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- LUNDMARK, MARTINA, et al.
(author)
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Health transition after lung transplantation - a grounded theory study
- 2016
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In: Journal of Clinical Nursing. - Chichester : Wiley-Blackwell. - 0962-1067 .- 1365-2702. ; 25:15-16, s. 2285-2294
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Journal article (peer-reviewed)abstract
- Aims and objectives: To investigate lung recipients' process of transition from prior the transplantation to one year afterwards, as well as what their main concerns are and how they deal with these concerns. Background: During the last three decades, lung transplantation has been established as an effective treatment for patients with end-stage pulmonary disease. Towards the end of the 20th century, the concept of survival expanded to also include improving health-related quality of life (HRQoL). Although many studies have been published regarding lung recipients' HRQoL, aspects of health and everyday life remain understudied. Lung transplantation demands some kind of transition. However, very little is known about this transitional process. Design: A qualitative inductive approach using Grounded Theory (GT) was used. Methods: A total of ten adult males and five adult females (n = 15) with a mean age of 55 years were included in the study and interviewed one year after transplantation. The open-ended interviews were digitally recorded and transcribed verbatim after each interview. The analysis of the material was performed consistent with Charmaz contructivistic approach of GT. Results: The core category Reconstructing daily occupations summarises a process wherein the generated GT is present through four main categories: Restricting, Regaining, Reorganising and Enriching. The process of reconstructing daily occupations is necessary to regain health. Conclusions: A trajectory of health transition is evident, starting pretransplant with the lung disease and severe illness and proceeding at least up to one year after the transplantation with experienced health. Relevance to clinical practice: The result enables a unique possibility to enhance the lung recipients' striving for everyday life and thereby promote health. There is a need for change in the existing multidisciplinary transplant team to also include an occupational therapist to support and guide the lung recipients in changing their occupational patterns. © 2016 John Wiley & Sons Ltd.
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| 2. |
- Almgren, Matilda, et al.
(author)
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Fatigue after heart transplantation - a possible barrier to self-efficacy
- 2021
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In: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 35:4, s. 1301-1308
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Journal article (peer-reviewed)abstract
- Rationale Recovery after heart transplantation is challenging and many heart recipients struggle with various transplant-related symptoms, side-effects of immunosuppressive medications and mental challenges. Fatigue has been reported to be one of the most common and distressing symptoms after heart transplantation and might therefore constitute a barrier to self-efficacy, which acts as a moderator of self-management. Aim To explore the prevalence of fatigue and its relationship to self-efficacy among heart recipients 1-5 years after transplantation. Research method An explorative cross-sectional design, including 79 heart recipients due for follow-up 1-5 years after transplantation. Three different self-assessment instruments were employed; The Multidimensional Fatigue Inventory-19, Self-efficacy for managing chronic disease 6-Item Scale and The Postoperative Recovery Profile. Ethical approval The study was approved by the Regional Ethics Board of Lund (Dnr. 2014/670-14/10) with supplementary approval from the Swedish Ethical Review Authority (Dnr. 2019-02769). Results The reported levels of fatigue for the whole group were moderate in all dimensions of the Multidimensional Fatigue Inventory-19, with highest ratings in the General Fatigue sub-scale. Those most fatigued were the groups younger than 50 years; pretransplant treatment with Mechanical Circulatory Support; not recovered or had not returned to work. Self-efficacy was associated with the sub-dimensions Mental Fatigue (rho = -0 center dot.649) and Reduced Motivation (rho = -0 center dot 617), which explained 40 center dot 1% of the variance when controlled for age and gender. Study limitations The small sample size constitutes a limitation. Conclusions The moderate levels of fatigue reported indicate that it is not a widespread problem. However, for those suffering from severe fatigue it is a troublesome symptom that affects the recovery process and their ability to return to work. Efforts should be made to identify those troubled by fatigue to enable sufficient self-management support.
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| 4. |
- Almgren, Matilda, et al.
(author)
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Self-efficacy in the context of heart transplantation - a new perspective.
- 2017
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In: Journal of clinical nursing. - : Wiley. - 1365-2702 .- 0962-1067. ; 26:19-20, s. 3007-3017
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Journal article (peer-reviewed)abstract
- An in-depth exploration of self-efficacy among heart transplant recipients by means of Bandura's self-efficacy theory.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.A directed content analysis using Bandura's self-efficacy theory.Open-ended, in-depth interviews were conducted with 14 heart transplant recipients at their 12-month follow-up after heart transplantation.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.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.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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| 5. |
- Almgren, Matilda, et al.
