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0.05). Implications for Practice: According to the results of this study, scheduled visitation by family members caused no significant differences in the physiological indices of ICU patients. It is recommended that future studies be conducted as to confirm this finding and revise patient visitation policies in hospitals.]]>
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18 years, not being hospitalized for transplant rejection, and two-month interval since renal transplant.
The data collection instrument was Transplant-Related Stressors Scale. The 17-item scale was developed by Frazier et al (1995). Before initiating the study, the scale was translated into Persian based on forward-backward method(11).
Items of this scale are categorized into five subscales assessing future health, finances, side-effects of medicinal treatment and physical limitations, interpersonal relations, and following the medical regimen. Patients are were asked to determine each item stressful on a scale ranging from 1 (not stressful) to 5 (extremely stressful); therefore, the scoring range is 17- 68 (8).
Validity and reliability of the scale were established by Weng (2008) and Achille (2004) with CVI=0.9 and Cronbach’s alpha=0.86 (3, 12). For the Persian version of the instrument, as estimated by expert panel, S-CVI score and Cronbach’s alpha were 0.89 and 0.89, respectively.
The obtained data were exported into SPSS, version 15; the data were analyzed using descriptive and inferential statistics (analysis of variance and independent t-test).
To ensure confidentiality, participants’ names were removed from the questionnaire and the questionnaires were coded by numbers.
Results
The majority of the subjects (65%) were male, aged between 18 and 60 years old (mean: 37±11.38 years), married (71.6%), and had basic education. Mean duration of being on renal transplant list was 38±44.71 months. Most subjects (56.8%) had undergone transplant less than two years before.
The most common stressor was fear of graft rejection and the least common stressor was getting medical questions answered (table 1).
The mean stress score in the male patients was 39.99±0.65 and in female was 38.40±9.98. This study used independent t-test to determine the effect of demographic variables on stress level. There were no significant differences between stress score and duration of being on the transplant waiting list (F=0.104, P=0.9) and duration of dialysis (F=0.694, P=0.5). However, there was a significant difference between stress score and age ((F=4.48, P=0.01) and marital statue (t=2.876, P=0.004) The highest stress scores were in ages less than 33 years old and the lowest stress scores were in ages more than 50 years.
Table1: Mean and standard deviation of the stressors in renal transplant patients
Standard deviation
Mean
Items
0.92
3.37
Fear of graft rejection
1.00
3.01
Financial pressure
1.04
2.68
Uncertainly about future health
1.25
2.60
Travelling for check-up
1.05
2.43
Physical limitation
0.98
2.39
Medicinal side effects
1.01
2.38
Lack of social support
1.10
2.32
Dietary restriction
1.01
2.30
Handling insurance
1.15
2.24
Dependency on medical personnel
1.06
2.17
Weight gain
0/94
2.06
Change in appearance
0.99
2.05
Being a burden to others
1.06
1.96
Susceptibility to other illnesses
1.06
1.82
Change in relationship with spouse
0.87
1.60
Getting medical questions answered
Discussion
The present study was conducted to determine the most common stressors in patients undergoing renal transplant. It was found that the main stressors in these patients were fear of graft rejection, financial issues, and uncertainly about future health. This result was not in agreement with study Frey (1990). He stated that the main stressor was fear of hospital readmission (7). The reason for this discrepancy might be the fact that Frey assessed stress during the first six weeks after transplant. Due to patients’ unstable condition, particularly in the first few days after transplant, they were readmitted to hospital for creatinine level and renal function examinations; thus, this stressor will be ruled out after some time.
In line with our study, several other studies demonstrated that fear of graft rejection is one of the most important stressors (3, 5, 8, 13-14). Graft rejection threatens transplant patients’ health and it implies undergoing dialysis and tolerating painful needles again. Renal transplant patients experience multiple stresses during dialysis such as awaiting organ transplant, financial pressure, and difficult process prior to receiving transplant.
According to the present study, a stress-generating factor related to liver transplant was financial pressure. Consistent with this result, Frazier (1995) showed that an important stressor in patients was financial pressure due to giving repeated tests, visits, follow-up issues(8). Despite consensus on financial pressure, the cost of insurance was not one of the stressors in some studies such as Chen (2010).
He stated that financial issues were not a significant concern in Taiwan. The Taiwanese have national health insurance; therefore, patients are only responsible for a small portion of the costs (6). However, since financial problems are one of the important stressors in countries like Iran, where transplant patients are directly responsible for treatment costs and health insurance is responsible for only a small portion of the costs.
In this study, uncertainty about future health was the third highly frequent stressor among the patients. McCormick (2002), quite consistent with our results, stated that uncertainty about future health was a major stressor in transplant patients, which can hinder recovery after renal transplant. Although, patients have learned some coping strategies for the post-transplant period, they are concerned about future health, returning to dialysis (15).
In the present study, fear of graft rejection was not the main stressor, the reason for which might be the religious and spiritual beliefs of Muslim patients. Muslims deem Allah as an omnipotent and all-knowing being, which results in accepting their fate with satisfaction.
According to the results, there was no significant difference between stress score and the length of post-transplant time; thus, passage of time after transplant cannot affect severity of stress.
Chen (2010) proposed that one year after transplant, the patients experienced lower level of stress; however, disregarding post-transplant time, stress continued to some extent (16). Kong (1999) demonstrated that renal transplant patients may experience stress of moderate intensity long after transplant (17). It is possibly reason that the problem related post time transplant is continuing, the stress factor related to transplant is continuing(18).
Implications for Practice
Disregarding the outcome of renal transplant, patients experience stress during post-transplant period. There are differences in type and severity of stress-generating factors depending on culture, health care system, insurance support, and religion.
These stressors can deteriorate patients’ physical, psychological, social, and spiritual condition; therefore, identifying and managing these stressors is important. Determination of transplant patients’ perception of stressors can help nurses promote patient outcome. Nursing staff are recommended to employ evidence-based practice to identify vulnerable patients and provide appropriate care for patients.
Acknowledgments
This article is part of a PhD dissertation and research project approved and supported by Ahvaz University of Medical Sciences (grant code: 1392.335). The authors would like to thank the Research Board of Ahvaz University of Medical Sciences, as well as the authorities, staff, and transplant patients of Montaserieh Hospital.
Conflict of interest
The authors declare that there is no conflict of interest.]]>
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