland, Australia
| | - Fellon Gaida
- School of Nursing, Midwifery and Public Health, University of Canberra, Canberra, Australian Capital Territory, Australia
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8
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Memory KE, Wilkinson TJ, Smith AC, Lightfoot CJ. A qualitative exploration of the facilitators and barriers to self-management in kidney transplant recipients. J Nephrol 2022; 35:1863-1872. [PMID: 35467326 PMCID: PMC9035973 DOI: 10.1007/s40620-022-01325-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/27/2022] [Indexed: 11/26/2022]
Abstract
Background Understanding the behaviours that facilitate or impede one’s ability to self-manage is important to improve health-related outcomes in kidney transplant recipients (KTRs). Previous studies exploring the self-management experiences of KTRs have focused on specific tasks (e.g., medication adherence), age groups (e.g., adolescent or older recipients), or have been conducted outside of the UK where transferability of findings is unknown. Our study aimed to explore the perceptions and experiences of self-management in UK KTRs to identify facilitators and barriers associated with self-management tasks. Methods Semi-structured interviews were conducted with eleven KTRs. Topics explored included experiences of self-management tasks (diet, exercise, medications, stress management), perceived healthcare role, and future interventional approaches. Thematic analysis was used to identify and report themes. Results Eight themes were identified which were mapped onto the three self-management tasks described by Corbin and Strauss: medical, role and emotional management. Perceived facilitators to self-management were: gathering health-related knowledge, building relationships with healthcare professionals, creating routines within daily life, setting goals and identifying motivators, establishing support networks, and support from family and friends. Complexity of required treatment and adjusting to a new health status were perceived barriers to self-management. Conclusions Participants described the importance of collaborative consultations and continuity of care. Tailored interventions should identify individualised goals and motivators for participating in self-management. Education on effective strategies to manage symptoms and comorbidities could help alleviate KTRs’ perceived treatment burden. Family and peer support could emotionally support KTRs; however, managing the emotional burden of transplantation warrants more attention. Graphic abstract ![]()
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Affiliation(s)
- Katherine E Memory
- Leicester Medical School, University of Leicester, Leicester, UK
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Thomas J Wilkinson
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Alice C Smith
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Courtney J Lightfoot
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK.
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9
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Bourkas S, Achille M. The Psychosocial Adjustment of Kidney Recipients in Canada's Kidney Paired Donation Program. Prog Transplant 2021; 32:35-40. [PMID: 34873986 PMCID: PMC8918868 DOI: 10.1177/15269248211064881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Kidney paired donation programs have been implemented globally. The involvement of at least 2 donors in these programs might exacerbate recipients' debt of gratitude and guilt, worries about the donor's health, and worries about graft failure documented by previous studies. However, there is an absence of research on the psychosocial implications of kidney paired donation. This study aimed to provide an in-depth examination of recipients' experience of kidney paired donation, with a focus on psychosocial adjustment. Methods/Approach: Individual interviews were conducted with 8 recipients who received a transplant through Canada's Kidney Paired Donation program. Data was analyzed using Interpretative Phenomenological Analysis. Findings: Four themes emerged: (a) an emotionally charged relationship with the known donor, (b) optimal distance regulation in the relationship with the anonymous donor, (c) kidney paired donation as a series of ups and downs, and (d) multilayered gratitude. Discussion: Findings are considered in relation to extant literature. Issues relevant to the transplant community's clinical and research efforts to provide kidney recipients responsive care are discussed.
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Affiliation(s)
| | - Marie Achille
- 141639Université de Montréal, Montreal, Quebec, Canada
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10
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Tang J, Kerklaan J, Wong G, Howell M, Scholes-Robertson N, Guha C, Kelly A, Tong A. Perspectives of solid organ transplant recipients on medicine-taking: Systematic review of qualitative studies. Am J Transplant 2021; 21:3369-3387. [PMID: 33866675 DOI: 10.1111/ajt.16613] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/16/2021] [Accepted: 04/02/2021] [Indexed: 01/25/2023]
Abstract
Medicine-taking among transplant recipients is a complex and ubiquitous task with significant impacts on outcomes. This study aimed to describe the perspectives and experiences of medicine-taking in adult solid organ transplant recipients. Electronic databases were searched to July 2020, and thematic synthesis was used to analyze the data. From 119 studies (n = 2901), we identified six themes: threats to identity and ambitions (impaired self-image, restricting goals and roles, loss of financial independence); navigating through uncertainty and distrust (lacking tangible/perceptible benefits, unprepared for side effects, isolation in decision-making); alleviating treatment burdens (establishing and mastering routines, counteracting side effects, preparing for the unexpected); gaining and seeking confidence (clarity with knowledge, reassurance through collective experiences, focusing on the future outlook); recalibrating to a new normal posttransplant (adjusting to ongoing dependence on medications, in both states of illness and health, unfulfilled expectations); and preserving graft survival (maintaining the ability to participate in life, avoiding rejection, enacting a social responsibility of giving back). Transplant recipients take medications to preserve graft function, but dependence on medications jeopardizes their sense of normality. Interventions supporting the adaptation to medicine-taking and addressing treatment burdens may improve patient satisfaction and capacities to take medications for improved outcomes.
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Affiliation(s)
- James Tang
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Jasmijn Kerklaan
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia.,Department of Pediatric Nephrology, Academic Medical Center, Emma Children's Hospital, Amsterdam, the Netherlands
| | - Germaine Wong
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Westmead, NSW, Australia
| | - Martin Howell
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Nicole Scholes-Robertson
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Chandana Guha
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Ayano Kelly
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
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11
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Urstad KH, Wahl AK, Moum T, Engebretsen E, Andersen MH. Renal recipients' knowledge and self-efficacy during first year after implementing an evidence based educational intervention as routine care at the transplantation clinic. BMC Nephrol 2021; 22:265. [PMID: 34266414 PMCID: PMC8284003 DOI: 10.1186/s12882-021-02468-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/30/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Following an implementation plan based on dynamic dialogue between researchers and clinicians, this study implemented an evidence-based patient education program (tested in an RCT) into routine care at a clinical transplant center. The aim of this study was to investigate renal recipients' knowledge and self-efficacy during first year the after the intervention was provided in an everyday life setting. METHODS The study has a longitudinal design. The sample consisted of 196 renal recipients. Measurement points were 5 days (baseline), 2 months (T1), 6 months (T2), and one-year post transplantation (T3). Outcome measures were post-transplant knowledge, self-efficacy, and self-perceived general health. RESULTS No statistically significant changes were found from baseline to T1, T2, and T3. Participants' levels of knowledge and self-efficacy were high prior to the education program and did not change throughout the first year post transplantation. CONCLUSION Renal recipients self-efficacy and insight in post-transplant aspects seem to be more robust when admitted to the hospital for transplantation compared to baseline observations in the RCT study. This may explain why the implemented educational intervention did not lead to the same positive increase in outcome measures as in the RCT. This study supports that replicating clinical interventions in real-life settings may provide different results compared to results from RCT's. In order to gain a complete picture of the impacts of an implemented intervention, it is vital also to evaluate results after implementing findings from RCT-studies into everyday practice.
