The effect of self-efficacy, depression and symptom distress on employment status and leisure activities of liver transplant recipients

[[abstract]]Aim To examine the effect of self‐efficacy, subjective work ability, depression and symptom distress on and to provide a description of, the employment and leisure activities of liver transplant recipients. Background Return to work and leisure activities have become an important aspect of life for liver transplant recipients worldwide. An investigation of the factors that influence the employment status and leisure activities has been recommended as a means to help transplant recipients restore their productivity. Design This was a cross‐sectional, descriptive and correlational study in 2010. Methods A convenience sampling method was used. Data were collected using a set of questionnaires that were administered retrospectively. A total of 106 liver transplant patients were included in this study. Results The post‐transplantation employment rate was 45·2%. The positive predictors of employment were higher subjective work ability and higher symptom distress. Gender (female), monthly family income (<US $2,000), depression and unemployment pre‐transplantation were negatively associated with employment status. Of the 106 patients, 62 (58·5$2,000 was associated with a low diversity of participation in leisure activities. Conclusion Subjective work ability and symptom distress were positive predictors of employment, while depression was a negative predictor. Nurses in the transplant team should focus on increasing a sense of confidence, decreasing depressive symptoms and monitoring the severity of symptoms to improve the employment status of liver transplant recipients

Effects of self-efficacy, self-care behaviours on depressive symptom of Taiwanese kidney transplant recipients.

[[abstract]]Aims.  The aim of this study was to examine the effect of self‐efficacy on depression and to consider the mediating effect of self‐care behaviour. Background.  Depression is a problem for kidney transplant recipients and can compromise their quality of life. From other studies on chronic illnesses, self‐efficacy and self‐care behaviour have been considered to be potential determinants for depressive symptoms. However, none of these previous studies have investigated the relationships among these variables in kidney transplantation recipients. Design.  A cross‐sectional survey employing correlation design and purposive sampling was used. Methods.  One hundred and seventy‐seven persons who had received a kidney transplant participated. A self‐administrated questionnaire and a medical record audit were used to collect data. The data were analysed using correlation and hierarchical linear regression methods. Results.  The average score of depressive symptoms was 8·61 SD 7·64. Among the participants in the study, 32·8% had scores of depressive symptoms higher than 11 (indicating mild to severe symptoms of depression). Self‐efficacy and self‐care behaviour had direct negative effects on depressive symptoms. Self‐care behaviour had partial mediating effect on the relationship between self‐efficacy and depression. Total variance explained was 23%. Conclusion.  Depressive symptoms are still a problem that need to be addressed among kidney transplantation patients. Patients who have higher self‐efficacy and higher self‐care behaviour will have lower depressive symptoms. Our results support that self‐efficacy is the significant predictor of depressive symptoms. Relevance to clinical practice.  Self‐efficacy is a powerful and modifiable determinant of depressive symptoms. We should design interventions that focus not only on the skill aspects of self‐care behaviour but also on those that have a strong connection with self‐efficacy. We could incorporate the self‐efficacy‐enhanced strategies as proposed by social cognitive theory into the kidney transplantation care programme

Predicting survival with the palliative performance scale in a minority-serving hospice and palliative care program

[[abstract]]Palliative Performance Scale (PPS) scores have shown potential for prognosticating survival in Caucasian samples, but have not been studied for prognostic value in cancer patients from minority groups. Using data obtained from a retrospective chart audit of 492 cancer patients admitted over an 18-month period to a minority-serving home-based hospice and palliative care program, we examined the relationship between PPS scores and length of survival (survival days). Patients with PPS scores of 10% to 30% had fewer survival days than those with scores of 40% and those with scores of 50% to 100% (median = 6, 19, and 34 days, respectively; F = 25.02, P < 0.001). A PPS score of 40% serves as a reliable inclusion criterion for a study requiring two weeks for completion, while 50% to 100% is required for a three-week study. Findings from a predominantly minority sample are similar to those from predominantly Caucasian samples

Predictors of decision ambivalence and the differences between actual living liver donors and potential living liver donors

