Introduction: Life-altering changes in health status, such as those that occur when moving from being a lung transplant candidate to lung transplant recipient (LTR) trigger a process of transition. Health-related transitions are thought to be an opportunity to enhance well being, but also a period of vulnerability until the patient and family adjust to the challenges that accompany the changed health status. Little research has been done to identify the challenges that LTR face and the nursing interventions that promote a healthy transition after lung transplantation.
Objective: This presentation describes the findings of two completed studies that were conducted to identify challenges that LTR face and three current studies aimed at promoting a healthy transition after lung transplantation.
Completed Study 1: explored whether lung rejection poses a challenge to LTR by describing the patterns and predictors of rejection in the first year after lung transplantation. Data were retrieved for 250 LTR. Major findings were: 1) 85% of LTR developed clinically significant acute rejection and 75% of first episodes occurred within 6 weeks of transplantation; 2) most episodes responded to treatment, but rejection recurred in 23% or became serious (refractory or chronic) in 26% of LTR; 3) the frequency, severity, and earlier onset of acute rejection were significant predictors of the development of serious rejection. Findings confirm that acute rejection is a challenge that nearly all LTR face and predisposes LTR to the loss of lung function that accompanies serious rejection.
Completed Study 2: explored whether physical symptoms and physical impairment pose challenges to LTR by characterizing the key physical symptoms, level of physical impairment, and psychosocial status among a cross-sectional cohort of 50 transplant recipients and explored whether psychosocial factors rendered recipients vulnerable to increased symptoms or impairment. Major findings were: 1) physical symptoms, physical impairment, and psychological distress were common among recipients; 2) recipients with a psychiatric history pre-transplant and low sense of mastery or self-esteem after transplant were significantly more likely to develop psychological distress (anxiety and/or depression); and 3) psychological distress rendered recipients vulnerable to the development of increased physical symptoms and physical impairment. Findings confirm that psychological distress, symptoms, and physical impairments continue to challenge LTR and that psychological distress predisposes LTR to poorer outcomes after transplantation.
Both studies provide support for continuing to explore ways to assist LTR to deal with the challenges that accompany the transition after lung transplantation. To this aim, three additional studies are currently underway.
Current Study 1: employs quantitative methods to describe the relationships between the symptoms reported by LTR and the development of clinically significant complications such as rejection and infection; qualitative methods to discover how LTR perceive, interpret, and relate symptoms to the development of complications; and conceptual triangulation to achieve a complete description of the symptom experience. A better understanding of post-transplant symptoms may be used to assist LTR to master the skills needed to manage symptoms and detect complications.
Current Study 2: employs a cross-sectional survey design to explore the attitudes that LTR hold regarding decision-making, information seeking, and communicating with the transplant team. A better understanding of these attitudes may be used to assist LTR to play an active role in meeting the challenges that accompany the transition of lung transplantation.
Current Study 3: employs focused, ethnographic techniques to explore the components (conditions, patterns of responses and therapeutics) and relationships of the transition after lung transplantation from the perspective of LTR and transplant clinicians. Knowledge of the particulars inherent in the transition will help identify nursing interventions that promote a healthy transition after lung transplantation.
Implications: Ultimately, findings from these studies will guide future research aimed at identifying the “best practice” for promoting a healthy transition, thereby improving outcomes for lung transplant recipients.
Funded by NIH, NINR F31 NR 07425 ajdst42@pitt.edu
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