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Affiliation(s)
- Kristin Hjorthaug Urstad
- Faculty of Health Sciences, Department of Quality and Health Technology, University of Stavanger, 4036, Stavanger, Norway.
| | - Astrid Klopstad Wahl
- Faculty of Medicine, Department of Health Sciences, University of Oslo, Oslo, Norway
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Torbjørn Moum
- Faculty of Medicine, Department of Behavioural Sciences in Medicine, University of Oslo, Oslo, Norway
| | - Eivind Engebretsen
- Faculty of Medicine, Department of Health Sciences, University of Oslo, Oslo, Norway
| | - Marit Helen Andersen
- Faculty of Medicine, Department of Health Sciences, University of Oslo, Oslo, Norway
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
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12
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Guerra F, Ranieri J, Passafiume D, Lupi D, Maccarone D, Pisani F, Ferri C, Di Giacomo D. Psychosomatic interactions in kidney transplantation: role of personality dimensions in mental health-related quality of life. Ther Adv Chronic Dis 2021; 12:20406223211024359. [PMID: 34290848 PMCID: PMC8274123 DOI: 10.1177/20406223211024359] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/21/2021] [Indexed: 11/17/2022] Open
Abstract
Background and aims: The increase in innovative and personalized medicine solutions in kidney surgery can improve patients’ chances of survival; however, during the transplantation process, patients are exposed to many psychological challenges. This study aimed to evaluate the role and impact of personality dimensions on the behaviour of waiting-list patients towards the post-surgery adaptation process. Method: The participants were 113 out-patients aged 18–70 years (mean age 54.7 years, SD ± 9.9) who had received a kidney transplant at least 3 years prior to the study. Results: The results of the study revealed that personality dimensions can predict mental health-related quality of life after kidney transplantation; in particular, the dimensions play an important role in patients’ behavioural ability to manage their quality of life both during end-stage renal disease and after kidney transplantation. Psychological distress and anxiety were associated with a low level of the conscientiousness dimension, while a high level of the openness dimension was associated with a high level of psychological distress and stress. In addition, body self-perception was associated with personality dimensions. Conclusion: Personality dimensions were found to predict behavioural reactions when emotional traits and body self-perception for each patient were combined; clinical psychologists could apply personalized intervention by modeling the treatments step by step and mitigating the negative effects of the whole kidney transplantation disease, thus helping the individual to adapt to a new life.
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Affiliation(s)
- Federica Guerra
- MESVA Department, University of L'Aquila, L'Aquila, Abruzzo, Italy
| | - Jessica Ranieri
- MESVA Department, University of L'Aquila, L'Aquila, Abruzzo, Italy
| | | | - Diana Lupi
- Regional Centre for Transplantation (Abruzzo-Molise), L'Aquila, Italy
| | - Daniela Maccarone
- Regional Centre for Transplantation (Abruzzo-Molise), L'Aquila, Italy
| | - Francesco Pisani
- ASL AQ Abruzzo, S. Salvatore Hospital, L'Aquila, Italy DISCAB Department, University of L'Aquila, Italy
| | - Claudio Ferri
- MESVA Department, University of L'Aquila, L'Aquila, Abruzzo, Italy S. Salvatore Hospital, ASL AQ Abruzzo, L'Aquila, Italy
| | - Dina Di Giacomo
- MESVA Department, University of L'Aquila, L'Aquila, Abruzzo, Italy
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13
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Varsi C, Stenehjem AE, Børøsund E, Solberg Nes L. Video as an alternative to in-person consultations in outpatient renal transplant recipient follow-up: a qualitative study. BMC Nephrol 2021; 22:105. [PMID: 33752608 PMCID: PMC7983085 DOI: 10.1186/s12882-021-02284-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/28/2021] [Indexed: 01/10/2023] Open
Abstract
Background Renal transplant recipients have to see a nephrologist for regular follow-up for the rest of their lives. To reduce the burden for the patients, video consultation can be an alternative to traditional in-person hospital consultations. The aim of the current study was, from the perspectives of patients and health care providers, to investigate the perceived benefits and challenges of using video consultations in outpatient renal transplant recipient follow-up. Methods Patients (i.e., renal transplant recipients; n = 18) alternated between regular in-person follow-up consultations and video consultations. Patients and health care providers were then invited to participate in semi-structured interviews. The interviews were analyzed using thematic analysis. Results Patients interviewed (n = 15) were median 53 years old (range 37–64) and 53% female. The video consultation solution used in the study turned out to have major technical deficiencies. Despite the technical challenges, however, the majority of the patients reported appreciating being able to alternate between video and in-person hospital consultations. Main benefits reported included not needing to travel to the hospital and thereby saving time, less focus on being chronically ill and potential economic benefits for patients and society. The health care providers (n = 3) also valued the benefits provided by the use of video consultations, but described the reoccurring technical challenges as disruptive. The fact that patients were in a stable phase of their health condition and already had an established, trusting relationship with their nephrologist, acted as facilitators for success. Possible challenges and harms described included concerns related to security, confidentiality and interruptions, as well as the potential need for physical examinations. Conclusions Benefits from using video consultations as an alternative to in-person consultations may outweigh potential technological challenges for patients as well as health care providers. A long-lasting mutually trusting relationship between patient and provider may be an important prerequisite for the experienced benefits of using video consultation. Findings also indicate that starting such care delivery changes in a small-scale, with a few selected patients in a stable phase of their condition, may be an important factor for success. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02284-3.
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Affiliation(s)
- Cecilie Varsi
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Pb 4950 Nydalen, N-0424, Oslo, Norway. .,Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
| | - Aud-Eldrid Stenehjem
- Department of Nephrology, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Elin Børøsund
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Pb 4950 Nydalen, N-0424, Oslo, Norway
| | - Lise Solberg Nes
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Pb 4950 Nydalen, N-0424, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
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Rota-Musoll L, Brigidi S, Molina-Robles E, Oriol-Vila E, Perez-Oller L, Subirana-Casacuberta M. An intersectional gender analysis in kidney transplantation: women who donate a kidney. BMC Nephrol 2021; 22:59. [PMID: 33593306 PMCID: PMC7885450 DOI: 10.1186/s12882-021-02262-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 01/12/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Living-donor transplantation is the best treatment option in patients with chronic kidney failure. Global data show that women are less likely to be kidney recipients than men but are more likely to become living kidney donors. We explored the experience of women who donate a kidney to relatives with biological and socio-cultural ties and to understand the similarities and differences in their experience. METHODS A qualitative hermeneutic phenomenological study with an intersectional analysis of gender. Ten women donors accepted in the transplant evaluation period participated, all of whom donated a kidney to a pre-dialysis relative. Two categories were included: women with biological kinship ties (mothers, sisters) and women who have a socio-cultural relationship (wives) with kidney recipient. The data were collected through semi-structured in-depth interviews and analysed using thematic analysis. RESULTS Women donate their kidneys in a convinced manner, without worrying about their health, with an optimistic and positive attitude, and without believing that they are acting heroically. Women with biological kinship ties see it as a 'naturalization thing'. In contrast, wives donate conditioned by gender roles, but also as a form of empowerment and as a personal benefit: they donate in order to avoid taking on carer role for their husband and as a way of protecting their children. CONCLUSION The study's findings expand the conception of kidney donation as solely altruistic and may help professionals to pay attention to the complexity and intersectionality of features present in women who are living kidney donors.
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Affiliation(s)
- Laura Rota-Musoll
- Department of Nephrology, Consorci Hospitalari de Vic, Vic, Catalunya, Spain
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
| | - Serena Brigidi
- Department of Anthropology, Philosophy and Social Work in the University of Rovira i Virgili (URV), Tarragona, Catalunya, Spain.
| | - Esmeralda Molina-Robles
- Department of Nephrology, Consorci Hospitalari de Vic, Vic, Catalunya, Spain
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
| | - Ester Oriol-Vila
- Department of Nephrology, Consorci Hospitalari de Vic, Vic, Catalunya, Spain
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
| | | | - Mireia Subirana-Casacuberta
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
- Department of Nursing Management, Parc Taulí Health Corporation Consortium, Sabadell, Catalunya, Spain
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15
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Kristensen IV, Birkelund R, Henriksen J, Norlyk A. Living in limbo while one's identity is changing: Patients' existential experiences 6 months after a kidney transplantation with a living donor. J Adv Nurs 2020; 77:1403-1410. [PMID: 33277747 DOI: 10.1111/jan.14683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 09/25/2020] [Accepted: 10/29/2020] [Indexed: 11/27/2022]
Abstract
AIM To investigate patients' existential experiences in everyday life after a kidney transplantation with a living donor. DESIGN A qualitative study anchored in a hermeneutic-phenomenological approach inspired by Ricoeur's theory of narrative and interpretation. METHOD Eleven patient interviews were conducted approximately 6 months after a kidney transplantation with a living donor. The interviews were conducted between August 2017-May 2019. Analysis and interpretation are based on Ricoeur's theory of interpretation. RESULTS Four themes were identified: Experiencing bodily vulnerability while getting back to life; Feeling guilt while experiencing gratitude; Living in limbo while one's identity is changing; and Facing the future with hope while having reservations. CONCLUSION This study reveals that patients experience multifaceted existential challenges in their everyday lives during the transition of the kidney transplantation process. Post-surgery complications for donors lead to feelings of guilt in patients; plus, they must adapt to a new existence, including a new identity. The patients feel they are in limbo, as they experience their existence as uncertain and their identity as unknown. IMPACT The study highlights a need for developing a rehabilitation programme to address the individual and various existential challenges faced by patients who need to undergo a kidney transplantation.
