Comparison on Gender-Specific Dilemma and Coping Strategies Perceived By Heart Transplant Recipients and Their Families

• Main Authors: Ya-Ling Chen, 陳雅玲
• Other Authors: Fu-Jin Shih
• Format: Others
• Language: zh-TW
• Published: 2013
• Online Access: http://ndltd.ncl.edu.tw/handle/37529548565084827909

碩士 === 國立陽明大學 === 臨床暨社區護理研究所 === 101 === Background According to the statistics of American Heart Association (AHA) in 2009, there are 5.8 million heart failure patients in America. The numbers of new cases are five hundred and fifty thousand annually, and the increased new cases are related to aging of population and extended average life expectancy (Willetle, Surrells, Danis, and Bush, 2007). Heart failure usually accompanies many physiological symptoms, which are needed to be improved by treatment in the hospital. One hundred and thirty thousand patients were admitted due to heart failure, and the medical expenses were as high as 7.7 billion dollars (Kao, Ding, Yeh and Chang, 2008). Besides physiological symptoms-induced discomforts, heart failure patients may not be able to fulfill job requirements due to physical overload. Long-term discomfort, dependency on caregivers, changes of life styles, and strict diet and medication control all lead to patient depression and anxiety. When the condition deteriorates and the symptoms cannot be improved, heart transplantation is the only therapeutic strategy. According to the statistics of the International Society for Heart and Lung Transplantation (ISHLT) in 2007, eighty thousand patients had received heart transplantation, and five- and ten-year survival rates are 65% and 45%, respectively (Taylor et al., 2008). The post heart transplantation survival rates in one, five and ten years are 80%, 73%, and 69%, respectively in Taiwan (National Health Insurance Administration, 2009). After receiving heart transplantation, taking lifelong immunosuppressive drugs and obtaining biopsies regularly in follow-up clinics are necessary in order to confirm if there are any signs of rejection. With regard to heart transplantation recipients, they not only worry about rejection, infection and death (Frigerio et al., 2008; Goezmann et al., 2008), but suffer the many side effects derived from immunosuppressive drugs. Besides physiological discomfort, the recipients receive lots of psychological pressure after surgery, such as fear of death, worry about recovery, and may easily become melancholy, depressed and anxious (Kuhn, 1988). In addition, heart recipients are concerned with their competence for original work, how to go back to their previous normal life, and not to be the burden of others (Christie et al., 2008; Kirk et al., 2008). When heart recipients are admitted, they need major care givers’ company in the hospital, and major caregivers of heart recipients also endure enormous pressures, far more than the ones of other general diseases (Dew et al., 2004). Starting from the period of heart failure under medical treatment, to the moment when heart transplantation is required, the major caregiver needs to stay aside with the recipient in order to understand and supply proper care at each stage, learn how to take care of the recipient, and provide psychological support continuously. All of these require hard efforts from the major care giver. Some stereotypes about the roles of men and women exist in the society. Men are expected to express manhood and to be responsible for the financial stability of the family; on the contrary, women are expected to stay at home and be the major caregiver for the family, which represent part of feminine characteristics (Yan, 2004; Huang, Wu, 2004). However, whether the stereotypes and the expectations about the roles and functions of both genders affect the recovery process of heart recipients and the care provided by major caregivers, it is important to compare the differences in recovery process of heart recipients and the care provided by major caregivers between males and females. This information will help us better understand about the evaluations and requirements of nursing in both genders before and after surgery, and subsequently provide more adequate care. Objective 1. To compare the dilemmas and reasons that adult heart recipients encounter at each stage between both genders. 2. To compare the coping strategies that adult heart recipients have at each stage between both genders. 3. To compare the dilemmas and reasons that major caregivers meet between both genders. 4. To compare the coping strategies that major caregivers have between both genders. 5. To compare the assessments for medical team and required assistances that adult heart recipients and their major caregivers have between both genders. Methods This is an exploratory study which focuses on post surgical heart transplant recipients and their major care givers in a specific medical center of north Taiwan. A semi-structured interview strategy was planned to conduct a face to face in-depth interview, and then type the contents as verbatim, finally adopt qualitative method to analyze and summarize the contents of interview. Results We have interviewed 8 heart transplant recipients and 9 major caregivers. There were 5 males and 3 females among 8 heart recipients, their ages from 35 to 58, and the average age was 47.8 years old. All 8 recipients were married, but 2 were divorced after heart transplantation. The longest period after surgery was 4 years and 9 months, and the shortest was 1 year and 5 months. 6 recipients were unemployed after surgery, and 2 had short-term contracted jobs. In view of current diseases, 7 recipients had diabetes, 4 had hypertension, 1 had kidney disease and 1 had gout. There were 7 females and 2 males among 9 major caregivers, 4 were husbands and wives of the recipients, 1 had mother-son relationship with the recipient, 1 was the church member with the recipient, 1 was sister-in-law of the recipient, 1 had father-daughter relationship with the recipient and 1 had father-son relationship with the recipient. All the care givers were between 27 to 58 years old, the average age was 39. 