Uncertainty after heart transplantation. A new perspective on self-efficacy and self-management

University dissertation from Lund University, Faculty of Medicine

Abstract: Background Self-management is the main concept constituting the foundation of follow-up care after heart transplantation. Self-efficacy is a foundation of self-management. Little is known about heart recipients’ experiences in relation to self-efficacy and self-management after heart transplantation. Aim The overall aim of this thesis was to explore uncertainty and self-efficacy as important aspects of the lived experience of heart recipients one year after heart transplantation. Methods Both an inductive and a deductive approach have been used in combination with qualitative research methods. The study group consisted of 14 patients (I and II) who were due for their one year follow-up after heart transplantation. Interviews were performed and analysed by phenomenological hermeneutics (inductive) developed by Lindseth & Norberg and directed content analysis (deductive) developed by Hsieh & Shannon. Results The meaning of uncertainty after heart transplantation involved: doubting survival, doubting the recovery process, doubting one’s performance, struggling with close relationships, feeling abandoned and doubting the future. Uncertainty emerges when the heart recipients are unable to ascribe meaning to illness-related events and might therefore be a source of distress. Performance accomplishment, which comprises physical, social and mental aspects, was seen as the main factor affecting self-efficacy after heart transplantation. Lack of performance accomplishment led to disappointment and therefore our hypothesis was that self-efficacy after heart transplantation concerns balancing expectations in accordance with realistic accomplishments. Conclusions Complications, setbacks and symptoms together with expectations are sources of uncertainty. Performance accomplishment enables expectations to be met and might therefore constitute a source of uncertainty when accomplishments are not achieved. Uncertainty can undermine performance and might thereby hamper selfefficacy and self-management.