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Affiliation(s)
- Ingrid Villadsen Kristensen
- Section for Nursing, Department of Public Health, Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University College, Aarhus University, Holstebro, Denmark
| | - Regner Birkelund
- Lillebaelt Hospital, Vejle & Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Annelise Norlyk
- Section for Nursing, Department of Public Health, Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University College, Aarhus University, Holstebro, Denmark
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16
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Petre OA, Crăciun IC, Băban A. The experiences of living with a transplanted kidney from a deceased donor. J Ren Care 2020; 47:58-67. [PMID: 32964692 DOI: 10.1111/jorc.12349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 05/19/2020] [Accepted: 06/12/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Kidney transplantation is considered an optimal treatment option for patients with end-stage kidney disease in terms of survival rate, quality of life and cost-effectiveness. However, posttransplant life involves many medical, psychological and social challenges for transplant recipients. Understanding individuals' challenges and needs after transplantation is a prerequisite for developing effective patient education and self-management programmes. OBJECTIVE To explore how individuals experience life with a transplanted kidney from a deceased donor. METHODS The purposive sample included eight kidney transplant recipients. In-depth semi-structured interviews were conducted and analysed using interpretative phenomenological analysis. FINDING Three main themes emerged from the data and each one presents a certain aspect of the posttransplant experience: an inner struggle to find a new normality (personal level), me and the others (relational level) and only between me, my donor and god (spiritual level). CONCLUSION The experience of receiving a kidney from a deceased donor represents a complex psychological challenge for recipients. The study is unique as it shows the spiritual dimension of the transplantation experience and how the recipients' views on transplantation and organ donation are shaped by their religious and cultural background, indicating the importance of a holistic nursing approach.
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Affiliation(s)
| | - Irina C Crăciun
- Babeș-Bolyai University, Cluj Napoca, Romania.,Freie Universität Berlin, Berlin, Germany
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17
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Rota-Musoll L, Subirana-Casacuberta M, Oriol-Vila E, Homs-Del Valle M, Molina-Robles E, Brigidi S. The experience of donating and receiving a kidney: A systematic review of qualitative studies. J Ren Care 2020; 46:169-184. [PMID: 31868304 DOI: 10.1111/jorc.12309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The experiences described by people who have undergone kidney transplant are complex. Understanding how donors and recipients experience kidney transplantation can help us to design strategies that provide a more person-centred health care. OBJECTIVES To review articles that report the experiences of donors and recipients in the living-donor kidney transplantation process. METHOD A systematic review of qualitative studies was carried out. PubMed, Scopus, Web of Science, CINAHL and PsycINFO databases were used to search for articles published in English, French and Spanish between 2005 and 2018. RESULTS Twenty-nine articles were included in this review. For recipients, receiving a kidney is a positive experience (positive feelings and significant experience) that also involves certain difficulties and stressors (making a difficult decision, fears and worries). The experience of the donors is positive as they are motivated to improve the life of the recipient. They are committed to donating and use coping strategies as well as experiencing personal growth. On the contrary, being a donor involves certain difficulties and stressors (personal investment, mental, physical and economic impact and overcoming opposition) and a perception of deficiency in the health system (lack of information and attentiveness). CONCLUSION Donating and receiving a kidney is a positive experience that involves certain difficulties and a variety of stressors for both the donors and recipients. Moreover, the donors note deficiencies in the health system.
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Affiliation(s)
- Laura Rota-Musoll
- Consorci Hospitalari de Vic, Nephrology, Vic, Barcelona, Spain
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
| | - Mireia Subirana-Casacuberta
- Department of Nursing Management, Consorci Hospitalari de Vic, Vic, Catalunya, Spain
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
| | - Ester Oriol-Vila
- Department of Nephrology, Consorci Hospitalari de Vic, Vic, Catalunya, Spain
| | | | - Esmeralda Molina-Robles
- Department of Nephrology, Consorci Hospitalari de Vic, Vic, Catalunya, Spain
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
| | - Serena Brigidi
- Faculty of Health Science and Welfare, Universitat de Vic-Universitat Central de Catalunya, Vic, Catalunya, Spain
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
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18
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McKeaveney C, Noble H, Courtney AE, Gill P, Griffin S, Johnston W, Maxwell AP, Teasdale F, Reid J. Understanding the holistic experiences of living with a kidney transplant: an interpretative phenomenological study (protocol). BMC Nephrol 2020; 21:222. [PMID: 32527229 PMCID: PMC7289222 DOI: 10.1186/s12882-020-01860-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/20/2020] [Indexed: 11/11/2022] Open
Abstract
Background Currently very little is known about the perceptions and experiences of kidney transplant recipients from a qualitative perspective. As highlighted by the European Kidney Health Alliance recommendations, providing holistic care to kidney patients is important however this is currently an unmet care need in renal disease. It is imperative to understand patient experiences to ensure that they are included in key strategies and future renal service planning. Ignoring these important patient views means that there is a significant risk of inappropriate renal service provision and lack of adequate support impacting on overall health. Method A purposive sampling strategy will recruit individuals currently living with a kidney transplant, 6 months to 5 years post-transplant. A maximum of 30 patients will be recruited between two Regional Nephrology units within the United Kingdom via clinical gatekeepers. In-depth interviews will be undertaken with participants living with a kidney transplant across the two sites. Interviews will be digitally-recorded, transcribed verbatim and subjected to interpretative phenomenological analysis. Discussion Renal healthcare professionals need to understand more than the biological impact of receiving a kidney transplant. Understanding the holistic and multi-domain experiences that these patients experience will help healthcare professionals to recognize the needs of this group and ensure more responsive care.
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Affiliation(s)
| | - H Noble
- Queen's University Belfast, Belfast, UK
| | | | - P Gill
- Cardiff University, Cardiff, UK
| | - S Griffin
- University Hospital of Wales, Cardiff, UK
| | - W Johnston
- Northern Ireland Kidney Patients Association, Belfast, UK.,Kidney Care UK, Alton, UK
| | - A P Maxwell
- Queen's University Belfast, Belfast, UK.,Belfast Health & Social Care Trust, Belfast, UK
| | | | - J Reid
- Queen's University Belfast, Belfast, UK.
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19
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Jones J, Damery S, Allen K, Nicholas J, Baharani J, Combes G. 'You have got a foreign body in there': renal transplantation, unexpected mild-to-moderate distress and patients' support needs: a qualitative study. BMJ Open 2020; 10:e035627. [PMID: 32234745 PMCID: PMC7170619 DOI: 10.1136/bmjopen-2019-035627] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To explore why transplant patients experience unexpected mild-to-moderate distress and what support they may need. DESIGN Qualitative study using individual in-depth interviews. SETTING Four National Health Service (NHS) Trusts in the Midlands, UK. PARTICIPANTS Fifteen renal transplant patients meeting the criteria for mild-to-moderate distress from their responses to emotion thermometers. MAIN OUTCOME MEASURES Identification of the reasons for distress and support options acceptable to renal transplant patients. RESULTS Three themes were interpreted from the data: 'I am living with a "foreign body" inside me', 'why am I distressed?' and 'different patients want different support'. Following their transplant, participants felt that they should be happy and content, but this was often not the case. They described a range of feelings about their transplant, such as uncertainty about the lifespan of their new kidney, fear of transplant failure or fear of the donor having health conditions that may transfer to them. A few experienced survivors' guilt when others they had met at the dialysis unit had not received a transplant or because someone had died to enable them to receive the transplant. No longer having regular contact with the renal unit made participants feel isolated. Some participants did not initially attribute the source of their distress to their transplant. Participants' preferred support for their distress and their preferences about who should deliver it varied from peer support to seeing a psychologist. CONCLUSIONS Raising the issue of post-transplant mild-to-moderate distress with patients and encouraging them to think about and plan coping strategies pretransplant may prove beneficial for the patient and healthcare provider. Patients should be able to choose from a variety of support options.
