Social support mediates the relationship between illness perception and psychosocial adaptation among young and middle-aged kidney transplant recipients in China

Behind the Healing: Exploring the Psychological Battles of Kidney Transplant Patients: A Qualitative Insight

Background and Aims

Kidney transplantation is widely regarded as the optimal treatment for end-stage renal disease, offering benefits like prolonged life expectancy, enhanced quality of life, and greater cost-effectiveness compared to dialysis. While dialysis imposes considerable restrictions on patients, including diminished independence, many of these challenges can be alleviated through successful transplantation. However, despite the physical advantages of kidney transplants, the psychological struggles faced by transplant recipients are often overlooked, particularly in Ethiopia. This study aimed to delve into the psychological experiences of kidney transplant patients, shedding light on the emotional and mental battles they encounter post-transplant.

Methods

This qualitative study involved kidney transplant patients at SPMMC (St. Paul's Millennium Medical College). during the study period, regardless of donor type. A total of ten participants were selected using purposive sampling. Data were collected through semi-structured, interviewer-administered questionnaires containing both closed and open-ended questions. The data were transcribed verbatim and analyzed using interpretative phenomenological analysis (IPA). The analysis focused on understanding participants' experiences and their interpretations of these experiences. Themes were identified by examining commonalities and differences in the participants' accounts, with special attention to areas of convergence and divergence.

Results

The analysis revealed both positive and negative psychological experiences among kidney transplant patients. Positive experiences included feelings of "re-birth," thankfulness, strengthened social bonds, freedom from dialysis, enhanced self-efficacy, and increased social support. Negative experiences included dependency, fear of the future, challenges with adherence to treatment, and occasional regret.

Conclusion

Life after a kidney transplant is significantly more positive and empowering compared to life on dialysis. However, psychological challenges remain, highlighting the need for ongoing psychological support to address both positive and negative aspects of the transplant experience. Future research should focus on providing continuous support, including counseling and support groups, and integrating these systems into kidney transplant care to enhance overall recovery.

The mediating effect of job burnout on the relationship between practice environment and workplace deviance behavior of nurses in China: a cross-sectional study

BACKGROUND

Faced with a shortage of nurses in China, the factors affecting the stability of the nursing workforce require urgent attention. The workplace deviance behavior of nurses is considered an important behavior in clinical practice, which will bring negative effects and affect the development of nurse team. However, no research has been done to examine the associations among workplace deviance behavior of nurses, practice environment and job burnout. Thus, this study aimed to determine the influence of practice environment on nurses' workplace deviance behavior and confirm the mediating role of job burnout.

METHODS

This study was designed as a multicentre cross-sectional study, and recruited 598 nurses in China to complete a survey of the general information questionnaire, Scale of Workplace Deviance Behavior of Nurses, Practice Environment Scale, and Maslach Burnout Inventory General Survey. The model was examined using descriptive analysis, Pearson's correlation analysis, and the PROCESS Macro in SPSS 26.0.

RESULTS

The results of the correlation analysis demonstrated a significant relationship between the practice environment and work deviance behavior of nurses, as well as a negative relationship between job burnout and these two factors. Moreover, the relationship between practice environment and work deviance behavior among nurses was partially mediated by job burnout.

CONCLUSION

A healthy practice environment and a decrease in job burnout could directly lower the work deviant behavior of nurses. Hospital managers must actively endeavor to improve the practice environment for nurses by fostering a just, fair, and supportive practice environment and by keeping lines of communication open and strong with the nursing staff. Furthermore, managers can also reduce nurses' work deviance behavior by lower their job burnout.

Self-Management of Kidney Transplant Recipients Research: A Comprehensive Bibliometric Analysis

Objective

This study analyzes research trends in self-management among kidney transplant recipients to inform future directions.

Methods

Bibliometric analysis was performed on 444 English articles related to self-management of kidney transplant recipients in the Core Collection of Web of Science and Scopus databases using COOC 12.8, R software, Microsoft Excel 2019, VOSviewer, and CiteSpace, with a focus on citation ranking, publication year, journal, country, organization, author, impact factor, and keywords.