(author)
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Self-efficacy, recovery and psychological wellbeing one to five years after heart transplantation: a Swedish cross-sectional study
- 2021
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In: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 20:1, s. 34-39
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Journal article (peer-reviewed)abstract
- Background Self-efficacy refers to a person ' s confidence in carrying out treatment-related activities and constitutes the foundation of self-management as well as long-term follow-up after heart transplantation. Exploring the heart recipients ' experiences by means of self-report instruments provides healthcare professionals with valuable information on how to supply self-management support after heart transplantation. Aims The aim was to explore self-efficacy in relation to the self-reported level of recovery and psychological wellbeing, among adult heart recipients, one to 5 years after transplantation. Methods This cross-sectional study includes 79 heart recipients, due for follow-up one to 5 years after transplantation. Three different self-assessment instruments were employed: the self-efficacy for managing chronic disease 6-item scale; the postoperative recovery profile; and the psychological general wellbeing instrument. Results The reported level of self-efficacy was high (median 8.3, maximum score 10). Significantly higher self-efficacy was seen among those who had returned to work (P = 0.003) and those without pre-transplant mechanical circulatory support (P = 0.033). In total, 65.5% (n = 52) reported being reasonably recovered, while 18.8% (n = 12) were not recovered. The median total psychological general wellbeing score was 108 (P-25 = 24,P-75 = 117), suggesting overall good psychological wellbeing in the whole group of heart recipients. Conclusion The heart transplant recipients in our study had an overall high level of self-efficacy. Low self-efficacy was found among those with a low self-reported level of recovery, pre-transplant treatment with mechanical circulatory support or who had not returned to work. This is important information for transplant professionals when helping heart recipients to balance their expectations about recovery.
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| 6. |
- Almgren, Matilda, et al.
(author)
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The meaning of being in uncertainty after heart transplantation - an unrevealed source to distress.
- 2017
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In: European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology. - : Oxford University Press (OUP). - 1873-1953 .- 1474-5151. ; 16:2, s. 167-174
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Journal article (peer-reviewed)abstract
- As many as 88% of heart transplant recipients (HTRs) suffer from psychological distress. Both psychosocial factors and physical health are associated with increased psychological distress. However, the causes and impacts of psychological distress are unclear. HTRs strive for a sense of control over their health and daily lives in order to improve their psychological well-being. Perceived control was found to be related to the patients' construction of normality, their emotional state, as well as their thoughts and feelings of uncertainty about the future.An in-depth exploration of the meaning of uncertainty during the first year after a heart transplantation (HTX).A phenomenological-hermeneutic method was employed. Interviews were conducted with 14 patients, four women and ten men, with a mean age of 51 years (range: 28-67 years).Being in uncertainty after HTX means losing a sense of coherence, which shatters the HTR's whole worldview. The HTRs search for meaning and strive for coherence, which is no longer achievable. By using a nursing theory, we understand that uncertainty should be seen as a natural state among HTRs. It constitutes the starting point from which the HTRs can reorganise their self-structure and find a new view of life. When striving for normality, certainty and predictability (i.e., the healthcare professional's perspective), we block or prolong this process, thus causing distress among HTRs because they are unable to create a new orientation in life.This study presents a hypothesis of the primary cause of psychological distress after HTX and provides a useful framework for how to approach this condition.
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| 7. |
- Almgren, Matilda
(author)
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Uncertainty after heart transplantation. A new perspective on self-efficacy and self-management.