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Affiliation(s)
- Janet Jones
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sarah Damery
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kerry Allen
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Johann Nicholas
- Renal Unit, Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, Shropshire, UK
| | - Jyoti Baharani
- Renal Unit, Birmingham Heartlands Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gill Combes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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20
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Ranahan M, Von Visger J, Kayler LK. Describing barriers and facilitators for medication adherence and self-management among kidney transplant recipients using the information-motivation-behavioral skills model. Clin Transplant 2020; 34:e13862. [PMID: 32199030 DOI: 10.1111/ctr.13862] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 03/05/2020] [Accepted: 03/13/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND We aimed to develop an adapted information-motivation-behavioral skills (IMB) model to describe barriers and facilitators for adherence and self-management among kidney transplant recipients. METHODS We conducted a review of literature about kidney transplant recipients' knowledge, perceptions, and experiences and organized our results using the IMB framework. We then conducted interviews with transplant recipients and transplant providers to supplement our literature search. RESULTS Our proposed adaption of the IMB model describes informational, motivational, and behavioral skills barriers and facilitators for medication adherence and self-management among kidney transplant recipients. Moderating factors influence not only behavioral skills, but also recipients' understanding of information and motivation to adhere and practice self-management. CONCLUSION By using the IMB model to organize current research and interviews with recipients and providers, we developed an adapted model for medication adherence and self-management. Results are promising to impact future educational and behavioral interventions for kidney transplant recipients.
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Affiliation(s)
- Molly Ranahan
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, New York, USA.,Transplant and Kidney Care Regional Center of Excellence, Erie County Medical Center, Buffalo, New York, USA
| | - Jon Von Visger
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, New York, USA.,Transplant and Kidney Care Regional Center of Excellence, Erie County Medical Center, Buffalo, New York, USA
| | - Liise K Kayler
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, New York, USA.,Transplant and Kidney Care Regional Center of Excellence, Erie County Medical Center, Buffalo, New York, USA
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21
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Abstract
Objetivo: Explorar de manera comprensiva la experiencia vivida en el tratamiento de la Enfermedad Renal Crónica y los significados del cuidado elaborados por enfermeras y familiares que interactúan con estas personas. Método: Estudio cualitativo, enfoque fenomenológico-hermenéutico, empleando el referente teórico de Van Manen, 11 personas con la enfermedad, 5 cuidadores y 5 enfermeros participaron en el estudio, en la ciudad de Neiva; información recolectada a través de entrevistas en profundidad. Resultados: emergió el dilema entre la libertad y la vida al construir el sentido de afrontar el tratamiento de la Enfermedad Renal Crónica, los subtemas se enmarcaron en la dureza de la hemodiálisis, el significado de la máquina de diálisis, la apariencia de la fístula arterio venosa, el impacto del catéter peritoneal y la dieta. Conclusiones: el tratamiento de la enfermedad irrumpe en la vida de las personas produciendo cambios abruptos en su vida que los lleva a reconocer la finitud de su existencia, las alternativas para sobrevivir, los cambios en su corporeidad. De los cuales no son ajenos sus cuidadores y enfermeras, llamados a brindarles apoyo para lograr enfrentar el tratamiento.
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22
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Walker RC, Naicker D, Kara T, Palmer SC. Children's experiences and expectations of kidney transplantation: A qualitative interview study. Nephrology (Carlton) 2019; 24:647-653. [PMID: 29785719 DOI: 10.1111/nep.13405] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2018] [Indexed: 01/01/2023]
Abstract
AIM Kidney transplantation offers improved quality of life and life expectancy compared with dialysis for children. This study aims to understand the experiences and expectations of children during the kidney transplantation process to inform clinical care. METHODS Face-to-face, semi-structured interviews were conducted with 13 children and adolescents aged between 7 and 17 years in New Zealand who had received a kidney transplantation. Findings were conceptualized using thematic analysis with inductive coding. RESULTS Three major themes were identified: transplant as the goal (the only real treatment and escaping dialysis); dealing with negative emotions (coping with anxiety and fear, guilt for siblings and burden of parent as donor); and enhancing understanding and knowledge (individualised education and reassurance from peer support). CONCLUSION Children and adolescents view transplantation as freedom from dialysis and return to a more normal life. Children focus on the positive aspects of transplantation to reduce anxiety and be reassured in the face of uncertainty. Complex emotions arise when thinking about their donor. Children recognize transplantation is not a return to full health and actively seek out ways to self-manage their care, while remaining anxious about their future.
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Affiliation(s)
- Rachael C Walker
- School of Nursing, Eastern Institute of Technology, Hawke's Bay, New Zealand
| | - Derisha Naicker
- Renal Department, Starship Children's Health, Auckland, New Zealand
| | - Tonya Kara
- Renal Department, Starship Children's Health, Auckland, New Zealand
| | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand.,Department of Nephrology, Canterbury District Health Board, Christchurch, New Zealand
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23
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Frech A, Natale G, Tumin D. Couples' employment after spousal kidney donation. SOCIAL WORK IN HEALTH CARE 2018; 57:880-889. [PMID: 30300111 DOI: 10.1080/00981389.2018.1523823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We used data from the United Network for Organ Sharing registry of living kidney donors and recipients to identify correlates of paid employment among couples following spousal living donation. Among such couples, post-transplant employment of both spouses (41%) was as common as employment of the donor only (41%). However, when the recipient was female, donor-only employment after transplant was more than twice as likely as compared to employment of both spouses (relative risk ratio = 2.57; p < .001). We conclude that traditional gender roles regarding paid workforce participation may be associated with the likelihood of employment after spousal kidney donation.
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Affiliation(s)
- Adrianne Frech
- a Department of Health Sciences , University of Missouri , Columbia , Missouri , USA
| | - Ginny Natale
- b Department of Sociology , Kent State University , Kent , Ohio , USA
| | - Dmitry Tumin
- c Department of Pediatrics , The Ohio State University College of Medicine , Columbus , Ohio , USA
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24
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Ramírez-Perdomo CA, Solano-Ruíz MC. Social construction of the experience of living with chronic kidney disease. Rev Lat Am Enfermagem 2018; 26:e3028. [PMID: 30110104 PMCID: PMC6091367 DOI: 10.1590/1518-8345.2439.3028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 05/06/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To understand the experience of people living with Chronic Kidney Disease who have been transplanted, from the meanings constructed based on the experienced phenomenon. METHOD Hermeneutic-phenomenological study based on the five lifeworld existentials, according to Van Manen's theoretical framework. Eleven transplanted patients participated in the study and data collection was carried out through semi-structured interviews, after approval of the study by the Ethics Committee of the University of Antioquia. RESULTS The theme of Living with Chronic Kidney Disease emerged, and the subthemes were grouped as lifeworld existentials of Temporality: something unexpected, being present and not seeing it, being young and sick. Relationality: support, feeling stuck and Terminal Chronic Renal Failure. Spatiality: changes in life, sadness and depression. Corporeality: body deterioration and changes in sex life. Materiality: effects on the economic status. CONCLUSIONS The care provided to people must be oriented in order to recognize their individualities, understanding what the illness means for the individual and his family, how they live with it and what the changes are, leading them to modify their lives and start a long process, such as living with a chronic disease.
