Low Jac Kee, Crawford Kimberley, Manias Elizabeth, Williams Allison
Faculty of Medicine, Nursing & Health Sciences, School of Nursing & Midwifery, Monash University, Clayton, Vic., Australia.
Royal Melbourne Hospital, The University of Melbourne, Parkville, Vic., Australia.
J Clin Nurs. 2017 Jun;26(11-12):1495-1507. doi: 10.1111/jocn.13435. Epub 2017 Mar 20.
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.
Although kidney transplantation offers enhanced quality and years of life for patients, the management of a kidney transplant post surgery is a complex process.
A descriptive exploratory study.
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.
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.
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.
Using these findings to make informed changes to the usual care of a kidney transplant recipient is likely to result in better patient outcomes.
了解肾移植术后与生活相关的压力源，重点关注药物依从性，以及人们用于应对这些压力源的应对资源。
尽管肾移植为患者带来了更高的生活质量和更长的寿命，但肾移植术后的管理是一个复杂的过程。
一项描述性探索性研究。
从澳大利亚维多利亚州的五个肾移植单位招募参与者。2014年3月至5月，对肾移植维持≥8个月或因不依从药物治疗而肾移植失败的患者进行访谈。所有访谈录音均逐字转录，并采用里奇和斯宾塞的框架分析法进行分析。
参与者包括15名男性和10名女性，年龄在26至72岁之间。所有确定的主题分为：（1）困扰原因和（2）应对资源。肾移植术后，困扰原因包括维持移植所需的严格日常安排，以及对潜在移植排斥、感染和患癌的持续恐惧。用于管理压力源的应对资源首先是，对肾移植管理比依赖透析更容易的看法转变，其次是除了使用电子提醒外，还从其他患者、家庭成员和医疗保健专业人员那里获得外部帮助。
具备良好应对资源的个体能够更好地应对压力源。建议做出一些改变，如定期提醒肾移植的生活方式益处、为患者创造分享经验的机会以及推广使用提醒闹钟服药，这将减轻肾移植管理的压力。
利用这些发现对肾移植受者的常规护理做出明智的改变，可能会带来更好的患者预后。