7 of them were married, and 2 of them were single. Currently 2 have hypertension and 1 has lung cancer. During the nursing period, 8 care givers had physical discomfort and weariness, 7 had sore waists and aching backs and insomnia, and those that had headaches and gained or lost weight were 3 each. We will separate and then discuss the issues containing differences of encountered dilemmas, coping strategies, the assessments for the medical team, and required assistance that both genders of heart recipients and major care givers face in three stages, which are “wait for transplantation”, “duration of hospital stay after surgery”, and “postoperative home care ”. The common dilemmas of heart recipients in “wait for transplantation” stage of both genders are: (1) preoperative syndromes endanger life; (2) concerns about receiving transplantation; and (3) desires for healthy recovery as others. The specific dilemma of female heart recipients is their lack of major care givers. The common dilemmas of heart recipients in “duration of hospital stay after surgery” stage are: (1) postoperative discomforts; (2) concerns about recovery; (3) worry that admission and surgical expenses are not affordable; and (4) insecurity of new environment. The specific dilemma of female heart recipients is their lack of major care givers. The common dilemmas of heart recipients in “postoperative home care” stage are: (1) physical discomforts which affect current life; (2) overloaded psychological stresses; (3) uncertainty about the future; (4) the income does not cover expenditure; and (5) fear of different judgment from the society to heart recipients. The specific dilemma of female heart recipients is their lack of major care givers. The common coping strategies of heart recipients in “wait for transplantation” stage of both genders are: (1) learning to adapt physical symptoms; and (2) to have the power of faith and hope. The exclusive coping strategies of female heart recipients are: not getting along with their spouses, their sister-in-law and church members becoming the major sources of care givers. The common coping strategies of heart recipients in “duration of hospital stay after surgery” stage are: (1) in celebration of a new life; (2) thoughts and care from family, relatives and friends; and (3) emotion adjustment and optimistically dealing with the recovery processes. The common coping strategies of heart recipients in “postoperative home care” stage are: (1) learning to re-adapt to physical changes; (2) sufficient nursing information provided by the medical team; (3) support from family and friends is the most powerful motivation for recovery; (4) accepting the new self; (5) emotional changes after major surgeries; (6) looking forward to going back to original life; and (7) saving life expenses. The specific coping strategies of female heart recipients is to seek for financial support from social welfare. The common assessments for medical team and required assistance of heart recipients in “wait for transplantation” stage of both genders are: (1) clear explanations from the transplantation team, which can relieve the recipients; and (2) having intensive care unit tours before transplantation, which will help to relieve anxiety of admission. The exclusive assessments and required assistance of female heart recipients are having the company and experience sharing from successful transplantation recipients. The common assessments and required assistance of heart recipients in “duration of hospital stay after surgery” stage are: (1) the terrible experiences of staying in the intensive care unit, which are very frightening; and (2) the care and encouragement from medical team, which are also inspiring. The common assessments and required assistance of heart recipients in “postoperative home care” stage are: (1) any nursing questions can be solved by making phone calls; (2) if urgent medical care is needed because of postoperative complications, national health insurance guaranteed ward will be available as soon as possible; (3) volunteers trained by the hospital can visit patients at home regularly and provide necessary assistance depending on patient recovery situations; and (4) scheduled appointments arranged by medical staffs, which are greatly helpful for clinical follow ups and requisitions for medications. The specific assessments and required assistance of female heart recipients are: (1) meal delivery services provided by the hospital if the recipients don’t have major caregivers; and (2) the requirements of more patience from the medical staffs especially when the recovery processes are not going smoothly. The specific assessment and required assistance of male heart recipients is to have assistances in applying foreign nursing workers in order to reduce the nursing burdens of the family. The common dilemma of major care givers in “wait for transplantation” stage of both genders is rapid deterioration of the recipients’ condition. The common dilemmas of major care givers in “duration of hospital stay after surgery” stage are: (1) concerns about postoperative recovery of the recipients; and (2) not knowing how to care for the recipients. The common dilemmas of major care givers in “postoperative home care” stage are: (1) physical fatigue; (2) overloaded psychological stresses; (3) conflict with original life; and (4) diverted opinions about home care from relatives and friends. The exclusive dilemma of female care givers is the extra workload for assisting the recipients in recovery. The exclusive dilemma of male care givers is the gender differences, which