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Dalvindt M, Nozohoor S, Kisch A, Lennerling A, Forsberg A. Symptom Occurrence and Distress after Heart Transplantation-A Nationwide Cross-Sectional Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218052. [PMID: 33139609 PMCID: PMC7663327 DOI: 10.3390/ijerph17218052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 10/27/2020] [Accepted: 10/30/2020] [Indexed: 12/20/2022]
Abstract
Experiencing symptoms after heart transplantation may hamper the heart recipient’s self-management which can lead to negative effects. We know little about symptom occurrence and distress after heart transplantation, especially in relation to sociodemographic variables. The aim of the study was to explore self-reported symptom occurrence and distress after heart transplantation and their relationship with self-reported psychological well-being and sociodemographic factors. This multicenter, cross-sectional, cohort study is associated with the Swedish national Self-Management After Thoracic Transplantation study (SMATT). Two questionnaires were distributed at the heart recipients’ yearly follow-up, one to five years post-transplant at three Swedish university hospitals from 2014–2017. In a total 79 heart recipients, 54 men and 25 women, with a mean age 53 years returned the questionnaires. Symptoms occurred differently depending on type and duration of follow-up. The most common symptoms, trembling hands, and decreased libido were also the most distressing. Heart recipients most burdened by symptoms were those younger than 50 years, not working, with poor psychological well-being or living alone. Fatigue explained more than 60% of the variation in transplant specific well-being. In conclusion this study points at the target groups within the heart transplant population that needs person centered symptom management support where the focus should be on side-effects of the medication i.e., trembling hands as well as the patients’ sexual health.
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Affiliation(s)
- Marita Dalvindt
- Department of Cardiothoracic Surgery, Skåne University Hospital, 222 42 Lund, Sweden; (S.N.); (A.F.)
- Care in High Tech Environments, Institute of Health Sciences at Lund University, 221 00 Lund, Sweden;
- Correspondence:
| | - Shahab Nozohoor
- Department of Cardiothoracic Surgery, Skåne University Hospital, 222 42 Lund, Sweden; (S.N.); (A.F.)
| | - Annika Kisch
- Care in High Tech Environments, Institute of Health Sciences at Lund University, 221 00 Lund, Sweden;
- Department of Haematology, Skåne University, 222 42 Lund, Sweden
| | - Annette Lennerling
- The Transplant Centre, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden;
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Anna Forsberg
- Department of Cardiothoracic Surgery, Skåne University Hospital, 222 42 Lund, Sweden; (S.N.); (A.F.)
- Care in High Tech Environments, Institute of Health Sciences at Lund University, 221 00 Lund, Sweden;
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Lindberg C, Almgren M, Lennerling A, Forsberg A. The Meaning of Surviving Three Years after a Heart Transplant-A Transition from Uncertainty to Acceptance through Adaptation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155434. [PMID: 32731539 PMCID: PMC7432631 DOI: 10.3390/ijerph17155434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/25/2020] [Accepted: 07/26/2020] [Indexed: 01/10/2023]
Abstract
The rationale was to longitudinally follow-up interviews performed with heart recipients at their one-year examination in order to deepen the understanding of the meaning of surviving a heart transplant. The aim was to explore the meaning of surviving three years after a heart transplant compared to one year and to identify what constitutes the change process. A phenomenological–hermeneutic method was used. This multicenter study was carried out at the two hospitals in Sweden where heart transplants are performed. A total of 13 heart recipients who survived three years after a heart transplant were invited to participate in this three-year follow-up study and 12 accepted, 3 women and 9 men, with a mean age of 51.25 years. The naïve understanding revealed that the heart recipients strongly accepted their life situation and that time had enabled this acceptance of limitations through adaptation. The thematic structural analyses cover six themes illustrating the meaning of acceptance and adaptation, i.e., accepting life as it is, adapting to post-transplant limitations, adapting to a changed body, social adaptation, showing gratitude and trusting oneself and others. In conclusion, achieving acceptance and a solid sense of self-efficacy after heart transplantation is a time-consuming process that involves courage to face and accept the reality and adapt in every life dimension.