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Affiliation(s)
- Claudia Andrea Ramírez-Perdomo
- Doctoral student, Facultad de Enfermería, Universidad de Antioquia,
Medellín, Ant, Colombia. Associate Professor, Departamento de Enfermería,
Universidad Surcolombiana, Neiva, Huila, Colombia
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25
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Valizadeh Zare N, Mohammadi E, Zarea K, Elahi N, Manzari Z. The meaning of coping for kidney transplant recipients: a phenomenological study. J Res Nurs 2018; 23:584-595. [PMID: 34394477 DOI: 10.1177/1744987118785949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background The meaning of coping, which can be affected by the nature and type of stress and by individuals' background and culture, has not been studied in the context of specific stress conditions, such as kidney transplant. Aims The present study aims to explore the meaning of coping for kidney transplant recipients. Methods Purposeful sampling was employed for this hermeneutic phenomenological study. Participants were nine kidney transplant recipients who had received treatment at specialised hospital centres in Mashhad and Ahwaz, Iran, in 2013. Data were collected from unstructured interviews and analysed using Van Manen's approach. Results From 10 sub-themes emerged 4 major themes characterising the meaning of coping with renal transplantation: intelligent acceptance of changes, understanding the necessity of self-care, enduring, and understanding supportive encouragement. Conclusions The meaning of coping for kidney transplant recipients in Iran encompasses a wide range of cognitive, behavioural, psychological, spiritual and social dimensions. Relying on God's eternal power and on imams emerged as major dimensions of the meaning of coping.
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Affiliation(s)
- Najmeh Valizadeh Zare
- Assistant Professor, Evidence Based Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Eesa Mohammadi
- Full Professor, Nursing Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Kourosh Zarea
- Associate Professor, Nursing Care Research Center in Chronic Disease, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nasrin Elahi
- Assistant Professor, Nursing Care Research Center in Chronic Disease, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Zahra Manzari
- Assistant Professor, Nursing and Midwifery School, Mashhad University of Medical Sciences, Mashhad, Iran
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Urstad KH, Wahl AK, Engebretsen E, Larsen MH, Vidnes TK, Stenwig AGK, Simensen ØW, Nordli A, Reisaeter AV, Andersen MH. Implementation of a new patient education programme for renal transplant recipients. J Ren Care 2018; 44:106-114. [PMID: 29460501 DOI: 10.1111/jorc.12236] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Nurses' strategies regarding patient education should be informed by the best available research evidence. Clinical nurses play an essential role in implementing new patient education programmes for renal transplant recipients. AIM This study investigated transplant nurse job satisfaction, competence, training and perceptions of quality of care in relation to the implementation of a new, evidence-based, patient education programme. This paper reports the results from the first part of an implementation study. METHODS Data were collected in the form of a survey from 50 clinical transplant nurses at a single national transplant centre in Norway in 2015, six months after the patient education programme was implemented. A descriptive, cross-sectional design was used. RESULTS Seventy-two percent of the respondents reported that they had sufficient knowledge about the new programme; 54.4 % stated that the new programme resulted in renal transplant recipients being better educated. The new programme was found to be more structured, patient-centered and visible for the nurses across the wards, as compared with their previous practice. Nurses with less nursing experience were significantly more motivated about the new patient education programme, than the more experienced nurses (p = 0.05). CONCLUSIONS Nurses were generally satisfied with their new patient education practice. Knowledge derived from the research evidence on patient education was found to be valuable and transferable to everyday clinical nursing practice.
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Affiliation(s)
- Kristin H Urstad
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Astrid K Wahl
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | | | - Marie H Larsen
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Tone K Vidnes
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Anne G K Stenwig
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Øystein W Simensen
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Arve Nordli
- The Norwegian Kidney Disease Patient Association, Oslo, Norway
| | - Anna V Reisaeter
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Marit H Andersen
- Institute of Health and Society, University of Oslo, Oslo, Norway.,Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
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Mesa-Melgarejo L, Carrillo-Algarra AJ, Castiblanco RA, Reina LM, Ávila TM. Terapias de sustitución de la función Renal: Metaestudio y síntesis de evidencias cualitativas. AQUICHAN 2017. [DOI: 10.5294/aqui.2017.17.3.9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
El objetivo del presente estudio fue sintetizar en términos de evidencias cualitativas o evidencias Q hallazgos derivados de estudios cualitativos frente al tema de las terapias de sustitución de la función renal (TSFR). Método: metaestudio cualitativo desarrollado en cuatro momentos. Resultados: se integraron 75 estudios. De los cuales, 52 exploraban experiencias relacionadas con hemodiálisis (HD), 10 de diálisis peritoneal (DP), 6 trasplante, 6 DP y HD al mismo tiempo y 1 estudio exploró las 3 TSFR. Los estudios incluidos describen y representan el fenómeno de vivir en una condición de cronicidad y estar sometido a una TSFR de manera muy semejante, que se agruparon en patrones comunes del fenómeno, estos son descritos en tres grandes temáticas: la metamorfosis de la vida; dolores diversos y la terapia invade la vida. Conclusión: los resultados dan cuenta de la estrecha interrelación de las dimensiones humanas, por esto el fenómeno de vivir en una TSFR genera una transfiguración el “Ser”, como totalidad, pues no es posible desligar una dimensión de otra, de allí la importancia de pensar la atención de las necesidades en perspectiva relacional y no jerarquizada.
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Maple H, Chilcot J, Weinman J, Mamode N. Psychosocial wellbeing after living kidney donation - a longitudinal, prospective study. Transpl Int 2017; 30:987-1001. [PMID: 28445627 DOI: 10.1111/tri.12974] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 12/12/2016] [Accepted: 04/21/2017] [Indexed: 01/07/2023]
Abstract
Living kidney donation (LKD) has become routine practice across the world as the gold standard treatment of end-stage renal failure. Whilst the physical risks and harms of LKD surgery are well documented, relatively little is known about psychosocial outcomes. The aim of this study was to determine whether it was possible to quantify the psychosocial impact of LKD. A prospective longitudinal study of 93 living kidney donors was performed. Data were collected preoperatively, and 3 and 12 months after donation. Questionnaires included 11 validated psychosocial outcome measures and questions specific to LKD. Over time, there was no significant change in wellbeing, life satisfaction, self-esteem, social comparison, distress, depression, stress, anxiety or social support at 3 or 12 months. Despite this, questions specific to LKD indicated that donors felt positively about donation, with low levels of regret. This study provides a thorough assessment of psychosocial outcomes after LKD over the first year. Donors felt positive about LKD although there was no evidence of any significant change in psychosocial outcomes. Despite no measurable psychosocial benefit after living kidney donation, there was also no evidence of harm.
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Affiliation(s)
- Hannah Maple
- Department of Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Joseph Chilcot
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - John Weinman
- Institute of Pharmaceutical Sciences & Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Nizam Mamode
- Department of Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Low JK, Crawford K, Manias E, Williams A. Stressors and coping resources of Australian kidney transplant recipients related to medication taking: a qualitative study. J Clin Nurs 2017; 26:1495-1507. [PMID: 27323293 DOI: 10.1111/jocn.13435] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2016] [Indexed: 11/29/2022]
Abstract
AIM AND OBJECTIVE To understand the stressors related to life post kidney transplantation, with a focus on medication adherence, and the coping resources people use to deal with these stressors. BACKGROUND Although kidney transplantation offers enhanced quality and years of life for patients, the management of a kidney transplant post surgery is a complex process. DESIGN A descriptive exploratory study. METHOD Participants were recruited from five kidney transplant units in Victoria, Australia. From March-May 2014, patients who had either maintained their kidney transplant for ≥8 months or had experienced a kidney graft loss due to medication nonadherence were interviewed. All audio-recordings of interviews were transcribed verbatim and underwent Ritchie and Spencer's framework analysis. RESULTS Participants consisted of 15 men and 10 women aged 26-72 years old. All identified themes were categorised into: (1) Causes of distress and (2) Coping resources. Post kidney transplantation, causes of distress included the regimented routine necessary for graft maintenance, and the everlasting fear of potential graft rejection, contracting infections and developing cancer. Coping resources used to manage the stressors were first, a shift in perspective about how easy it was to manage a kidney transplant than to be dialysis-dependent and second, receiving external help from fellow patients, family members and health care professionals in addition to using electronic reminders. CONCLUSION An individual well-equipped with coping resources is able to deal with stressors better. It is recommended that changes, such as providing regular reminders about the lifestyle benefits of kidney transplantation, creating opportunities for patients to share their experiences and promoting the usage of a reminder alarm to take medications, will reduce the stress of managing a kidney transplant. RELEVANCE TO CLINICAL PRACTICE Using these findings to make informed changes to the usual care of a kidney transplant recipient is likely to result in better patient outcomes.