[[abstract]]Abstract Background The decision to become a living liver donor is a stressful event. Ambivalence in decision making may result in psychological distress. Thus, the purpose of this study was to provide a description of the ambivalence of potential living liver donors, to examine the predictors of ambivalence, and to compare the ambivalence of potential living liver donors with that of actual living liver donors. Methods This descriptive and correlational study was conducted in a medical center from August 2013 to December 2015. Self-reported questionnaires were used to collect data. A total of 263 potential living liver donors who were assessed for donation to their parents were included in this study. Results The mean age of the total sample was 30.7 years (SD = 6.39, range = 20–47), and males comprised 53.6% of the sample. The majority of the potential donors had a college education (70.8%) and were single (63.5%). Of the total sample, the mean score for ambivalence was 4.27 (SD = 1.87, range = 0–7). Multivariate analysis revealed that the Mental Component Summary (MCS) of quality of life (β = -0.24, p < 0.01), family support (β = -0.17, p = 0.007), and intimacy (β = -0.13, p = 0.04) were significant protective predictors of ambivalence. Actual living liver donors had significantly lower ambivalence (3.82 versus 4.60), higher intimacy with recipients (3.55 versus 3.34), higher MCS (45.26 versus 42.80), and higher family support (34.39 versus 29.79) than did the remaining potential living liver donors. Conclusion Ambivalence is common in potential living liver donors. The MCS of quality of life, family support, and intimacy were protective predictors in terms of ambivalence. Future research should explore other factors and design interventions targeted toward reducing ambivalence, promoting family support, and enhancing the mental dimensions of quality of life in potential living liver donors

The coping experience of Taiwanese male donors in living donor liver transplantation

[[abstract]]Background: Living donor liver transplantation is an option for effective treatment for patients with liver disease or a liver tumor. One disadvantage, however, is the risk of complications or death in a healthy donor. Thus, promoting the donor’s safety and well-being is a major goal of transplantation care. In this regard, more research on physical and psychological complications and adjustment among donors is needed. b Objectives: The aim of this study was to describe the experiences of living liver donors, focusing on their perceptions of living liver transplantation and corresponding coping strategies. b Methods: The data were analyzed using content analysis in this qualitative design. b Results: Seven of 12 donors, all men, agreed to participate in the study. The core theme that emerged in regard to adjustment was ‘‘maintaining peace of mind.’’ In addition, there were 4 subthemes: (a) removing themselves from information, (b) viewing the surgery as common, (c) having overall confidence, and (d) assigning value to their decision. b Discussion: Living donor liver transplantation is a treatment option that requires acceptance by both the donor and his or her family. The process is enormously stressful, and the living liver donor needs adjustment strategies to maintain his or her peace of mind throughout the proces

Primary caregiver stress as related to caring for a living-related liver transplantation recipient during the post-operative stage: A qualitative study

[[abstract]]Abstract Aim.  The aim of this study was to explore the stress experienced by the primary family caregiver of the living‐related liver transplantation patient during the postoperative stage. Background.  Living‐related liver transplantation is a treatment choice for end‐stage liver disease patients who face a shortage of available donated livers. Research suggests that the caregiver of the liver transplant recipient experiences tremendous stress because a family member is on the waiting list. Nevertheless, there are limited studies that investigate the caregiver experience of stress during this surgery. Method.  This qualitative study used face‐to‐face semi‐structured interviews to understand the subjective experiences of study participants. The study participants were drawn from a tertiary medical centre in northern Taiwan. During the data collection period (October 2007 to May 2008), 6 of the 12 caregivers agreed to participate in this study (N = 6), all of whom were female and, except for one participant, were the wives of the recipients. Results.  Participant stress was caused by the gap between expectations and primary caregiving experiences. In particular, the five themes that were identified: (a) unstable sentiment towards liver transplantation; (b) entanglement of burden; (c) non‐synchronized family interaction; (d) distance from the healthcare professional; and (e) concern about the protector role function. Conclusions.  The stress of primary caregivers of living‐related liver transplantation is related to the gap between expectations and primary caregiving experiences. The immediate postoperative stage is a critical one for health professionals to provide intervention and management

Factors that determine self-reported immunosuppressant adherence in kidney transplant recipients: a correlational study

