The meaning of being in uncertainty after heart transplantation – an unrevealed source to distress

• Published in: European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology Vol. 16; no. 2; pp. 167 - 174
• Main Authors: Almgren, Matilda, Lennerling, Annette, Lundmark, Martina, Forsberg, Anna
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-02-2017; Oxford University Press
• Subjects: Adaptation, Psychological; Adult; Aged; Female; Health Sciences; Heart Transplantation - adverse effects; Heart Transplantation - psychology; Heart transplants; Humans; Hälsovetenskap; Hälsovetenskaper; Male; Medical and Health Sciences; Medicin och hälsovetenskap; Middle Aged; Nursing; Omvårdnad; Qualitative Research; Stress, Psychological - etiology; Stress, Psychological - therapy; Transplants & implants; Uncertainty; Sweden; distress; phenomenological–hermeneutic; qualitative study; uncertainty; cardiac event; Heart transplantation
• ISSN: 1474-5151; 1873-1953; 1873-1953
• DOI: 10.1177/1474515116648240

Background:
As many as 88% of heart transplant recipients (HTRs) suffer from psychological distress. Both psychosocial factors and physical health are associated with increased psychological distress. However, the causes and impacts of psychological distress are unclear. HTRs strive for a sense of control over their health and daily lives in order to improve their psychological well-being. Perceived control was found to be related to the patients’ construction of normality, their emotional state, as well as their thoughts and feelings of uncertainty about the future.
Aim:
An in-depth exploration of the meaning of uncertainty during the first year after a heart transplantation (HTX).
Method:
A phenomenological–hermeneutic method was employed. Interviews were conducted with 14 patients, four women and ten men, with a mean age of 51 years (range: 28–67 years).
Results:
Being in uncertainty after HTX means losing a sense of coherence, which shatters the HTR’s whole worldview. The HTRs search for meaning and strive for coherence, which is no longer achievable. By using a nursing theory, we understand that uncertainty should be seen as a natural state among HTRs. It constitutes the starting point from which the HTRs can reorganise their self-structure and find a new view of life. When striving for normality, certainty and predictability (i.e., the healthcare professional’s perspective), we block or prolong this process, thus causing distress among HTRs because they are unable to create a new orientation in life.
Conclusion:
This study presents a hypothesis of the primary cause of psychological distress after HTX and provides a useful framework for how to approach this condition.