may affect the fluency of nursing work. The common coping strategies of major caregivers in “wait for transplantation” stage of both genders is to wish for miracles and hope for suitable heart donation. The common coping strategies of major care givers in “duration of hospital stay after surgery” stage are to take care of the recipients closely and learning how to be a good care giver. The common coping strategies of major care givers in “postoperative home care” stage are: (1) sharing nursing workload with family; (2) understand the care givers have overloaded psychological stresses; and (3) readjustments of the caregivers’ pace of life. The specific coping strategies of female care givers are to integrate diverse nursing opinions, seek for assistance from the medical team, and convince themselves as the most proper caregivers. In terms of the assessments for medical team and required assistance, the common assessment and required assistance of major caregivers in “wait for transplantation” stage of both genders is the support and company of the medical team. The common assessments and required assistance of major caregivers in “duration of hospital stay after surgery” stage are the related nursing information and consultations provided by the medical team. The common assessments and required assistance of major caregivers in “postoperative home care” stage are: (1) providing the information and consultation about postoperative frequently asked home care questions; and (2) active care by making phone calls and assistance provided by medical staffs. The specific assessment and required assistance of female major care givers is the assistance in applying foreign nursing workers. Conclusion We found that the dilemmas and coping strategies of heart recipients of both genders in the three stages of “wait for transplantation”, “duration of hospital stay after surgery”, and “postoperative home care” were approximately the same. The results showed that: heart recipients who (1) lacked major caregivers; (2) had more symptoms; (3) had more daily life compromised by symptoms; (4) lived alone; (5) were of the female gender would encounter more dilemmas due to self perception of appearance changes, surgical recovery is not as expected, or social segregation. To prevent post surgical recovery of heart recipients from being affected by living alone or lacking support system, adequate and on time psychological supports, together with financial assistance from community resources, hospital volunteers and charity groups in the society, and the combination of regular visits or evaluations by the volunteers for meal delivery service or various activities are necessary. This study revealed that the marriage status of female heart recipients were very important to postoperative recovery. The major reasons were listed as below: female heart recipients (1) moved away from familiar living environment after getting married; (2) were far away from original family, and their focus were on family after marriage; (3) drifted apart from friends, and job options were chosen for more convenience to take care of the family; (4) had unstable incomes; and in addition, (5) had more obvious symptoms or were not able to go to work before surgery. If the female heart recipients did not get along well with their spouses or got divorced, all of these preoperative reasons would make their situations more difficult, and the recovery processes would be more challenging, such as: their lack of major caregivers or lack of economy. Therefore, marriage status should be brought into part of the pre-transplantation evaluations, and further understand whether the recipients’ spouses would be able to assist the nursing treatment and provide psychological support during postoperative recovery. If the spouse cannot play the role of caregiver, are there any other family members who can provide the nursing treatment? To eliminate the heart recipient’s concerns, it is necessary to choose q major caregiver before performing transplantation. The study results showed that if the nursing relationships between the major caregivers in both genders are the care co-givers, it is easier for both givers to find coping strategies when they are facing dilemmas. However, if the recipient and the caregiver are spouses, and the female spouse is the major caregiver, female are more willing to pay more efforts on nursing, spend longer time to company the recipients, and assist the recipients to release negative emotions or feelings than male caregivers. Additionally, female caregivers more easily regard the nursing work as their own duties. With the stereotypes about the roles of genders, all factors make female caregivers have more nursing burdens in all aspects. Hence more support and approval, attentive listening and realization of the female caregiver’s demands, providing assistance for new resources from the medical team are all necessary for female caregivers to relieve workloads. According to the results of this study, hopefully the transplantation team will understand the differences of encountered dilemmas, coping strategies and required assistance of heart recipients and major caregivers in both genders at different stages, and provide adequate resolutions for the male and female heart recipients and major caregivers to prevent dilemmas from happening as early as possible while performing nursing treatments. In the meantime, the medical team can provide related resources and assistance based on the results of this study as soon as possible to the recipients and major caregivers who suffer from dilemmas during recovery processes more easily. Furthermore, the results may also be helpful to improve the nursing quality of the transplantation team as well as promote the heart recipients’ and major caregivers’ quality of life during recovery in both genders.