[[abstract]]Aims To determine the factors related to immunosuppressant therapy adherence in kidney transplant recipients in Taiwan. Background Adherence to immunosuppressant treatment is critical after kidney transplantation. Thus, the factors associated with self‐reported medication adherence in kidney transplant recipients warrant investigation. Design The study used a cross‐sectional and correlation design. Methods A convenience sample of 145 kidney transplant recipients was included. Structured questionnaires were used to collect data during 2012–2013. Multivariate linear regression was used to examine the factors related to immunosuppressant therapy adherence. Results Over half of the participants were female (54·5%), mean age was 45·5 years, and mean year after transplant was 7·4. The mean score for medication adherence was 29·73 (possible score range 7‐35). The results of the multivariate linear regression analysis showed that gender (male), low income with a high school or college education, years after transplantation and concerns about medication taking were negatively associated with adherence. Medication self‐efficacy was positively associated with adherence. Therapy‐related factors, partnerships with healthcare professionals and having private healthcare insurance did not significantly relate to immunosuppressant therapy adherence. Conclusions Kidney transplant recipients demonstrated a high level of adherence. Strategies to enhance patients’ self‐efficacy and alleviate concerns about medication may promote medication adherence. Male patients, those with a lower income and those with a higher education level, should be a focus of efforts to maintain adherence to the medication regimen

Self-efficacy, self-care behaviours and quality of life of kidney transplant recipients

[[abstract]]Aim.  This paper is a report of an exploration of the effects of self‐efficacy and different dimensions of self‐management on quality of life among kidney transplant recipients. Background.  Self‐efficacy is an important factor influencing self‐management. Patients with higher self‐efficacy have better self‐management and experience better quality of life. Self‐efficacy influences the long‐term medication‐taking behaviour of kidney transplant recipients. Method.  A longitudinal, correlational design was used. Data were collected during 2005–2006 with 150 adult kidney transplant recipients on self‐efficacy, self‐management and quality of life using a self‐efficacy scale, self‐management scale and the Medical Outcomes Scale SF‐36 (Chinese), respectively. Relationships among variables were analysed by path analysis. Results.  Participants with higher self‐efficacy scored significantly higher on the problem‐solving (β = 0·51), patient–provider partnership (β = 0·44) and self‐care behaviour (β = 0·55) dimensions of self‐management. Self‐efficacy directly influenced self‐care behaviour and indirectly affected the mental health component of quality of life (total effect = 0·14). Problem‐solving and partnership did not statistically significantly affect quality of life. Neither self‐efficacy nor self‐management had any effect on the physical health component of quality of life. Conclusion.  Transplant care teams should incorporate strategies that enhance self‐efficacy, as proposed by social cognitive theory, into their care programmes for kidney transplant recipients. Interventions to maintain and improve patients’ self‐care behaviour should continue to be emphasized and facilitated. Support to enhance patients’ problem‐solving skills and the partnership of patients with health professionals is needed

Relationships among self-management, psycho-physical stress and health of kidney transplant recipients