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Affiliation(s)
- Catharina Lindberg
- Department of Health Sciences, Blekinge Institute of Technology, 374 35 Karlskrona, Sweden;
| | - Matilda Almgren
- Care in High Tech Environments, Institute of Health Sciences at Lund University, 221 00 Lund, Sweden;
| | - Annette Lennerling
- The Transplant Centre, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden;
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Anna Forsberg
- Care in High Tech Environments, Institute of Health Sciences at Lund University, 221 00 Lund, Sweden;
- Department of Thoracic Surgery, Skåne University Hospital, 222 42 Lund, Sweden
- Correspondence:
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Dalvindt M, Kisch A, Nozohoor S, Lennerling A, Forsberg A. Chronic pain 1-5 years after heart transplantation-A nationwide cross-sectional cohort study. Nurs Open 2020; 7:1146-1156. [PMID: 32587734 PMCID: PMC7308699 DOI: 10.1002/nop2.489] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 03/09/2020] [Indexed: 12/28/2022] Open
Abstract
Aim To provide a multidimensional assessment of self-reported chronic pain 1-5 years after heart transplantation and its relationship with self-reported well-being, fatigue, recovery, self-efficacy and socio-economic factors and to explore differences between heart recipients and a cohort of lung recipients. Design This multicentre, cross-sectional, cohort study is a part of the Swedish national Self-management after thoracic transplantation study. Methods Six questionnaires were distributed at the heart recipients yearly follow-up (1-5 years) at three Swedish university hospitals 2014-2017. Results The study group comprised of 79 heart recipients, 25 women and 54 men with a mean age of 52.68 years. Chronic pain among heart recipients was common and those not in paid employment as well as those with low psychological well-being and high general fatigue reported significantly more pain. Female heart recipients were more affected by pain. General health and vitality, general fatigue, physical fatigue and reduced activity were related to the pain intensity score. Relevance to clinical practice As it is the duty of the healthcare system to provide adequate pain treatment, screening for pain should be a mandatory part of long-term follow-up.
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Affiliation(s)
- Marita Dalvindt
- Institute of Health SciencesLund UniversityLundSweden
- Department of Cardiothoracic SurgerySkåne University Hospital, Lund UniversityLundSweden
| | - Annika Kisch
- Institute of Health SciencesLund UniversityLundSweden
- Department of HaematologySkåne University HospitalLundSweden
| | - Shahab Nozohoor
- Department of Cardiothoracic SurgerySkåne University Hospital, Lund UniversityLundSweden
| | - Annette Lennerling
- The Transplant CentreSahlgrenska University HospitalGothenburgSweden
- Institute of Health and Care SciencesThe Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Anna Forsberg
- Institute of Health SciencesLund UniversityLundSweden
- Department of Cardiothoracic SurgerySkåne University Hospital, Lund UniversityLundSweden
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Annette L, Annika K, Anna F. Non-adherence to Immunosuppressant after Lung Transplantation – A Common Risk Behavior. Open Nurs J 2019. [DOI: 10.2174/1874434601913010108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background:
After lung transplantation, life-long treatment with immunosuppressive medication is required to prevent rejection and graft loss but adherence to immunosuppressive treatment may be difficult for the lung recipient. Adherence is essential and non-adherence to immunosuppressive treatment can lead to graft loss and death.
Objective:
The aim of this cross-sectional study was to investigate the prevalence of non-adherence 1 to 5 years after lung transplantation in relation to symptom burden, health literacy, psychological well-being and relevant demographic variables.
Methods:
117 adult lung recipients, due for their annual follow-up 1-5 years after lung transplantation, participated. Four self-report instruments were used for assessment: the Basel Assessment of Adherence with Immunosuppressive Medication Scale, the Newest Vital Sign, the Psychological General Well-Being and the Organ Transplant Symptom and Wellbeing Instrument. Statistical analysis was performed.
