Write a Research proposal- Being a kidney transplant recipient: A qualitative research on their feelings regarding discharge education.
Transplantation is an innovative and progressive field of healthcare practice that has attracted considerable attention in the recent few years. Since the first kidney transplantation was carried out five decades back, success and expertise in this area have grown with an exponential curve. For patients who are suffering from end-stage kidney diseases, kidney transplantation is the choice of treatment, bringing in opportunities for better quality of life. For a considerable section of the population, kidney transplantation is followed by chances to resort back to a healthy life with suitable modifications made in daily activities of living (Amrouche et al. 2017). Kidney transplantation requires the patient to undergo lifelong treatment, and care is to be provided to ensure that regularly follow up is done. Researchers point out that kidney transplantation needs constant supervision. This implies that healthcare professionals have the responsibility of providing adequate education to patients at the time of discharge in order to ensure that the patient outcomes are desirable. Discharge education ensures lifelong medication treatment and prevention from coexisting morbidities. In addition, self-care strategies also make up an important part of the discharge education (Ghadami et al. 2012). The proposed research proposal aims to highlight the feelings of kidney transplant recipients, that is the patients, regarding discharge education, received.
According to Patzer et al., (2012) kidney transplant requires a treatment which is long-term in nature and follow up is essential to ensure that patients do not suffer from morbidities. Patients undergoing transplantation require support in the fields of motivation, skills and knowledge. A rich pool of literature highlights that a number of key challenges are faced while providing education to patients prior to the commencement of the surgery process and at the time of discharge. Education might be a tricky process and need an organized combination of scholastic activities for fostering changes in health behaviour. Education at the time of discharge mainly revolves around administration of the medication guidance, management of new life roles, and management of the emotions and feelings. Supporting patient through education is the most promising strategy to ensure that results of the transplantation are directed towards clinical success.
Hwang and Yi (2015) have given a clear account on the hindrances faced in educating patients at the time of discharge. These include lack of time for education during discharge; excess of guideline materials; communicational challenges; lack of continuity in education, cultural barriers; repetition of the academic concepts; low acceptibilty of the patients in their self-care, and the level of depression of the patients. These factors significantly contribute to poor satisfaction levels of patients after receiving education at the time of discharge. Since the main aim of patient education for kidney transplantation is their adaptation to the changes imposed by the surgical process, education has to be a continual process instead of a mere passage of information. The education process is to be broken down into a series of steps including inspection, assessment of scholarly needs, educational programming, educational management, and assesment of education.
Urstad et al. (2012) had carried out qualitative research for evaluating awareness and knowledge of life for patients after kidney transplantation. Sixteen participants provided data through 6 weeks interview process. The key aim was to assess post transplantation education program’s efficacy. The study disclosed new acquaintance regarding renal recipients’ requirement for individual relevance to the educational matter. In addition, they reported cognitive difficulties along with a set of factors influencing learning at the time of discharge as well as postoperative phase.
Ongoing research aims to assess the underlying factors that influence patient’s perception and opinions about kidney transplant received at the time of discharge from the care setting. Such research has mostly focused on quantitative methodologies, giving negligible attention to the adequate exploration of patient’s feelings (Gordon and Wolf 2009). Quantitative research, though has attempted to quantify the multidimensional aspects of patient education, the drawback had mostly been associated with the inability to bring into focus the feelings, attitudes and perceptions. In spite of consensus on the efficiency of transplantation, common stressors have been reported by recipients. These mainly include stress anxiety, issues related to gender bias and feelings of guilt. More qualitative studies are therefore required to investigate the feelings and experience of surviving with a kidney transplant after being educated by the care provider. Longitudinal and qualitative studies are required for investigating the unique practical knowledge of patients and the individual dissimilarities in the kidney transplantation process. Transplantation is more than just a bodily experience. It importantly impacts the recipient as well as the family on the whole. The psychological aftermath of transplantation together with the underlying instruments would be better clarified if qualitative studies are carried out (Kamran 2014).
The prime focus of the proposed study would be on the evaluation of the kidney transplant patient’s experience about their received education at the time of discharge from care setting. Such an evaluation holds the potential to reveal concerns and factors driving kidney transplant patient’s education in Singapore.
The research question that is to be addressed is “What are the feelings and perceptions of kidney transplant recipients regarding discharge provided at by the healthcare setting?
