Viver a adesão ao regime terapêutico: experiências vividas do doente submetido a transplante cardíaco

Abstract

In nursing terms, adherence to the therapeutic regimen is a concept that includes not only the fulfilment of the pharmacological prescription but also health promoting behaviours; therefore it is important that the nurse understands how the therapeutic regimen impacts on the patient’s life.

A cardiac transplant is a moment of many changes, not only on a physical level, but also on a social and psychological level. As the patient undergoes changes to their self–image, they will also be unable to proceed with their professional activities, will become
economically dependent on their family and be experiencing feelings such as anxiety, guilt and fear. Furthermore, they will have to simultaneously adapt to a new phase of their life, one which will include following a heavy and complex therapeutic regimen with unpleasant side-effects that will sometimes require profound changes to their way of life. It is therefore important to understand the experience of adhering to a therapeutic regimen in heart transplant patients.

To this end, a descriptive study was carried out using a qualitative method of phenomenological orientation. The non-structured interview method was chosen focusing on 9 patients who had previously undergone a heart transplant. A phenomenological analysis of the participants’ descriptive expressions was carried out according to the van Kaam method (1959, 1969). From the beginning of the analysis both descriptive expressions of adherence behaviours and descriptive expressions of non-adherence behaviours were apparent. Patients who undergo a heart transplant value life, because the possibility of death is possible at any moment and is always present in their everyday life. Such patients are aware of their immuno-suppressed status and adopt consequent self-protection behaviours because they believe in the benefits of doing so. By mobilising self-control mechanisms, the patient assumes a commitment and a responsibility for their own health. Confidence in the attending doctor is also valued by these patients, because this gives them a feeling of safety, protection and calm.

However, the perception that patients have of their health status, namely being asymptomatic, having another related health problem or the existence of side effects from the medication, are responsible for the non-adherence to the therapeutic regim