Results:
Thirty percent of the lung recipients were non-adherent. The most common non-adherence dimension was not taking a dose (43%) and not being punctual with the regimen (80%). Of those working full time or part time, 43% were non-adherent (p=.032). A higher level of non-adherence was reported a long time after LuTx with the highest level at the 3-year follow-up.
Conclusion:
The level of non-adherence among lung recipients was high. The highest levels were found among those who had returned to work. Non-adherence increased with time after lung transplantation.
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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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Almgren M, Lennerling A, Lundmark M, Forsberg A. Self-efficacy in the context of heart transplantation - a new perspective. J Clin Nurs 2017; 26:3007-3017. [PMID: 27865026 DOI: 10.1111/jocn.13647] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2016] [Indexed: 01/28/2023]
Abstract
AIMS AND OBJECTIVES An in-depth exploration of self-efficacy among heart transplant recipients by means of Bandura's self-efficacy theory. BACKGROUND An essential component of chronic illness management is self-management, which refers to activities carried out by people to create order, structure and control in their lives. Self-efficacy is an important aspect of self-management, which seems to have become the main paradigm for long-term management after solid organ transplantation. DESIGN A directed content analysis using Bandura's self-efficacy theory. METHODS Open-ended, in-depth interviews were conducted with 14 heart transplant recipients at their 12-month follow-up after heart transplantation. RESULTS This study generated the hypothesis that from the patients' perspective, self-efficacy after heart transplantation concerns balancing expectations to find the optimum level of self-efficacy. Performance accomplishment was found to have the greatest impact on self-efficacy, while its absence was the main source of disappointments. It was also revealed that the gap between performance accomplishment and efficacy expectations can be understood as uncertainty. CONCLUSIONS It is essential to assess both expectations and disappointments from the patient perspective in order to promote an optimum level of self-efficacy among heart transplant recipients. This includes supporting the heart recipient to adopt mental and physical adjustment strategies to balance her/his expectations as a means of minimising disappointments. The understanding that uncertainty can undermine self-efficacy is crucial. RELEVANCE TO CLINICAL PRACTICE The merging of the uncertainty in illness and self-efficacy theories provides an excellent framework for the provision of self-management support. In addition, focusing on a partnership between the transplant professionals and the recipient is essential because it minimises the use of a behavioural approach.
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Affiliation(s)
- Matilda Almgren
- Thoracic Intensive Care Unit, Skåne University Hospital, Lund, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden
| | - Annette Lennerling
- The Transplant Center, Sahlgrenska University Hospital, Gothenburg, Sweden.,The Institute of Health and Caring Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Martina Lundmark
- Thoracic Intensive Care Unit, Skåne University Hospital, Lund, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden
| | - Anna Forsberg
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Transplantation and Cardiology, Skåne University Hospital, Lund, Sweden
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Lundmark M, Lennerling A, Almgren M, Forsberg A. Recovery after lung transplantation from a patient perspective - proposing a new framework. J Adv Nurs 2016; 72:3113-3124. [PMID: 27346667 DOI: 10.1111/jan.13058] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2016] [Indexed: 02/02/2023]
Abstract
AIMS The aims of this study were two-fold: to develop the concept analysis by Allvin et al. from lung recipients' perspective of their post-transplant recovery process and to identify the recovery trajectories including critical junctions in the post-transplant recovery process after lung transplantation. BACKGROUND Lung transplantation is an established treatment for patients with end-stage lung disease. The recovery process after lung transplantation is very demanding. Today, patients are expected to play an active role in their own recovery but require ongoing support during the process. DESIGN A deductive, retrospective interview study using directed content analysis and Allvin's recovery concept analysis. METHOD Fifteen adult lung transplant recipients who were due their 12-month follow-up were consecutively included and interviewed during 2015. Patients who were medically unstable or had difficulties speaking Swedish were excluded from this multi-centre study. FINDINGS Allvin's concept analysis is partly applicable to the context of lung transplantation. The recipients' experience of the post-transplant recovery process could be confirmed in the main dimensions of the concept analysis, while several sub-dimensions were contradictory and were excluded. Six new sub-dimensions emerged; symptom management, adjusting to physical restraints, achieving an optimum level of psychological well-being, emotional transition, social adaptation and reconstructing daily occupation. CONCLUSION The concept analysis by Allvin et al. was possible to expand to fit the lung transplantation context and a new contextual definition of post-transplant recovery after solid organ transplantation was developed. Recovery and health were viewed as two different things.