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Affiliation(s)
- Jac Kee Low
- Faculty of Medicine, Nursing & Health Sciences, School of Nursing & Midwifery, Monash University, Clayton, Vic., Australia
| | - Kimberley Crawford
- Faculty of Medicine, Nursing & Health Sciences, School of Nursing & Midwifery, Monash University, Clayton, Vic., Australia
| | - Elizabeth Manias
- Royal Melbourne Hospital, The University of Melbourne, Parkville, Vic., Australia.,Melbourne School of Health Sciences, The University of Melbourne, Parkville, Vic., Australia.,School of Nursing and Midwifery, Deakin University, Burwood, Vic., Australia
| | - Allison Williams
- Faculty of Medicine, Nursing & Health Sciences, School of Nursing & Midwifery, Monash University, Clayton, Vic., Australia
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Meyer KB, Bjørk IT, Wahl AK, Lennerling A, Andersen MH. Long-term experiences of Norwegian live kidney donors: qualitative in-depth interviews. BMJ Open 2017; 7:e014072. [PMID: 28209606 PMCID: PMC5318577 DOI: 10.1136/bmjopen-2016-014072] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Live kidney donation is generally viewed as a welcome treatment option for severe kidney disease. However, there is a disparity in the body of research on donor experiences and postdonation outcome, and lack of knowledge on long-term consequences described by the donors. This study was conducted to provide insight into donors' subjective meanings and interpretation of their experiences ∼10 years after donation. DESIGN Qualitative explorative in-depth interviews. The sampling strategy employed maximum variation. Setting Oslo University Hospital is the national centre for organ transplantation and donation in Norway, and there are 26 local nephrology centres. PARTICIPANTS 16 donors representing all parts of Norway who donated a kidney in 2001-2004 participated in the study. The interviews were analysed using an interpretative approach. RESULTS The analysis resulted in 4 main themes; the recipient outcome justified long-term experiences, family dynamics-tension still under the surface, ambivalence-healthy versus the need for regular follow-up, and life must go on. These themes reflect the complexity of live kidney donation, which fluctuated from positive experiences such as pride and feeling privileged to adverse experiences such as altered family relationships or reduced health. CONCLUSIONS Live kidney donors seemed to possess resilient qualities that enabled them to address the long-term consequences of donation. The challenge is to provide more uniform information about long-term consequences. In future research, resilient qualities could be a topic to explore in live donation.
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Affiliation(s)
- Käthe B Meyer
- Department of Transplantation, Oslo University Hospital, Rikshospitalet, Norway
- Institute of Clinical Medicine University of Oslo, Oslo, Norway
| | | | | | - Annette Lennerling
- Department of Transplantation, Sahlgrenska University Hospital, Gothenburg, Sweden
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Craig JA, Miner D, Remtulla T, Miller J, Zanussi LW. Piloting a Coping Skills Group Intervention to Reduce Depression and Anxiety Symptoms in Patients Awaiting Kidney or Liver Transplant. HEALTH & SOCIAL WORK 2017; 42:e44-e52. [PMID: 28395080 DOI: 10.1093/hsw/hlw064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 01/26/2016] [Indexed: 06/07/2023]
Abstract
The authors evaluated the use of a coping skills group (CSG) therapy intervention to decrease depression and anxiety and increase healthy coping skills in a population of kidney and liver transplant candidates. The study, using a pre-posttest design, piloted a CSG with a convenience sample of 41 consenting participants on a waiting list or in workup for kidney or liver transplant. Two transplant social workers led five eight-week closed psychoeducational groups. Coping skills, depression symptoms, and anxiety symptoms were assessed preintervention, postintervention, and at follow-up one month later. Results suggest that the CSG group created significant changes in some coping areas, such as decreasing the use of denial and self-blame and increasing the use of acceptance, religion, and instrumental supports. In this study, instrumental supports are strategies such as seeking assistance, finding information, or asking for advice about what to do. The effects on instrumental supports did not sustain at the one-month follow-up. Anxiety and depression scores were significantly reduced, and these changes were sustained at one-month follow-up. This study supports the use of a group-based psychosocial intervention for the pretransplant population and will be most relevant to social workers practicing in the transplant field.
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Affiliation(s)
- Julie Anne Craig
- Forensic Adolescent Program, Alberta Health Services, Sunridge Professional Building, 2675 36th Street, NW, Calgary, Alberta, Canada
| | - Dee Miner
- Southern Alberta Transplant Program, Foothills Medical Centre, Alberta Health Services, Calgary, Canada
| | - Tasneem Remtulla
- Southern Alberta Transplant Program, Foothills Medical Centre, Alberta Health Services, Calgary, Canada
| | - Janet Miller
- Mount Royal University, Calgary, Alberta, Canada
| | - Lauren W Zanussi
- Department of Psychiatry, Foothills Medical Centre, and assistant professor, University of Calgary, Alberta, Canada
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Ralph AF, Butow P, Hanson CS, Chadban SJ, Chapman JR, Craig JC, Kanellis J, Luxton G, Tong A. Donor and Recipient Views on Their Relationship in Living Kidney Donation: Thematic Synthesis of Qualitative Studies. Am J Kidney Dis 2016; 69:602-616. [PMID: 27889296 DOI: 10.1053/j.ajkd.2016.09.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 09/25/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Many donors and recipients report an improved relationship after transplantation; however, tension, neglect, guilt, and proprietorial concern over the recipient can impede donor and recipient well-being and outcomes. We aimed to describe donor and recipient expectations and experiences of their relationship in the context of living kidney donation. STUDY DESIGN Thematic synthesis of qualitative studies. SETTING & POPULATION Living kidney donors and recipients. SEARCH STRATEGY & SOURCES Electronic databases were searched to October 2015. ANALYTICAL APPROACH Thematic synthesis. RESULTS From 40 studies involving 1,440 participants (889 donors and 551 recipients) from 13 countries, we identified 6 themes. "Burden of obligation" described the recipient's perpetual sense of duty to demonstrate gratitude to the donor. "Earning acceptance" was the expectation that donation would restore relationships. "Developing a unique connection" reflected the inexplicable bond that donor-recipient dyads developed postdonation. "Desiring attention" was expressed by donors who wanted recognition for the act of donation and were envious and resentful of the attention the recipient received. "Retaining kidney ownership" reflected the donor's inclination to ensure that the recipient protected "their" kidney. "Enhancing social participation" encompassed relieving both the caregiver from the constraints of dialysis and the recipient from increased involvement and contribution in family life. LIMITATIONS Non-English articles were excluded. CONCLUSIONS Living kidney donation can strengthen donor-recipient relationships but may trigger or exacerbate unresolved angst, tension, jealousy, and resentment. Facilitating access to pre- and posttransplantation psychological support that addresses potential relationship changes may help donors and recipients better adjust to changes in the relationship dynamics, which in turn may contribute to improved psychosocial and transplantation outcomes following living kidney donation.
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Affiliation(s)
- Angelique F Ralph
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia; School of Psychology, The University of Sydney, Sydney, NSW, Australia.
| | - Phyllis Butow
- School of Psychology, The University of Sydney, Sydney, NSW, Australia; Psycho-oncology Co-operative Research Group, The University of Sydney, Sydney, NSW, Australia; Centre for Medical Psychology & Evidence-based Decision-making, The University of Sydney, Sydney, NSW, Australia
| | - Camilla S Hanson
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Steve J Chadban
- Central Clinical School, The University of Sydney, Sydney, NSW, Australia; Transplantation Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Jeremy R Chapman
- Centre for Transplant and Renal Research, The University of Sydney, Westmead Hospital, Westmead, NSW, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - John Kanellis
- Department of Nephrology, Monash Health and Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia; Department of Medicine, Monash University, Clayton, VIC, Australia
| | - Grant Luxton
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
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Santos BPD, Viegas ADC, Feijó AM, Lise F, Schwartz E. It was/wasn't everything I had imagined: advantages and disadvantages after kidney transplantation. ACTA ACUST UNITED AC 2016; 37:e60135. [PMID: 27849285 DOI: 10.1590/1983-1447.2016.03.60135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 09/26/2016] [Indexed: 11/22/2022]
Abstract
Objective To know the advantages and difficulties that people with chronic kidney disease experience after renal transplantation. Methodology A qualitative and descriptive study with 20 kidney transplant patients in a city in Southern Brazil, from May to July of 2013. Semi-structured interviews were used, analyzed according to the critical incident technique. Results The main advantages were presented in the similarity to "normal" living: advantages resulting from the kidney transplant category, related to the patient's discharge from dialysis, food and water restriction, among others. The difficulties were presented in the permanent chronic condition and the need for care category. Final considerations The advantages and disadvantages depend on each person's experience. The health professionals need to understand and promote health actions that promote the uniqueness and context of renal transplant.