Results

Four hundred and forty-four English articles revealed the United States as the leading publisher on kidney transplant recipient self-management. Norway's University of Oslo was the most productive institution, with Mirjam Tielen as the most prolific author and SCHÄFER-KELLER as the most influential. Belgium's research was most cited. Emerging hotspots included medication adherence, quality of life, psychological aspects, telemedicine, and health literacy in self-management research.

Conclusion

This study has identified the most influential articles concerning the self-management of kidney transplant recipients, documented the pivotal journals in the field, and noted the most prolific countries, organizations, and authors contributing to the literature, as well as highlighted upcoming research trends. Going forward, the research in kidney transplant recipient self-management should explore the full potential of interdisciplinary integration, particularly by incorporating telemedicine into self-management education. Future efforts should also be directed towards refining the existing post-transplant follow-up management systems and enhancing lifelong care for kidney transplant recipients. Concurrently, there is a need to improve health literacy and self-management capabilities among these patients, with the ultimate goal of improving their prognosis.

The Predictive Power of the Transplant Evaluation Rating Scale (TERS) for Psychosocial Outcomes in Living-Donor Kidney Transplant Recipients: A Two-Year Prospective Study

Background/Objectives: The Transplant Evaluation Rating Scale (TERS) assesses the psychosocial risk of transplant candidates; however, its predictive value for outcomes in living-donor kidney transplant (LDKT) recipients remains unclear. This study evaluated the predictive power of the TERS for psychosocial outcomes in LDKT recipients over two years post-transplant. Methods: In this prospective single-center cohort study, 107 LDKT recipients completed assessments pre-transplant (T0), 6 months post-transplant (T1), and 24 months post-transplant (T2). The outcomes measured were mental distress, physical complaints, and perceived social support. Linear mixed-effects models were used to examine the relationship between the pre-transplant TERS scores and outcomes over time. Results: Higher TERS scores predicted increased physical complaints (p < 0.001) and lower perceived social support (p = 0.035) at all time points. Additionally, higher TERS scores were associated with greater mental distress between T0 and T2 (p < 0.001). A hierarchical partitioning revealed that the TERS accounted for 11.9% of the variance in mental distress, 14.6% of that in physical complaints, and 6.0% of that in perceived social support. Conclusions: The pre-transplant psychosocial risk, as measured by the TERS, significantly predicted the psychosocial outcomes in the LDKT recipients over two years, with small-to-medium effect sizes. The TERS may serve as a valuable tool for identifying patients who could benefit from targeted psychosocial interventions to improve their long-term outcomes.

Transition of care from pediatric to adult nephrology post-renal transplant: a review

Pediatric renal transplant recipients (RTRs) face heightened risks when they transition from a childhood nephrologist to an adult-centered one. The transition of care usually occurs when an individual is between ages 18 and 21 years, although some change providers earlier or later depending on varying circumstances. Turbulence during this shift can significantly impact daily life and, in severe cases, lead to graft loss. Several modern studies have explored the transition from pediatric to adult-centered nephrology care post-renal transplant. In this review, we first provide an overview of the differences between pediatric and adult renal transplant, highlighting unique challenges faced by pediatric patients such as donor-recipient size disparity, growth impairment, and need for additional immunizations. We then emphasize the criticality of a well-planned transition process, identifying factors that can hinder a smooth transition-such as medical and medication nonadherence, lack of health literacy, patient psychosocial challenges, and systemic shortcomings in coordination between care teams. Furthermore, this review outlines existing protocols and risk assessment tools, in addition to highlighting recent advancements aimed at facilitating smoother transitions such as the RISE protocol, readiness assessment, and the use of multidisciplinary teams. Proper implementation of coordinated, evidence-based transition protocols can improve patient outcomes, promote medication and appointment adherence, and reduce graft rejection rates. Efforts from multidisciplinary teams utilizing technology, risk stratification tools, and open communication between providers and patients are key to optimizing the transition process for pediatric RTRs as they transfer to adult-centered care.