【背景與目的】臟移植的主要適應症為末期腎臟疾病，一般認為腎臟移植的成果優於血液透析與腹膜透析治療，然手術後還是有可能經歷各種生理與心理的壓力而衝擊到病人的健康，腎臟移植病人的健康一般是以客觀的移植體存活及主觀的生活品質為指標，移植成功指的是移植體與病人的存活，而隨著移植體存活與病人存活率的提升，移植照護目標也轉向以提升病人的生活品質為重點，許多的因素可以影響腎臟移植病人的健康，有些是屬於醫療介入因素，有些則是受到病人的知識行為與社會背景所影響，從過去相關研究指出病人的自我效能及自我管理可以有效降低生理心理壓力，而促進病人的健康，因此本研究目的為探討腎臟移植手術後病人的自我效能及自我管理對壓力及健康的影響。方法】研究為一相關研究，以longitudinal panel收集資料，每位個案收集兩次資料，間隔6個月，採目的取樣法，自民國94年8月起到95年11月止於北部某一醫學中心共收集到150位個案。最主要的資料收集工具為自擬量表及問卷、貝克氏憂鬱量表以及MOS SF-36生活品質量表中文版，資料分析方法主要以多元迴歸分析法( multiple regression)進行因徑分析(path analysis)， 結果】研究的主要研究結果歸納為：150位病人的移植手術後平均年數為4.64年，平均年齡41.79歲，多數為臨危捐贈(屍腎)移植(n=128, 85.3%) ，生活品質次量表得分最高的是「生理功能」，得分最低的是「一般健康」，在兩次資料收集的過程中，移植腎功能及生理健康有顯著進步。在第一次收案時間，自我效能的平均得分為42.31，問題解決為30.56，自我照顧行為為39.73，夥伴關係為11.94。自我效能對問題解決、夥伴關係及自我照顧行為呈現正向的直接影響效果，β值分別為0.50、0.44及0.54；自我效能對心理健康的整體影響效果為0.37，自我效能對生活品質的影響效果為間接的，藉著自我照顧行為的作用，而提升生活品質。自我管理方面，自我照顧行為對生活品質之心理健康的直接影響效果β值為0.25，而問題解決及夥伴關係對生活品質沒有顯著影響效果。結論】臟移植病人的自我效能、自我管理、生理心理壓力及生活品質之間有顯著的關係，本研究結果有助於作為移植照護實務的實証基礎，且支持有關腎臟移植照護應強調促進病人的自我效能及自我管理。【Background and specific aims】idney transplantation (KT) has emerged as the renal replacement therapy of choice for patients with end-stage renal disease. Advances in surgical and medical protocols have resulted in excellent survival rates. More recently, greater attention has also been given to quality of life (QOL). Many factors influence the health outcome of kidney transplant recipients including medical issues, knowledge, behavior and social background of patients. Evidences have been shown that self-efficacy and self-management are able to decrease individual’s physical and psychological stress and to improve health effectively. The purpose of this study is to examine the effect of self-efficacy and self-management on stress and health outcome of kidney transplant recipients.Methods】ogitudinal panel, descriptive correlational design and purpose sampling was employed in this study. One hundred and fifty kidney transplant recipients from single medical center participated. We have employed two data collection in six months apart dursing the period of August 2005 to Nomenber 2006. We use questionnaires which were developed by author for this study, Beck Depression Inventory and MOS SF-36 quality of life questionnaire as major data collecting tools. The data were analyzed by multiple linear regression methods.Results】he mean age of the participants was 41.79 years. The mean duration post the surgery was 4.64 years. Most of the participants have received the cadaver kidney transplantation (n=128, 85.3%). The highest score of the subscale of MOS SF-36 was “physical function, PF”, the lowest score was “general health, GH”. The renal graft function and the “physical health ” of quality of life was better at the second data collecting time. At the first data collection time, the average score of self-efficacy was 42.31, problem solving was 30.56, partnership was 11.94 and self-care behavior was 39.73. Participants who have higher self-efficacy will have better problem solving (β = 0.50), partnership (β= 0.44), and self-care behavior (β = 0.54). Self-efficacy had positive effect on quality of life indirectly (the total effect was 0.37). Self-efficacy can influence the self-care behavior and then had indirect effect on the quality of life. Self-care behavior has direct effect on the “mental health ” subscale of quality of life ( β = 0.25). The score of problem solving and partnership did not show any significant effect on quality of life. Conclusion】here are significant relationships among self-efficacy, self-management, physical and psychological stress, and quality of life of renal transplant recipients. These results can be used as the evidence base for the care practice of kidney transplantation. The results of this study also support that kidney transplantation care program should emphasis on promoting patient’s self-efficacy and self-management.