The objectives of the proposed research in alignment with the research question is as follows-
The results of the study would highlight the performance of structured and coordinated education provided by healthcare teams, especially nurses at the time of patient discharge after kidney transplantation. The study would be highly beneficial in highlighting the viewpoints and opinions of the patients regarding the positive as well as negative aspects of the comprehensive education process undertaken. As a result, researchers can identify the varied needs in the patient education process that are to be addressed in future for ensuring optimal results. By delivering suitable education addressing the diverse needs of the clients, reduction in imposed healthcare costs would be possible that is otherwise high due to poor patient knowledge about self-care (Howell et al. 2012). The concerned committee can consider revising organisational policies for redesigning patient education plan as deemed appropriate for transplantation candidates. Adequate training would also seem crucial for being given to the care professionals who can engage in stronger educational sessions in future (Tong et al. 2010).
Research design- The proposed study would have a qualitative research design for evaluating the feelings of kidney transplant recipient’s regarding discharge education. A qualitative study would be the suitable approach for defining patient’s experience of the received education. According to LoBiondo-Wood and Haber (2017), humans present two different operating systems. The first one is the subconscious method of operation that is the instinctual observations made when data is available. The second operating system is more methodical and evaluates all data sources before coming to a conclusion. Different forms of research depend on the second operating system and ignore the instinctual nature of human mind. Qualitative research, on the contrary, considers the instincts of humans and embraces the data collected from this domain. Qualitative research methodology would be appropriate as in-depth data can be extracted regarding the feelings and perceptions of participants, that is the kidney transplant recipients.
The research would look deeper instead of analysing ranks, and record behaviours and attitudes. Creation of openness is also a factor as participants can be encouraged to expand their responses through qualitative research approach on a new research topic. The chosen approach would also enable simulation of individual experiences of individuals. A comprehensive depiction can be built regarding why patients are satisfied with their discharge education and what suggestion they put forward (Parahoo 2014).
Research setting and sampling- The research setting would be a private hospital in Singapore that is reputed for its services. The research participants would be those having undergone a kidney transplant at the hospital. The first inclusion criteria would be that the patients need to be ready for being discharged from the hospital after kidney transplantation. Secondly, the age of the participants needs to be between 30-70 years. 10 participants are to be recruited for the research of where the number of male and female participants would be equal. The participant recruitment would be done through purposive sampling. A purposive sampling is a form on non-probability sampling in which the patients are selected on the basis of a set of features of a population and the study objective. The sampling form is known to be selective and judgemental sampling. There are a number of merits of the purposive sampling method. It is less time consuming and less costly as compared to other sampling methods. Proper representation of a population is a key advantage as the sampling ensures that the research is free from bias. An intensive study of the selected population is ensured by the sampling method. Lastly, the study done with purposive sampling gives better and accurate results is the researcher has the ability to demonstrate sound judgement (Moule, Aveyard and Goodman 2016).
Data collection method- Data collection is to be done with the help of a semi-structured in-depth interview conducted with the participants. The data collection tool would be an open-ended questionnaire comprising of at least ten questions regarding the research objective. The advantages of using open-ended are multifaceted. Such questions permit respondents to provide more information regarding an understanding of the research subject, feelings and attitudes. This allows the researchers to possess better access to the real feelings of the respondents on the concerned research topic. A close-ended question does not enable clear reflection on true feelings (Cannon 2015). The interviews are to be conducted in an enclosed room for minimising disturbances. Patients are to be given a safe and comfortable environment so that they are ready and at ease to participate in the interview optimally (Parahoo 2014).
The interview is to be carried out for 30-45 minutes for promoting in-depth interviews. Throughout the process, the participants would be encouraged to engage in effective communication with the researchers for promoting informal communication. The responses are to be recorded in writing as well as through audio recording for future references. A written informed consent is to be received prior to the commencement of the interview. This is an ethical principle inevitable for primary research wherein the participants are to be explained about the purpose of the research and the potential importance for clinical practice Further the patients are to be given security that participant confidentiality would be maintained (Tappen 2015).
Data analysis method- Data analysis is to be done with the help of Graneheim and Lundman Content Analysis Method. Firstly, each of the interviews is to be carefully analysed. Successively, the important education-related items are to be underlined. Net, the existing primary contents are to be coded, and titles for the codes are to be provided. Finally, the primary codes are to be made inclusive, and themes are to be classified. This would enable the emergence of the results (Cannon 2015).
Three criteria of dependability, credibility and confirmability would be employed for increasing rigour. Verbatim interviews are to be reviewed for ensuring detailed and rich data extraction, allowing credibility. The researchers are to preserve all evidence of the research steps for proving confirmability. The researchers are also to check dependability through revision of the transcript (McPake, Burnapp and Fernandes 2009).