The effect of illness perception on psychosocial adjustment of patients with breast cancer and their spouses: actor-partner independence model

OBJECTIVE

With the increase in the prevalence rate and improvements in the survival of breast cancer patients, there is a growing interest in understanding the level of psychosocial adjustment in these patients. The study aimed to describe the illness perception and psychosocial adjustment levels of both breast cancer patients and their spouses, to use the Actor-Partner Interdependence Model (APIM) to clarify the actor-partner relationships between spouses, and to explore the impact of illness perception on psychosocial adjustment to the disease within the joint actions of both spouses.

METHODS

A total of 216 female patients with breast cancer and their spouses participated in the study. They were selected from two tertiary hospitals in Guangdong Province, China from October 2022 to May 2023 using a convenience sampling method. The participants were assessed using the Brief Illness Perception Questionnaire and the Psychosocial Adjustment to Illness Scale to examine the relationship between illness perception and psychosocial adjustment. AMOS24.0 was used to test and analyze the actor-partner interdependence model.

RESULTS

The illness perception score (57.75 ± 10.91) was slightly higher than that of the spouse (57.10 ± 11.00), and the psychosocial adjustment score (64.67 ± 6.33) was slightly lower than that of the spouse (64.76 ± 7.49). The results of the actor-partner interdependence model indicated that there was a couple partner between breast cancer patients and their spouses: the spouse's illness perception significantly affected the patient's psychosocial adjustment (β = 0.095, p = 0.015); the patient's illness perception also significantly affected the spouse's psychosocial adjustment (β = 0.106, p = 0.033). Among them, the patient's psychosocial adjustment was found to be related to the patient's illness comprehensibility or coherence of illness (β = 0.433, p = 0.009), the spouse's emotional illness representation (β = 0.218, p = 0.037), and the spouse's illness comprehensibility or coherence of illness (β = 0.416, p = 0.007), while the spouse's psychosocial adjustment was only related to the spouse's illness comprehensibility or coherence of illness (β = 0.528, p = 0.007).

CONCLUSIONS

The psychosocial adjustment of breast cancer patients is affected by both their own and spouse's illness perception. Therefore, in the future, the healthcare staff can implement early psychological interventions for patients diagnosed with breast cancer and their spouses as a unit to promote the psychosocial adjustment of them.

Early Post-Transplant Adaptation Experience in Young and Middle-Aged People With Kidney Transplant in China: A Qualitative Study

BACKGROUND

Successful adaptation to post-transplantation life in patients who have undergone kidney transplants is crucial. The psychosocial needs of people with kidney transplants are closely related to the health of the transplanted kidney. If transplant recipients cannot adapt to the effects of the transplant, their physical and mental health will be seriously impaired.

OBJECTIVE

The purpose of this study was to explore the early post-transplant adaptation experience of young and middle-aged persons with kidney transplants in China based on the Roy adaptation model.

METHODS

A qualitative descriptive study was conducted using semi-structured interviews. Fifteen young and middle-aged persons with kidney transplant were recruited from a tertiary hospital in China between September 2022 and March 2023 through purposive sampling. Data were analyzed using a thematic analysis approach.

RESULTS

This study identified 4 themes: (1) "two-sided" changes in physiological functioning, (2) "dawn and darkness" (conflicting perceived emotions about the future), (3) role functioning adaptation conflict and impairment, and (4) social isolation and the challenges of coping.

CONCLUSIONS

This study found that early post-transplant adaptation in young and middle-aged people with kidney transplant included both positive and negative experiences, and these findings can provide new insights into research related to successful post-operative adaptation.

Psychosocial adaptation profiles in young and middle-aged patients with acute myocardial infarction: a latent profile analysis

AIMS

We sought to explore the latent classifications of psychosocial adaptation in young and middle-aged patients with acute myocardial infarction (AMI) and analyse the characteristics of different profiles of AMI patients.

