| Summary: | 碩士 === 國立陽明大學 === 臨床暨社區護理研究所 === 97 === Background End-stage-heart-failure is there terminal phase of heart disease with irreversibly multiple dysfunction, and heart transplantation (HT) has been long acknowledged as the only avenue for the patients’ survival and possibility of quality of life. Nevertheless, most of the recipients (HTR) and their care givers, primary family caregivers (PFC) in particular, continued to suffer from numerous discomforts/distress during the recipients’ recovery process of resuming their holistic well-being including physical, psychological, cognitive, social and spiritual optimal functions. Dark recovery stage (DRS) is referred to the post-HT stage when the HRT or their PFC reported having suffered from intolerable recovery experiences. Did the DRS exist in Taiwan’s HTR and their PFC groups? What are the contents and rationales for their DRS experiences? What are their coping strategies and needed help during DRS? All these questions deserve HT health professionals’ investigation.
Aims The aims of this project were to explore:
1. the DRS experiences for Taiwan’s adult HTR and their PFC;
2. the coping strategies employed by Taiwan’s adult HTR and their PFC;
3. Taiwan’s adult HTR’s and their PFC’s needed help from others during DRS; and
4. Twain’s adult HTR’s appraisals for the discharge-planning provided by hospital.
Design & Method An explorative descriptive qualitative design was used. A purposive sample of adult HTR and their PFC with DRS experiences in the most famous HT hospital in Taiwan was obtained. . Face-to-face depth interviews were and conducted with a semi-structured interview guide. Data were analyzed by qualitative content analysis mode.
Results A total of 52 informants including 20 HTR and 13 of their PFC participated in this project. In the HTR group, 16 of them were male aging from 32 to 70 (M = 46.95) years old. Most of them are married. Their post-HT duration ranged from 3 months to 2 years and 10 months. In the PFC group, 11 of them were females aging from 28 to 67 (M = 47.53) years old; 12 were married, and 1 was single. The relationships of the PFC group were reported spousal (n =11), mother/son (n = 1), and boy/girlfriend (n = 1). Five of them reported suffering from various disease including hypertension (n = 2), duodenal ulcer (n = 1), cardiopalmus (n = 1), and breast cancer (post-operation) (n = 1).
The DRS experienced by HTR were: (a) The physical and psychological discomforts caused by intrusive examinations and major changes of the health status（n = 8）; (b) the sense of uncertainty with future health condition（n = 15）; (c) the sense of uncertainty with future life（n = 13）; (d) the sense of becoming a burden for families（n = 2）; and (e) the unfamiliar medical treatment and environment（n = 2）. Their coping strategies were: (a) setting a goal for recovery and maintaining healthy status（n = 10）; (b) searching for spiritual support（n = 10）; (c) complying with the difficulties（n = 10）; (d) holding positive attitudes（n = 11）; and (e) searching for possible job opportunities（n = 1）. Their needs help included: (a) help from HT and other health professionals（n = 10）; (b) spiritual support（n = 11）; (c) assistance from HTR supporting groups（n = 1）; and (d) social welfare resources（n = 4）.
The DRS experiences for PFC were: (a) worries about HTR’s physical discomforts caused by disease/treatment（n = 1）; (b) psychological turmoil caused by HTR’s unstable health condition（n = 6）; (c) worries about the loss of HTR’s healthy status（n = 5）; (d) psychological stress from HTR’s inadequate physical strength after HT（n = 2）; (e) worries about poor quality of care by PFC（n = 2）;. (f) being unable to take care of other families and HTR in the same time（n = 1）; (g) psychological suffering from the HTR’s suffers（n = 1）; and (h) difficulties in having part-time job to meet financial needs（n = 1）. The PFC’s needed help were identical to the HTR’s. In terms of HTR’s appraisals for discharge-planning, the benefits were systematical help from health professionals（n = 10）, exchanges of recovery tips with other HTR（n = 2）, and learning strategies of health information（n = 2）. The limitations were lacking of complete health teaching package（n = 5） and advertisement（n = 2）, as well as inadequate health care manpower such as case manager（n = 2）.
Conclusions This project identified the contents, rationales, coping strategies and needed help of Taiwan’s adult HTR and their PFC during the most difficult recovery time from HT named as DRS. In order to facilitate the adult HTR’s post-HT recovery, their experiences of DRS need to be prevented, early detected and effectively managed.
HT health professionals are encouraged to further develop related caring plans and systematically evaluate the effectiveness of the protocols. The findings of this project can also serve as innovative information for other organ transplant societies.
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