- 2018
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Licentiate thesis (other academic/artistic)abstract
- Background Self-management is the main concept constituting the foundation of follow-up care after heart transplantation. Self-efficacy is a foundation of self-management. Little is known about heart recipients’ experiences in relation to self-efficacy and self-management after heart transplantation. Aim The overall aim of this thesis was to explore uncertainty and self-efficacy as important aspects of the lived experience of heart recipients one year after heart transplantation. Methods Both an inductive and a deductive approach have been used in combination with qualitative research methods. The study group consisted of 14 patients (I and II) who were due for their one year follow-up after heart transplantation. Interviews were performed and analysed by phenomenological hermeneutics (inductive) developed by Lindseth & Norberg and directed content analysis (deductive) developed by Hsieh & Shannon. Results The meaning of uncertainty after heart transplantation involved: doubting survival, doubting the recovery process, doubting one’s performance, struggling with close relationships, feeling abandoned and doubting the future. Uncertainty emerges when the heart recipients are unable to ascribe meaning to illness-related events and might therefore be a source of distress. Performance accomplishment, which comprises physical, social and mental aspects, was seen as the main factor affecting self-efficacy after heart transplantation. Lack of performance accomplishment led to disappointment and therefore our hypothesis was that self-efficacy after heart transplantation concerns balancing expectations in accordance with realistic accomplishments. Conclusions Complications, setbacks and symptoms together with expectations are sources of uncertainty. Performance accomplishment enables expectations to be met and might therefore constitute a source of uncertainty when accomplishments are not achieved. Uncertainty can undermine performance and might thereby hamper selfefficacy and self-management.
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| 8. |
- Bonander, Carl, et al.
(author)
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A regression discontinuity analysis of the social distancing recommendations for older adults in Sweden during COVID-19.
- 2022
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In: European Journal of Public Health. - : Oxford University Press. - 1101-1262 .- 1464-360X. ; 32:5, s. 799-806
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Journal article (peer-reviewed)abstract
- BACKGROUND: This paper investigates the impact of a non-mandatory and age-specific social distancing recommendation on isolation behaviors and disease outcomes in Sweden during the first wave of the COVID-19 pandemic (March to July, 2020). The policy stated that people aged 70 years or older should avoid crowded places and contact with people outside the household.METHODS: We used a regression discontinuity design-in combination with self-reported isolation data from COVID Symptom Study Sweden (n = 96,053; age range: 39-79 years) and national register data (age range: 39-100+ years) on severe COVID-19 disease (hospitalization or death, n = 21,804) and confirmed cases (n = 48,984)-to estimate the effects of the policy.RESULTS: Our primary analyses showed a sharp drop in the weekly number of visits to crowded places (-13%) and severe COVID-19 cases (-16%) at the 70-year-threshold. These results imply that the age-specific recommendations prevented approximately 1,800 to 2,700 severe COVID-19 cases, depending on model specification.CONCLUSION: It seems that the non-mandatory, age-specific recommendations helped control COVID-19 disease during the first wave of the pandemic in Sweden, as opposed to not implementing a social distancing policy aimed at older adults. Our study provides empirical data on how populations may react to non-mandatory, age-specific social distancing policies in the face of a novel virus.SUPPLEMENTARY MATERIAL: Online appendix with figures, tables, extra methods and results.
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| 9. |
- Kisch, Annika M., et al.
(author)
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The Meaning of Being a Living Kidney, Liver or Stem Cell Donor : A Meta-Ethnography
- 2018
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In: Transplantation. - : Wolters Kluwer. - 0041-1337 .- 1534-6080. ; 102:5, s. 744-756
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Journal article (peer-reviewed)abstract
- BACKGROUND: Studies on living donors from the donors' perspective show that the donation process involves both positive and negative feelings involving vulnerability. Qualitative studies of living kidney, liver, and allogeneic hematopoietic stem cell donors have not previously been merged in the same analysis. Therefore, our aim was to synthesize current knowledge of these donors' experiences in order to deepen understanding of the meaning of being a living donor for the purpose of saving or extending someone's life.METHODS: The meta-ethnography steps presented by Noblit & Hare in 1988 were used.RESULTS: Forty-one qualitative studies from 1968 to 2016 that fulfilled the inclusion criteria were analyzed. The studies comprised experiences of over 670 donors. The time since donation varied from 2 days to 29 years. A majority of the studies, 25 out of 41, were on living kidney donors. The synthesis revealed that the essential meaning of being a donor is doing what one feels one has to do, involving 6 themes; A sense of responsibility, Loneliness and abandonment, Suffering, Pride and gratitude, A sense of togetherness, and A life changing event.CONCLUSION: The main issue is that one donates irrespective of what one donates. The relationship to the recipient determines the motives for donation. The deeper insight into the donors' experiences provides implications for their psychological care.
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| 10. |
- Lindberg, Catharina, et al.
(author)
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The meaning of surviving three years after a heart transplant : a transition from uncertainty to acceptance through adaptation
- 2020
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In: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 17:15
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Journal article (peer-reviewed)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. © 2020 by the authors. Licensee MDPI, Basel, Switzerland.
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