METHODS AND RESULTS

A cross-sectional study was performed in 438 Chinese young and middle-aged patients with AMI. The investigation time was 1 month after discharge. Three different self-report instruments were distributed to the participants, including the Psychosocial Adjustment to Illness Scale, the Perceived Stress Scale, and the Social Support Rating Scale. The seven dimensions of the Psychosocial Adjustment to Illness Scale were then used to perform a latent profile analysis. All participants signed informed consent forms in accordance with the ethical principles of the Declaration of Helsinki. Finally, a total of 411 young and middle-aged AMI patients were enrolled. Three distinct profiles were identified, including the 'well-adapted group' (44.8%), 'highlight in psychological burdens group' (25.5%), and 'poorly adapted group' (29.7%). The influencing factors included stress perception, social support, occupational type, and marital status (P < 0.05).

CONCLUSION

The psychosocial adaptation of young and middle-aged AMI patients can be divided into three profiles. Clinical nurses can carry out individualized psychological interventions according to the characteristics of patients in different potential profiles to improve the psychosocial adaptation of patients and the prognosis of their disease.

Association between illness perception and social alienation among maintenance hemodialysis patients: The mediating role of fear of progression

PURPOSE

This study aimed to investigate the mediating role of fear of progression on illness perception and social alienation among maintenance hemodialysis (MHD) patients.

BACKGROUND

MHD is frequently accompanied by increased pain and complications such as itchy skin, chronic fatigue, and muscle spasms. Cardiovascular disease rates are also elevated among MHD patients, which can heighten their anxiety regarding prognosis and treatment discomfort. This chronic fear may severely impact social functioning, leading patients to withdraw from interpersonal interactions and experience heightened helplessness and loneliness. Further investigation is necessary to understand the factors behind the high level of social alienation in MHD patients and their underlying mechanisms.

DESIGN

A cross-sectional study guided by the STROBE.

METHODS

A convenience sample of 230 MHD patients were enrolled from January to May 2023. Data including demographic and clinical characteristics, illness perception, fear of progression, and social alienation were collected. Descriptive analysis and Pearson correlations were conducted using IBM SPSS version 25.0. The mediating effect was analyzed using Model 4 of the PROCESS macro for SPSS, with the Bootstrap method employed to assess its significance.

RESULTS

The score of social alienation in MHD patients was high, with illness perception and fear of progression both significantly correlated with social alienation. In the mediating effects model, illness perception can predict social alienation in MHD patients, and fear of progression use plays a part in mediating the process by which illness perception affects social alienation. The Kappa Squared (κ2) value of 21.9%, suggests a medium effect size.

CONCLUSIONS

Illness perception directly predicts social alienation in MHD patients and exerts an indirect effect through the mediating role of fear of progression. Suggests that healthcare professionals should concentrate on MHD patients with high negative illness perceptions to alleviate their fear of progression, thereby decreasing the level of social alienation and enhancing their integration into society.

The Influence of Social Support in PROMs of Patients with COPD in Primary Care: A Scoping Review

Chronic obstructive pulmonary disease (COPD) is a prevalent and multidimensional disease with symptoms that greatly influence patients' health. Healthcare professionals utilize patient-reported outcome measures (PROMs) to classify and better manage the disease. Despite the value of PROMs, they inadequately represent some important dimensions of COPD, like social support and healthcare access/utilization. This is important, especially for social support, since it can positively influence PROMs results and the overall health of patients with COPD. Therefore, a scoping review was conducted to determine how social support affects PROMs of patients with COPD in primary care. The PRISMA-Scoping approach was adopted, and we sought articles published in MEDLINE and COHRANE. We screened 2038 articles for inclusion and finally included a total of 10 articles. Most of the articles were conducted in the U.S. and Norway. Social support had a strong positive impact on PROMs. Additionally, different types of social support were observed. Moreover, higher levels of social support were linked to better quality of life, mental health, self-care behaviors, self-management, functionality, and less severe COPD. Consequently, this scoping review highlights the value of social support in patients with COPD and its underrepresentation and misrepresentation in PROMs literature.