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Affiliation(s)
- Martina Lundmark
- Skåne University Hospital, Thoracic Intensive Care Unit, Lund, Sweden.,Department of Health Sciences at Lund University, Sweden
| | - Annette Lennerling
- The Transplant Center, Sahlgrenska University Hospital, Gothenburg, Sweden.,The Institute of Health and Caring Sciences, Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - Matilda Almgren
- Skåne University Hospital, Thoracic Intensive Care Unit, Lund, Sweden.,Department of Health Sciences at Lund University, Sweden
| | - Anna Forsberg
- Department of Health Sciences at Lund University, Sweden.,Skåne University Hospital, Department of Transplantation and Cardiology, Lund, Sweden
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Lundmark M, Erlandsson LK, Lennerling A, Almgren M, Forsberg A. Health transition after lung transplantation - a grounded theory study. J Clin Nurs 2016; 25:2285-94. [DOI: 10.1111/jocn.13269] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2016] [Indexed: 12/18/2022]
Affiliation(s)
- Martina Lundmark
- Skåne University Hospital; Thoracic Intensive Care Unit; Lund Sweden
- Department of Health Sciences at Lund University; Lund Sweden
| | | | - Annette Lennerling
- The Transplant Center; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Matilda Almgren
- Skåne University Hospital; Thoracic Intensive Care Unit; Lund Sweden
- Department of Health Sciences at Lund University; Lund Sweden
| | - Anna Forsberg
- Department of Health Sciences at Lund University; Lund Sweden
- Skåne University Hospital; Department of Transplantation and Cardiology; Lund Sweden
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Forsberg A, Cavallini J, Fridh I, Lennerling A. The core of social function after solid organ transplantation. Scand J Caring Sci 2015; 30:458-65. [PMID: 26395270 DOI: 10.1111/scs.12264] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 06/16/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Social function is a key aspect of health-related quality of life after solid organ transplantation (SOT). The focus of this study was to report how solid organ-transplanted patients change their social function after transplantation. AIM To investigate the main concerns associated with social function after SOT and how solid organ transplant recipients (SOTRs) deal with these concerns. METHOD Twenty SOTRs, 13 men and 7 women, with a mean age of 54 years (range 22-75 years) and due for their first-year follow-up were included in this study. The informants had received various types of solid organs. Data were collected through in-depth interviews, which were recorded and transcribed verbatim for analysis by the method of grounded theory (GT) developed by Charmaz. RESULT The GT of this study describes the efforts by the 20 SOTRs to adapt socially in order to maintain their social functioning and leading a normal life. The efforts summaries a process wherein the generated GT is present through three main categories: deconstruction, restriction and reconstruction, showing various ways to socially adapt. Through this process, a clear path of transition through adaptation is evident, starting before transplantation and continues beyond the first year after transplantation. CONCLUSION Social functions improved through a process of adaptation during the first year after transplantation. Working and travelling were the two most important aspects of social function. All the informants emphasised the importance of regaining a normal life, which was the outcome of a successful adaptation.
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Affiliation(s)
- Anna Forsberg
- Department of Health Sciences at Lund University, Lund, Sweden.,Department of Transplantation and Cardiology, Skåne University Hospital, Lund, Sweden
| | - Josefine Cavallini
- The Transplant Center, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Isabell Fridh
- Faculty of Caring Science, Work Life and Social Welfare at University of Borås, Borås, Sweden
| | - Annette Lennerling
- The Transplant Center, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Health and Caring Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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