title: The meaning of being in uncertainty after heart transplantation - an unrevealed source to distress.
abstract: As many as 88% of heart transplant recipients (HTRs) suffer from psychological distress. Both psychosocial factors and physical health are associated with increased psychological distress. However, the causes and impacts of psychological distress are unclear. HTRs strive for a sense of control over their health and daily lives in order to improve their psychological well-being. Perceived control was found to be related to the patients' construction of normality, their emotional state, as well as their thoughts and feelings of uncertainty about the future.
  
  
  
  An in-depth exploration of the meaning of uncertainty during the first year after a heart transplantation (HTX).
  
  
  
  A phenomenological-hermeneutic method was employed. Interviews were conducted with 14 patients, four women and ten men, with a mean age of 51 years (range: 28-67 years).
  
  
  
  Being in uncertainty after HTX means losing a sense of coherence, which shatters the HTR's whole worldview. The HTRs search for meaning and strive for coherence, which is no longer achievable. By using a nursing theory, we understand that uncertainty should be seen as a natural state among HTRs. It constitutes the starting point from which the HTRs can reorganise their self-structure and find a new view of life. When striving for normality, certainty and predictability (i.e., the healthcare professional's perspective), we block or prolong this process, thus causing distress among HTRs because they are unable to create a new orientation in life.
  
  
  
  This study presents a hypothesis of the primary cause of psychological distress after HTX and provides a useful framework for how to approach this condition.
authors.affiliation: 1 Skåne University Hospital, Thoracic Intensive Care Unit, Lund, Sweden.|2 Department of Health Sciences at Lund University, Lund, Sweden.
authors.forename: Matilda
authors.initials: M
authors.lastname: Almgren
authors.affiliation: 3 The Transplant Centre Sahlgrenska University Hospital, Gothenburg, Sweden.|4 The Institute of Health and Caring Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: Annette
authors.initials: A
authors.lastname: Lennerling
authors.affiliation: 1 Skåne University Hospital, Thoracic Intensive Care Unit, Lund, Sweden.|2 Department of Health Sciences at Lund University, Lund, Sweden.
authors.forename: Martina
authors.initials: M
authors.lastname: Lundmark
authors.affiliation: 2 Department of Health Sciences at Lund University, Lund, Sweden.|5 Skåne University Hospital, Department of Transplantation and Cardiology, Lund, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Forsberg
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects* / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D013315:Stress, Psychological / Q000209:etiology* / Q000628:therapy*; D035501:Uncertainty
keywords: Heart transplantation; cardiac event; distress; phenomenological–hermeneutic; qualitative study; uncertainty