Self‐efficacy in the context of heart transplantation – a new perspective

• Published in: Journal of clinical nursing Vol. 26; no. 19-20; pp. 3007 - 3017
• Main Authors: Almgren, Matilda, Lennerling, Annette, Lundmark, Martina, Forsberg, Anna
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-10-2017
• Subjects: Adult; Aged; Chronic Disease - therapy; chronic illness management; Content analysis; Female; Health Care Service and Management, Health Policy and Services and Health Economy; Health Sciences; Heart; heart transplantation; Heart Transplantation - psychology; Heart transplants; Humans; Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi; Hälsovetenskap; Interviews as Topic; Male; Medical and Health Sciences; Medicin och hälsovetenskap; Middle Aged; Nurse patient relationships; Nursing; Nursing Theory; Omvårdnad; patient perspective; qualitative; Qualitative Research; Self Care - methods; Self Efficacy; self‐management; Transplants & implants; Uncertainty; chronic illness management; content analysis; heart transplantation; patient perspective; qualitative; self-efficacy; uncertainty; self-management
• ISSN: 0962-1067; 1365-2702; 1365-2702
• DOI: 10.1111/jocn.13647

Aims and objectives
An in‐depth exploration of self‐efficacy among heart transplant recipients by means of Bandura's self‐efficacy theory.
Background
An essential component of chronic illness management is self‐management, which refers to activities carried out by people to create order, structure and control in their lives. Self‐efficacy is an important aspect of self‐management, which seems to have become the main paradigm for long‐term management after solid organ transplantation.
Design
A directed content analysis using Bandura's self‐efficacy theory.
Methods
Open‐ended, in‐depth interviews were conducted with 14 heart transplant recipients at their 12‐month follow‐up after heart transplantation.
Results
This study generated the hypothesis that from the patients’ perspective, self‐efficacy after heart transplantation concerns balancing expectations to find the optimum level of self‐efficacy. Performance accomplishment was found to have the greatest impact on self‐efficacy, while its absence was the main source of disappointments. It was also revealed that the gap between performance accomplishment and efficacy expectations can be understood as uncertainty.
Conclusions
It is essential to assess both expectations and disappointments from the patient perspective in order to promote an optimum level of self‐efficacy among heart transplant recipients. This includes supporting the heart recipient to adopt mental and physical adjustment strategies to balance her/his expectations as a means of minimising disappointments. The understanding that uncertainty can undermine self‐efficacy is crucial.
Relevance to clinical practice
The merging of the uncertainty in illness and self‐efficacy theories provides an excellent framework for the provision of self‐management support. In addition, focusing on a partnership between the transplant professionals and the recipient is essential because it minimises the use of a behavioural approach.