The core variable of the study would be discharged educational experiences provided by nursing professionals. Themes identified might relate to communication between provider-client, motivational factors, respect and empathy shown towards clients and nature of educational matter. Sub-themes might be emerging from the analysis that would support the major themes identified. Individual educational experience on transplant related care and support to enter a new phase in life would be crucial to be analysed (Vincenti et al., 2016). The findings might show insufficient information about certain issues that are important for nursing practice.
A number of ethical considerations need to be maintained by the researchers. Firstly, the researchers should clearly describe the rationale for conducting the research to the participants so that they may have a clear idea about the topic which they are interviewing. Secondly, before starting the interview sessions, the researchers should ask for informed consent and document their consents to avoid any legal obligations. The third factor is that the researchers should never disclose the identity of the patients to anyone and maintain strict anonymity. The fourth factor would be that the researchers should maintain the confidentiality and privacy of the patients. They should never sell the information or utilise them in any other sectors. The entire information should be used strictly for academic purposes and should never be commercialised. The participants should participate in the interview form their own will and shold not be provoked by moneytary benefits. Lastly, the research approach should be approved by the ethical committee.
References
Amrouche, L., Aubert, O., Suberbielle, C., Rabant, M., Van Huyen, J.P.D., Martinez, F., Sberro-Soussan, R., Scemla, A., Tinel, C., Snanoudj, R. and Zuber, J., 2017. Long-term outcomes of kidney transplantation in patients with high levels of preformed DSA: The Necker high-risk transplant program. Transplantation, 101(10), pp.2440-2448.
Cannon, S., 2015. Introduction to nursing research. Jones & Bartlett Publishers.
Ghadami, A., Memarian, R., Mohamadi, E. and Abdoli, S., 2012. Patients’ experiences from their received education about the process of kidney transplant: a qualitative study. Iranian journal of nursing and midwifery research, 17(2 Suppl1), p.S157.
Gordon, E.J. and Wolf, M.S., 2009. Health literacy skills of kidney transplant recipients. Progress in Transplantation, 19(1), pp.25-34.
Howell, M., Tong, A., Wong, G., Craig, J.C. and Howard, K., 2012. Important outcomes for kidney transplant recipients: a nominal group and qualitative study. American Journal of Kidney Diseases, 60(2), pp.186-196.
Hwang, Y.H. and Yi, M., 2015. Evaluation of an individualized education before discharge and follow-up telephone consultation on self-efficacy for kidney transplant patients. Journal of Korean Biological Nursing Science, 17(4), pp.331-340.
Kamran, F., 2014. Living with a kidney transplant: perceptions and experiences. Am J App Psychol, 2(1), pp.5-12.
LoBiondo-Wood, G. and Haber, J., 2017. Nursing Research-E-Book: Methods and Critical Appraisal for Evidence-Based Practice. Elsevier Health Sciences.
McPake, D., Burnapp, L. and Fernandes, T., 2009. Caring for patients after kidney transplantation. Nursing Standard, 23(19), p.49.
Moule, P., Aveyard, H. and Goodman, M., 2016. Nursing research: An introduction. Sage.
Parahoo, K., 2014. Nursing research: principles, process and issues. Palgrave Macmillan.
Patzer, R.E., Perryman, J.P., Pastan, S., Amaral, S., Gazmararian, J.A., Klein, M., Kutner, N. and McClellan, W.M., 2012. Impact of a patient education program on disparities in kidney transplant evaluation. Clinical Journal of the American Society of Nephrology, 7(4), pp.648-655.
Tappen, R.M., 2015. Advanced nursing research. Jones & Bartlett Publishers.
Tong, A., Howell, M., Wong, G., Webster, A.C., Howard, K. and Craig, J.C., 2010. The perspectives of kidney transplant recipients on medicine taking: a systematic review of qualitative studies. Nephrology Dialysis Transplantation, 26(1), pp.344-354.
Urstad, K.H., Wahl, A.K., Andersen, M.H., Øyen, O. and Fagermoen, M.S., 2012. Renal recipients’ educational experiences in the early post?operative phase–a qualitative study. Scandinavian journal of caring sciences, 26(4), pp.635-642.
Vincenti, F., Rostaing, L., Grinyo, J., Rice, K., Steinberg, S., Gaite, L., Moal, M.C., Mondragon-Ramirez, G.A., Kothari, J., Polinsky, M.S. and Meier-Kriesche, H.U., 2016. Belatacept and long-term outcomes in kidney transplantation. New England Journal of Medicine, 374(4), pp.333-343
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