title: Job resumption status, hindering factors, and interpersonal relationship within post-heart transplant 1 to 4 years as perceived by heart transplant recipients in Taiwan: a between-method triangulation study.
abstract: BACKGROUND
  This project examined heart transplant (HT) recipients' perspectives of (a) the changes in their working competence (WC), status for job resumption and related factors at 1- to 2-year, 2- to 3-year, and 3- to 4-year stages; and (b) impacts of HT on interpersonal relationships (IPR).
  
  
  METHODS
  We used a between-method triangulation (including qualitative and quantitative data) design. Quantitative data were collected using the Vertical Visual Analogue Scale and Taiwan's version of the World Health Organization Health-Related Quality-of-Life (HRQoL) questionnaire. Six qualitative semistructured questions were further applied to explore social and environmental domains.
  
  
  RESULTS
  The Fifty subjects (86% males and 14% females) had an age range from 20 to 70 years old (mean, 47.68 years). Their post-HT time ranged from 1 to 4.1 years with 42%, 42%, and 16% at 1- to 2-, 2- to 3-, or 3- to 4-years post-HT, respectively. Within 6 months, 10% of administration or restaurant staff, and police resumed their jobs. At 6 to 12 months, 8% of administration, quality control, and design and planning staff resumed their jobs. At 12 months, 14% of educators, insurance personnel, managers, informatics engineers, and ironworkers resumed their jobs. Hindering factors to returning to work included (a) physical (ie, lack of energy, second heart attack, recurrence of rejection, physical discomforts of dizziness, memory lapses/lack of concentration or bone pain from osteoporosis); (b) psychological (ie, lack of confidence, worries about discrimination, being different, maladaptation); and (c) environmental (inadequate job opportunities due to poor socioeconomic conditions). Additionally, 34% reported worse IPR after HT due to diet limitations, slower pacing, less contacts with friends, and changes in personality. Reflections on both the meaning and value of life caused 10% to report better IPR with a better personality and positive mindset. By the end of the first postoperative year, the mean score of HRQoL in the preoperative extracorporeal membrane oxygenation (ECMO) group was similar to the non-preoperative ECMO group; the mean scores of WC and physical functions for the preoperative ECMO group were even higher than the non-preoperative ECMO group. Meanwhile, the mean scores of HRQoL and WC were higher in the Clinical Trail Plan (CTP) group than non-CTP groups across the three stages. As such, the use of preoperative ECMO and CTP groups are suggested to be both clinically and significantly associated with HTs recovery in heath status, positive HRQoL, and job resumption in the society. Finally, HRQoL and related domains of physical, psychological, social, and environmental health were stable at 12 months post-HT, with no significant change between 1- to 2-, 2- to 3-, and 3- to 4-years post-HT.
authors.affiliation: Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: P H
authors.initials: PH
authors.lastname: Tseng
authors.forename: S S
authors.initials: SS
authors.lastname: Wang
authors.forename: C L
authors.initials: CL
authors.lastname: Chang
authors.forename: F J
authors.initials: FJ
authors.lastname: Shih
mesh_terms: D000328:Adult; D000368:Aged; D004651:Employment; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013624:Taiwan