目錄………………………………………………………………………i目錄…………………………………………………………………iii目錄…………………………………………………………………iii謝………………………………………………………………………v文摘要………………………………………………………………vii文摘要…………………………………………………………………ix壹章 緒論 一節 研究背景與重要性………………………………………………1二節 研究目的…………………………………………………………6三節 名詞界定…………………………………………………………6貳章 文獻查證 一節 腎臟移植病人的生理心理壓力………………………………8二節 腎臟移植病人的健康…………………………………………16三節 自我管理的相關概念…………………………………………30四節 自我效能的相關概念…………………………………………44五節 腎臟移植病人的自我效能、自我管理、生理心理壓力與健康的關係…………………………………………………………………49六節 文獻總結………………………………………………………54七節 研究概念架構…………………………………………………55八節 主要研究假設…………………………………………………56叁章 研究方法 一節 研究設計………………………………………………………57二節 研究對象與取樣方法…………………………………………57三節 研究變項的操作性測量………………………………………59四節 研究量表的項目分析與信效度測試…………………………68五節 資料收集方法與過程…………………………………………86六節 統計分析方法…………………………………………………87七節 樣本流失的預防與流失個案的資料處理……………………90八節 研究進行過程…………………………………………………90九節 研究倫理考量…………………………………………………90肆章 研究結果 一節 前測結果………………………………………………………92二節 收案說明………………………………………………………94三節 研究變項的描述性與比較分析………………………………96四節 自我效能、自我管理對健康之影響關係的分析……………112伍章 討論 一節 腎臟移植病人的生理心理壓力及健康的情形………………125二節 腎臟移植病人的自我效能與自我管理………………………133三節 腎臟移植病人的自我效能對自我管理的影響………………135四節 自我效能、自我管理對生活品質的影響……………………137五節 生理壓力、心理壓力、移植腎功能對生活品質的影響……142陸章 結論與建議 一節 結論……………………………………………………………145二節 護理應用………………………………………………………148三節 研究限制與建議………………………………………………154文參考文獻…………………………………………………………156文參考文獻…………………………………………………………158錄 錄一 量表專家效度名單…………………………………………176錄二 問題解決量表………………………………………………177錄三 夥伴關係量表………………………………………………178錄四 自我照顧行為量表…………………………………………179錄五 自我效能量表………………………………………………180錄六 生理壓力指標量表…………………………………………181錄七 症狀困擾量表………………………………………………182錄八 壓力感受量表………………………………………………183錄九 生活品質量表-MOS SF-36…………………………………184錄十 基本資料表…………………………………………………187錄十一 病歷查核紀錄表……………………………………………188錄十二 生理壓力指標審查專家名單………………………………191錄十三 參與研究同意書…………………………………………192錄十四.1 研究倫理委員會(IRB)審查通過函-台大醫院…………193錄十四.2 研究倫理委員會(IRB)審查通過函-長庚醫院…………194錄十五 免疫抑制劑的種類、主要作用及副作用…………………195錄十六 常態分佈檢視-直條圖……………………………………196錄十七 生活品質之生理健康散佈圖(Scatter plot)……………198錄十八.1 各方程式中依變項殘差值的相關情形…………………199錄十八.2 依變項殘差值與其預測變項的相關情形………………199目錄-1 影響移植腎功能存活的因素 21-2 自我效能、自我管理、生理心理壓力及健康的關係圖 55-1 生活品質之心理健康(MCS)之直條圖(T2) 196-2 生活品質之生理健康(PCS)之直條圖(T2) 196-3 移植腎功能(CGFR)之直條圖(T2) 197-4 生活品質之生理健康之散佈圖(scatter plot) 198-5 自我效能、自我管理對生理心理壓力及健康的因徑圖 123-6 自我效能、自我管理對健康的影響(簡圖) 124 目錄-1 MOS SF 36各構面相關題目、最高、最低可能得分及間距… 65-2 MOS SF 36需要重新譯碼及反向計分的題目………………… 65-3 問題解決量表的項目分析結果………………………………… 73-4 夥伴關係量表的項目分析結果………………………………… 74-5 自我照顧行為量表的項目分析結果…………………………… 75-6 自我效能量表的項目分析結果………………………………… 76-7 症狀困擾量表的項目分析結果………………………………… 77-8 壓力感受量表的項目分析結果………………………………… 78-9 自我效能量表的模式適合度與係數…………………………… 81-10 問題解決量表的模式適合度與係數…………………………… 82-11 夥伴關係量表的模式適合度與係數…………………………… 83-12 自我照顧行為量表的模式適合度與係數……………………… 84-13 自擬量表部分的題數及內在一致性信度……………………… 85-1 自我管理各變項及心理壓力各變項的得分情形(前測)………. 93-2 健康相關生活品質八個次量表的得分情形 (前測)…………... 93-3 已收案、未回、兩次收案及刪除個案的基本屬性比較……… 95-4 基本屬性………………………………………………………… 97-5 疾病及治療變項………………………………………………… 99-6 兩個收案期間再住院次數及人數情形………………………… 101-7 再住院原因的人數、住院次數及天數………………………… 101-8 共病症罹患情形………………………………………………… 103-9 共病症類別人數及百分比情形………………………………… 103-10 生理壓力指標各項情況的人數及百分比……………………… 105-11 憂鬱程度、症狀困擾及壓力感受得分情形…………………… 106-12 憂鬱程度的分類………………………………………………… 106-13 壓力感受的單項平均值、有此感受的人數及百分比………… 107-14 症狀困擾的單項平均值、有此困擾的人數及百分比…………. 108-15 血中肌氨酸酐值、血中尿素氮值及calculated GFR…………… 109-16 生活品質八個次量表的得分情形……………………………… 110-17 生活品質兩大建構的得分情形………………………………… 110-18 問題解決、夥伴關係、自我照顧行為及自我效能的得分情形.. 111-19 自我效能對自我管理各項的影響……………………………… 119-20 影響生理壓力、症狀困擾及憂鬱程度的分析結果…………… 120-21 影響壓力感受、移植腎功能的分析結果……………………… 120-22 影響生活品質之生理健康的分析結果………………………… 121-23 影響生活品質之心理健康的分析結果………………………… 12