Psychosocial factors that influence sibling donors during allogeneic bone marrow transplantation

Mc Kenzie, Lena (2013-03)

Thesis (MCurr)--Stellenbosch University, 2013.

Thesis

ENGLISH ABSTRACT: Haematopoietic stem cell transplantation has become an increasingly popular treatment option for persons with life-threatening blood related diseases such as leukemia, lymphoma, myeloma and certain forms of anaemia. Due to this new therapy the use of bone marrow from a healthy individual also called a living donor for transplantation is inevitable. These living donors can experience psychological and economic issues and these components needs to be addressed in the transplant protocol. The researcher described the psychosocial factors that influenced sibling donors during allogeneic bone marrow transplantation at a public sector hospital in Cape Town, whether the transplant team members explained the administrative process of the transplant in an understandable manner and language and the effect of the psychosocial factors and administrative process of the allogeneic bone marrow transplantation on the sibling donors. A quantitative research approach with a descriptive design was used in this study. The sample was selected by means of full population sampling. The final sample size of (n=64) stem cell sibling donors over 18 years of age participated in the study. A self-reporting questionnaire was used to gather data, inclusive of four open-ended questions to establish an in depth sense of what the donor experiences during the bone marrow donation process. Descriptive statistics used to describe the variables included frequency distributions in the form of histograms and frequency tables. The Pearson chi-square statistical analysis test was used to test for relationships amongst groups. The study drew on the Roy Adaptation Model (RAM) as the theoretical framework to explain the phenomena surrounding the psychosocial and administrative effect of the transplantation process on the sibling donor. Based on the findings the haematopoietic stem cell donors coped with the psychosocial impact of the donation process by making use of their coping mechanism to adapt to their situation according to the Roy Adaptation Model. This model also offers guidance to the nurses to apply this model to nursing practice. Results revealed that sibling donors developed feelings of anxiety in relation to the invasive procedures that cause them to experience physical pain. Most respondents claimed that they were not psychologically affected by the donation process. The moral obligation the sibling donor has towards his sister or brother outweighed the physical pain or discomfort experienced during the donation process. Results revealed that the responding donors claimed they were well informed regarding the donation process and understood the treatment plan of the recipient. However, results revealed that there was a lack in visual donor information such as books, pamphlets as well as internet information. Results concerning the demographics revealed that (n=29) respondents had no schooling and some respondents had some schooling which can give an indication of how to bridge the knowledge and information gap between them and the donor in terms of language. Statistical significance results regarding the emotional state and economic situation of the donors was found. Some of the respondents were responsible for their own transport and their own accommodation, some of those that are employed were responsible for leave without pay. An organ donation policy needs to be developed to prevent live organ donors from losing valuable working hours that could result in loss of salary and should provide other financial incentives. Furthermore, a lack in a post-donation follow-up medical to alleviate and detect post-donation complications was identified. Further nursing research can help nurses to understand living donation for transplantation, also how the nurses that practice in organ transplant units experience and deal with the psychosocial factors that influence them particularly.

AFRIKAANSE OPSOMMING: Hematopoïetiese stamseloorplanting het ’n toenemend gewilde-behandelingsopsie vir persone met lewensgevaarlike bloedverwante siektes soos leukemie, limfoom, miëloom en sekere soorte anemie geword. Vir hierdie tipe terapie word die beenmurg van ’n gesonde individu, ook bekend as ’n lewende skenker, vir oorplanting gebruik. Lewende skenkers kan sielkundige en ekonomiese probleme ervaar en hierdie kwessies moet in die oorplantingsprotokol hanteer word. In hierdie studie is ondersoek ingestel na die psigososiale faktore wat bloedverwante skenkers tydens allogeneïese beenmurgoorplanting by ’n openbare hospitaal in Kaapstad beïnvloed, of die oorplantingspan die administratiewe proses van die oorplanting op ’n verstaanbare manier en in verstaanbare taal verduidelik het, en wat die uitwerking wat die psigososiale faktore en administratiewe proses is op die bloedverwante skenkers tydens allogeneïese beenmurgoorplanting. ’n Kwantitatiewe benadering met ’n beskrywende navorsingsontwerp is in hierdie studie gebruik. Die steekproef is op grond van volledige populasiesteekproefneming gekies. ’n Finale steekproefgrootte van stamselskenkers (n=64) ouer as 18 jaar het aan die navorsing deelgeneem. ’n Selfverslaggewende vraelys is gebruik om data in te samel, wat vier oop vrae ingesluit het om grondige begrip te verkry van wat die skenker tydens die beenmurgskenkingsproses ervaar. Beskrywende statistiek wat gebruik is om die veranderlikes te beskryf, sluit in frekwensie-verspreidings in die vorm van histogramme en frekwensie-tabelle. Die Pearson chi-kwadraat- statistieseanalise is gebruik om die verwantskappe onder groepe te toets. Die Roy Adaptation Model (RAM) is as die teoretiese raamwerk vir die studie gebruik om die verskynsels betrokke by die psigososiale en administratiewe ervaring van die oorplantingsproses vir die bloedverwante skenker te verklaar. Op grond van die bevindinge het die hematopoïetiese stamselskenkers die psigososiale impak van die skenkingsproses hanteer deur gebruik te maak van hulle hanteringsmeganisme om by hulle situasie aan te pas, wat met die RAM ooreenstem. Hierdie model bied ook leiding aan verpleegkundiges om dit in die verplegingspraktyk toe te pas. Resultate het getoon dat bloedverwante skenkers gevoelens van angs ontwikkel het vanweë die indringende prosedures, wat fisiese pyn veroorsaak het. Die meeste deelnemers het aangedui dat hulle nie sielkundig deur die skenkingsproses geraak is nie. Die morele verpligting wat die bloedverwante skenker het teenoor sy of haar broer of suster het die fisiese pyn of ongemak gedurende die skenkingsproses oortref. Resultate het getoon dat die deelnemende skenkers aangedui het dat hulle goed ingelig was oor die skenkingsproses en die behandelingsplan van die ontvanger verstaan het. Die resultate dui egter daarop dat daar ’n gebrek was aan visuele skenkersinligting soos boeke, pamflette en internet-inligting. Resultate rakende die demografie het bewys dat van die deelnemers (n=29) ongeskoold en sommige deelnemers laag geskoold is, wat ’n aanduiding kan gee van hoe die kennis- en inligtingsgaping tussen hulle en die skenker ten opsigte van taal oorbrug kan word. Statisties beduidende resultate rakende die emosionele toestand en ekonomiese situasie van die skenkers is gevind. Sommige deelnemers was verantwoordelik vir hulle eie vervoer en verblyf. Diegene wat werk, het verlof sonder betaling geneem. ’n Orgaanskenkingsbeleid moet ontwikkel word om te verhoed dat lewende orgaanskenkers kosbare werksure verloor, wat kan lei tot ’n verlies aan salaris. Ander finansiële aansporings behoort ook gegee te word. Voorts is ’n gebrek aan opvolg mediese behandeling vir skenkers om skenkingskomplikasies vas te stel en te verlig, geïdentifiseer. Voortgesette navorsing kan verpleegkundiges help om begrip te verkry van die implikasies van lewende orgaanskenking. Verpleegkundiges wat in hierdie orgaanoorplantings- eenhede werksaam is, kan ‘n beter begrip kry van die psigososiale faktore wat hierdie skenkers spesifiek beïnvloed.

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