Appraisal of uncertainty while waiting for a kidney transplant

Abstract

This study tested a middle range nursing theory to better understand the experience of uncertainty in deceased-donor kidney transplant candidates with a goal of identifying ways to improve the care of persons by nurses as they await kidney transplant. From Mishel's Reconceptualized Uncertainty in Illness Theory a middle range theory was developed that proposes that deceased-donor kidney transplant candidates show growth through uncertainty as Mishel describes, waiting time for a transplant is related to the level of uncertainty, and growth through uncertainty is related to both waiting time and level of uncertainty in deceased-donor kidney transplant candidates. A descriptive survey research design was used to address two research questions: Do deceased-donor kidney transplant candidates experience growth through uncertainty as Mishel's Reconceptualized Uncertainty in Illness Theory proposes? What are the relationships among waiting time, level of uncertainty, and growth through uncertainty for deceased-donor kidney transplant candidates? The study sample was adults who: volunteered to participate, were English speaking and were actively waiting for a deceased-donor kidney transplant. A convenience sample of 134 deceased-donor kidney transplant candidates was recruited through dialysis clinics, an electronic message posted on a National Kidney Foundation message board, and a mailing to deceased- donor transplant candidates registered with a transplant center. A strength of the study was the sample size and the sub-sample of 103 African American persons. Mishel's Uncertainty in Illness Scale-Community version was used to measure uncertainty and the Growth through Uncertainty Scale quantified growth through uncertainty. The relationships among waiting time, level of uncertainty and growth through uncertainty were analyzed using Pearson correlation coefficients. The independent-groups t-test was used to compare those waiting above and below the national median time to transplant. Of the proposed relationships, a significant positive relationship between waiting time and growth through uncertainty was found. The findings provide further description of the uncertainty experienced by transplant candidates who are waiting for a deceased-donor kidney. The present study also supports the concept of growth through uncertainty when sustained uncertainty is present, contributing to the development of Mishel's Reconceptualized Uncertainty in Illness Theory.