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Affiliation(s)
- Bianca Pozza Dos Santos
- Universidade Federal de Pelotas (UFPEL), Departamento de Enfermagem, Programa de Pós-Graduação em Enfermagem. Pelotas, Rio Grande do Sul, Brasil
| | - Aline da Costa Viegas
- Universidade Federal de Pelotas (UFPEL), Departamento de Enfermagem, Programa de Pós-Graduação em Enfermagem. Pelotas, Rio Grande do Sul, Brasil
| | - Aline Machado Feijó
- Universidade Federal de Pelotas (UFPEL), Departamento de Enfermagem, Programa de Pós-Graduação em Enfermagem. Pelotas, Rio Grande do Sul, Brasil
| | - Fernanda Lise
- Universidade Federal de Pelotas (UFPEL), Departamento de Enfermagem, Programa de Pós-Graduação em Enfermagem. Pelotas, Rio Grande do Sul, Brasil
| | - Eda Schwartz
- Universidade Federal de Pelotas (UFPEL), Departamento de Enfermagem, Programa de Pós-Graduação em Enfermagem. Pelotas, Rio Grande do Sul, Brasil
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Abstract
Survival of a kidney transplant recipient beyond 2 decades is a relatively rare event. No studies have been conducted to describe individuals’ longevity attributions, who have had their kidney transplant for many years. The purpose of this qualitative analysis was to examine longevity attributions of kidney transplant recipients who have had a kidney transplant for 25 years or longer. The initial sample was obtained from an informal support group that includes only those who have had their kidney transplant >25 years. A semistructured 1-hour interview was conducted over the phone, audio-taped, and transcribed. Data were examined using thematic content analyses. The sample consisted of 19 participants (7 males and 12 females) ranging in age from 43 to 67 years, with a mean age of 52.8 years (standard deviation [SD] = 6.82). Transplants were performed between 26 and 36 years prior to the interviews, with a mean of 30.7 years (SD = 3.2). Emerging attributions included maintaining a healthy lifestyle, social support, positive attitude, faith, normalcy, participation in decision making, and luck. Prior to transplantation, patients were engaging in self-management behaviors, which many attributed to their success posttransplant. The findings of this study may provide insight and understanding for health-care providers and other transplant recipients regarding longevity attributions of those who have had their kidney transplants for over a quarter century. Future research should explore the impact of supporting kidney transplant recipients in self-management prior to and after transplantation.
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Affiliation(s)
- Michelle L. Matteson-Kome
- Division of Gastroenterology and Hepatology, Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | - Todd Ruppar
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | - Cynthia Russell
- School of Nursing & Health Studies, University of Missouri–Kansas City, Kansas City, MO, USA
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Bailey PK, Ben-Shlomo Y, Tomson CRV, Owen-Smith A. Socioeconomic deprivation and barriers to live-donor kidney transplantation: a qualitative study of deceased-donor kidney transplant recipients. BMJ Open 2016; 6:e010605. [PMID: 26936910 PMCID: PMC4785291 DOI: 10.1136/bmjopen-2015-010605] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 01/29/2016] [Accepted: 02/12/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Socioeconomically deprived individuals with renal disease are less likely to receive a live-donor kidney transplant than less-deprived individuals. This qualitative study aimed to identify reasons for the observed socioeconomic disparity in live-donor kidney transplantation. DESIGN A qualitative study using face-to-face in-depth semistructured interviews. SETTING A UK tertiary renal referral hospital and transplant centre. PARTICIPANTS Purposive sampling was used to select deceased-donor transplant recipients from areas of high socioeconomic deprivation (SED) (19 participants), followed by a low SED comparison group (13 participants), aiming for maximum diversity in terms of age, gender, ethnicity, primary renal disease and previous renal replacement therapy. METHODS Participants were interviewed following their routine transplant clinic review. Interviews were digitally audio-recorded and transcribed verbatim. Transcripts were coded using NVivo software and analysed using the constant comparison method described in Grounded Theory. RESULTS Themes common and distinct to each socioeconomic group emerged. 6 themes appeared to distinguish between individuals from areas of high and low SED. 4 themes were distinct to participants from areas of high SED: (1) Passivity, (2) Disempowerment, (3) Lack of social support and (4) Short-term focus. 2 themes were distinct to the low SED group: (1) Financial concerns and (2) Location of donor. CONCLUSIONS Several of the emerging themes from the high SED individuals relate to an individual's lack of confidence and skill in managing their health and healthcare; themes that are in keeping with low levels of patient activation. Inadequate empowerment of socioeconomically deprived individuals by healthcare practitioners was also described. Financial concerns did not emerge as a barrier from interviews with the high SED group. Interventions aiming to redress the observed socioeconomic inequity should be targeted at both patients and clinical teams to increase empowerment and ensure shared decision-making.
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Affiliation(s)
- Phillippa K Bailey
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Charles R V Tomson
- Department of Renal Medicine, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Amanda Owen-Smith
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Jamieson NJ, Hanson CS, Josephson MA, Gordon EJ, Craig JC, Halleck F, Budde K, Tong A. Motivations, Challenges, and Attitudes to Self-management in Kidney Transplant Recipients: A Systematic Review of Qualitative Studies. Am J Kidney Dis 2016; 67:461-78. [DOI: 10.1053/j.ajkd.2015.07.030] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 07/19/2015] [Indexed: 12/20/2022]
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Pinter J, Hanson CS, Craig JC, Chapman JR, Budde K, Halleck F, Tong A. 'I feel stronger and younger all the time'-perspectives of elderly kidney transplant recipients: thematic synthesis of qualitative research. Nephrol Dial Transplant 2016; 31:1531-40. [PMID: 27333617 DOI: 10.1093/ndt/gfv463] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 12/29/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Kidney transplantation offers improved survival and quality of life to an increasing number of elderly patients with end-stage kidney disease. However, elderly kidney transplant recipients may face unique challenges due to a higher burden of comorbidity, greater cumulative risk of immunosuppression-related complications and increasing frailty. We aimed to describe the perspectives of elderly kidney transplant recipients. METHODS Electronic databases were searched to April 2015. Qualitative studies were eligible if they reported views from elderly kidney transplant recipients (≥60 years). Thematic synthesis was used to analyse the findings. RESULTS Twenty-one studies involving >116 recipients were included. We identified seven themes. 'Regaining strength and vitality' meant valuing the physical and psychosocial improvements in daily functioning and life participation. 'Extending life' was the willingness to accept any organ, including extended criteria kidneys, to prolong survival. 'Debt of gratitude' entailed conscious appreciation toward their donor while knowing they were unable to repay their sacrifice. 'Moral responsibility to maintain health' motivated adherence to medication and lifestyle recommendations out of an ethical duty to protect their gift for graft survival. 'Unabating and worsening forgetfulness' hindered self-management. 'Disillusionment with side effects and complications' reflected disappointment and exasperation with the unintended consequences of medications. 'Finality of treatment option' was an acute awareness that the current transplant may be their last. CONCLUSIONS Kidney transplantation was perceived to slow and even reverse the experience of aging among elderly recipients, especially compared with dialysis. However, some were frustrated over persistent limitations after transplant, struggled with the burden of medication side effects and worried about a possible return to dialysis if the transplant failed. Clarifying patient expectations of transplantation, providing support to alleviate the debilitating impacts of immunosuppression and addressing fears about deteriorating health and graft failure may improve satisfaction and outcomes in elderly kidney transplant recipients.
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Affiliation(s)
- Jule Pinter
- Sydney School of Public Health, University of Sydney, Sydney, NSW 2006, Australia Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Camilla S Hanson
- Sydney School of Public Health, University of Sydney, Sydney, NSW 2006, Australia Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, University of Sydney, Sydney, NSW 2006, Australia Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Jeremy R Chapman
- Centre for Transplant and Renal Research, Westmead Hospital, Westmead, NSW, Australia
| | - Klemens Budde
- Department of Nephrology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Fabian Halleck
- Department of Nephrology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, NSW 2006, Australia Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
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Santos BPD, Schwartz E, Beuter M, Echevarría-Guanilo ME, Feijó AM, Duarte GDC. Transplante renal: análise comportamental a partir da Técnica dos Incidentes Críticos. AQUICHAN 2016. [DOI: 10.5294/aqui.2016.16.1.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objetivo: identificar os comportamentos das pessoas com o transplante renal empregando a Técnica dos Incidentes Críticos. Método: estudo com abordagem qualitativa do tipo descritivo utilizando a Técnica dos Incidentes Críticos. Os dados foram coletados por meio de entrevista semiestruturada e foram relacionados o perfil socioeconômico dos entrevistados e os incidentes críticos identificados. Fizeram parte do estudo 20 pessoas, dez homens e dez mulheres. Resultados: os resultados apontaram a ocorrência de 141 comportamentos, 108 positivos e 33 negativos, relacionados ao cuidado adotado à saúde, às atividades cotidianas e à vida com o transplante renal. Conclusões: a aplicação da Técnica dos Incidentes Críticos permitiu obter dados sobre o modo como o transplante renal influencia determinados comportamentos, positiva e negativamente, na vida da pessoa.
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Santos BPD, Schwartz E, Beuter M, Muniz RM, Echevarría-Guanilo ME, Viegas ADC. Consequences attributed to kidney transplantation: critical incident technique. ACTA ACUST UNITED AC 2015. [DOI: 10.1590/0104-07072015000270014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study aimed to describe the consequences experienced in the life of a person with kidney transplantation. This is a descriptive and qualitative approach, using the Critical Incident Technique, in which the interview content was analyzed, in an attempt to isolate the consequences of the kidney transplantation, showing positive and/or negative references. When confronted with what kidney transplantation provided to people's life, the independence from the hemodialysis machine, the existence of a quiet and normal life, the sensation of well-being, and the possibility of performing activities were demonstrated. In compensation, the transplantation provided changes that led them to another reality. Although some changes in the life of these people occurred, the process of transplantation did not represent significant change, which could install suffering.
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The Expectations and Attitudes of Patients With Chronic Kidney Disease Toward Living Kidney Donor Transplantation. Transplantation 2015; 99:540-54. [DOI: 10.1097/tp.0000000000000433] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Bertelsen KH, Rasmussen K, Ludvigsen MS, Finderup J. EXPERIENCES OF RECIPIENTS AND LIVING DONORS THE FIRST THREE DAYS AFTER KIDNEY TRANSPLANTATION. J Ren Care 2015; 41:195-201. [PMID: 25643643 DOI: 10.1111/jorc.12113] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Living donor transplantation is described as a stressful and complex process for both recipients and donors. Few studies have described the experiences of recipients and donors in the first three post-operative days after living kidney transplantation. OBJECTIVES To explore how recipients and living donors experienced the first three post-operative days after kidney transplantation. DESIGN A qualitative phenomenological-hermeneutic framework was used to uncover the meaning of lived experiences through interpretation of transcribed interviews. PARTICIPANTS Seven dyads of kidney recipients and donors admitted at a Danish university hospital were included from September 2013 to November 2013. APPROACH Fourteen semi-structured qualitative interviews were analysed using Malterud's principles of systematic text condensation. FINDINGS Recipients and donors both experienced post-operative discomfort, though not the same. Both recipients and donors expressed that it gave them peace of mind to be able to follow each other at close hand sharing the same room during the post-operative period. All recipients saw receiving a kidney as a huge gift; donating a kidney gave donors a feeling of satisfaction. CONCLUSION The first three post-operative days were characterised by different types of post-operative discomfort and caring needs. Recipients and donors all experienced benefits from staying in the same room during hospitalisation. All patients in this study were related; this may have influenced their experiences, choices and opinions.
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Affiliation(s)
| | - Katrine Rasmussen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
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Baillie J, Lankshear A. Patient and family perspectives on peritoneal dialysis at home: findings from an ethnographic study. J Clin Nurs 2014; 24:222-34. [DOI: 10.1111/jocn.12663] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Jessica Baillie
- School of Healthcare Sciences; Cardiff University; Cardiff UK
| | - Annette Lankshear
- Cardiff School of Healthcare Sciences; Cardiff University; Cardiff UK
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Soliman H, Mawgoud MAA. Factors Associated with Coping Mechanisms among Egyptian Patients with End Stage Renal Disease and on Haemodialysis. Psychol Rep 2014; 114:390-403. [DOI: 10.2466/15.20.pr0.114k20w6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study intends to identify factors that influence coping with physical and emotional impacts of haemodialysis on patients in Egypt. A questionnaire was administrated to a random sample of 162 participants, 87 men and 75 women, who had received outpatient treatment in health care clinics in seven Egyptian cities. A regression model was used with four independent variables (view of medical treatment, effect of pain, adjustment to treatment, and satisfaction with life) to explain variance in satisfaction with self and coping. Results show about half the variance in the patients' ability to cope and express satisfaction with the self was explained by the independent variables ( R2=–.55, R2=.45). Implications contributing to adjustment and coping are presented, showing the need to advance medical service and enhance patients' ability to develop effective strategies.
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Affiliation(s)
- Hussein Soliman
- School of Social Work, Southern Illinois University Carbondale, Illinois
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Gill P, Lowes L. Renal transplant failure and disenfranchised grief: participants' experiences in the first year post-graft failure--a qualitative longitudinal study. Int J Nurs Stud 2014; 51:1271-80. [PMID: 24560891 DOI: 10.1016/j.ijnurstu.2014.01.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 01/19/2014] [Accepted: 01/24/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Renal transplant failure has a devastating impact on patients and their families. However, little research has been conducted in this area, which limits insight and understanding of the transplant failure experience that could subsequently inform clinical practice. OBJECTIVES To explore participants' experiences of renal transplant failure in the first year post-graft failure. DESIGN A qualitative, longitudinal study informed by Heideggerian hermeneutics. PARTICIPANTS AND SETTINGS A purposive sample of 16 participants (8 recipients, 8 'significant others') from a regional renal transplant unit and 3 District General Hospitals in South-West England. METHODS Data were collected through a series of three recorded, semi-structured interviews in the first year post-renal transplant failure. Data analysis was informed by a three-step analytical process. RESULTS Renal transplantation was the treatment of choice and had a transformative effect on the lives of all participants. Graft failure has 2 distinct phases; failing and failed and the transition from one phase to the other is unpredictable, uncertain and stressful. Transplant failure had a devastating impact on all participants, regardless of time since transplantation and resulted in feelings of shock, grief, loss, anger, guilt and depression. Dialysis was disruptive and demanding and served as a constant reminder of transplant failure and lost freedom. Participants grieved the loss of their 'previous life' and 'imagined future' but, beyond the understanding of close family members, these losses appeared unrecognised, particularly by health professionals. Participants used various coping mechanisms to deal with stressors associated with transplant failure. Factors affecting coping and adjusting included improved physical health and social support, which was especially important within the marital dyad. Healthcare services were positively evaluated, although information concerning the prospect of transplant failure and support post-graft failure could be improved. CONCLUSION Renal transplant failure has a profound impact on recipients, spouses and other close family members and appears to resemble a form of disenfranchised grief. The theory of disenfranchised grief provides a coherent explication of participants' experiences in this study, which should help inform clinical practice, particularly in relation to the provision of information and emotional support post-graft failure.
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Affiliation(s)
- Paul Gill
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd CF37 1DL, UK.
| | - Lesley Lowes
- School of Healthcare Sciences, Cardiff University, 35-43 Newport Road, Cardiff CF24 0AB, UK.
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