Organ Nakli ve Gebelik: Watson İnsan Bakım Modeli Rehberliğinde Hemşirelik Bakımı
Özet
Organ nakli, genç ve doğurganlık çağındaki kadınlar için hayat kurtarıcı bir gelişme olmakla birlikte, başarılı operasyonlar sonrası fertilite hızla geri dönmekte ve bu durum plansız gebelik risklerini beraberinde getirmektedir. Organ nakli alıcılarında gebelik; greft reddi, preeklampsi ve enfeksiyon gibi maternal risklerin yanı sıra preterm doğum ve gelişim geriliği gibi fetal komplikasyonlar nedeniyle yüksek riskli kabul edilir. Bu hassas süreçte hemşirelik bakımı, bireyi zihin, beden ve ruh bütününde ele alan Watson’ın İnsan Bakım Modeli rehberliğinde yapılandırılabilir. Modelin sunduğu "Kişilerarası Bakım İlişkisi", "Bakım Anı" ve 10 temel "İyileştirici Süreç"; hastanın ölüm korkusu, ilaçların fetüse etkisi ve emzirme kaygıları gibi psikososyal ve spiritüel kriz durumlarıyla baş etmesini kolaylaştırır. Multidisipliner bir yaklaşımla sunulan gebelik öncesi danışmanlık, immünosupresif ilaçların optimizasyonu, güvenli bir klinik çevrenin sağlanması ve eş desteğinin sürece dahil edilmesi, hem anne hem de bebek sağlığını olumlu yönde etkiler. Sonuç olarak, İnsan Bakım Modeli'nin organ nakli ve gebelik sürecine entegrasyonu, alıcıların ve ailelerinin bütüncül olarak değerlendirilmesini sağlayarak yaşam kalitesini artırır ve süreci optimize eder.
Although organ transplantation is a life-saving development for young women of childbearing age, fertility returns rapidly after successful operations, bringing the risk of unplanned pregnancies. Pregnancy in organ transplant recipients is considered high-risk due to maternal risks such as graft rejection, preeclampsia, and infection, as well as fetal complications like preterm birth and developmental delay. In this sensitive process, nursing care can be structured under the guidance of Watson's Human Caring Model, which addresses the individual as a whole of mind, body, and spirit. The model's "Interpersonal Caring Relationship," "Caring Moment," and 10 core "Caritas Processes" facilitate the patient's coping with psychosocial and spiritual crisis situations, such as fear of death, the effects of medications on the fetus, and breastfeeding anxieties. Pre-pregnancy counseling delivered through a multidisciplinary approach, optimization of immunosuppressive drugs, provision of a safe clinical environment, and inclusion of partner support positively influence both maternal and infant health. Consequently, the integration of the Human Caring Model into the organ transplantation and pregnancy process ensures a holistic evaluation of recipients and their families, thereby increasing the quality of life and optimizing the outcomes.
Referanslar
Bezinover D, Saner F. Organ transplantation in the modern era. BMC Anesthesiology. 2019;19(1): 32. Doi: 10.1186/s12871-019-0704-z
WHO Global Observatory on Donation and Transplantation. Organ Transplanted Annually 2020. (27/01/2022 tarihinde http://www.transplant-observatory.org/ adresinden ulaşılmıştır.)
WHO Global Observatory on Donation and Transplantation. Organ Transplanted Annually Summary By Country-Turkey 2020. (27/01/2022 tarihinde http://www.transplant-observatory.org/summary/ adresinden ulaşılmıştır.)
WHO Global Observatory on Donation and Transplantation. International Raport on Organ Donation and Transplantation Activities Executive Annually Summary 2020. (27/01/2022 tarihinde http://www.transplant-observatory.org/2020-international-activities-report/ adresinden ulaşılmıştır.)
Türkiye Cumhuriyeti Sağlık Bakanlığı. Doku, Organ Nakli ve Diyaliz Hizmetleri Daire Başkanlığı 2020. (Accessed 27th January 2022) (27/01/2022 tarihinde https://organgiris.saglik.gov.tr/Login.aspx?ReturnUrl=%2f adresinden ulaşılmıştır.)
Al-Badri M, Kling JM, Vegunta S. Reproductive planning for women after solid-organ transplant. Cleveland Clinic Journal of Medicine. 2017;84(9): 719-728. Doi: 10.3949/ccjm.84a.16116.
Klein CL, Josephson MA. Post-Transplant Pregnancy and Contraception. Clinical Journal of the American Society of Nephrology. 2022;17(1): 114-120. Doi: 10.2215/CJN.14100820
Rao S, Ghanta M, Moritz, MJ, et al. Long -Term Functional Recovery, Quality of Life, and Pregnancy After Solid Organ Transplantation. Medical Clinics of North America. 2016;100(3): 613–629. Doi: 10.1016/j.mcna.2016.01.010
Kurz JM. Pregnancy after Solid Organ Transplantation. MCN The American Journal of Maternal/Child Nursing. 2018;43(2): 89-96. Doi: 10.1097/NMC.0000000000000403
Blume C, Pischke S, von Versen-Höynck F, et al. Pregnancies in liver and kidney transplant recipients: a review of the current literature and recommendation. Best Practice & Research: Clinical Obstetrics Gynaecology. 2014;28(8):1123-36. Doi: 10.1016/j.bpobgyn.2014.07.021.
Lai LC, Ufere NN, Bucuvalas JC. Liver Transplant Survivorship. Liver Transplantation. 2020;26(8):1030-1033. Doi: 10.1002/lt.25792
Saad M, de Medeiros R. Spirituality and Healthcare-Common Grounds for the Secular and Religious Worlds and Its Clinical Implications. Religions. 2021;12(1): 22. Doi: 10.3390/rel12010022
Smith MC, Parkeri ME. Nursing Theories & Nursing Practice. 4rd ed. United States of America: F.A. Davis Company; 2015.
Watson Caring Science Institute. Core Concepts of Jean Watson’s Theory of Human Caring/Caring Science 2010. (24/01/2022 tarihinde https://pmhealthnp.com/wp-content/uploads/2019/05/watsons-theory-of-human-caring-core-concepts-handout.pdf adresinden ulaşılmıştır.)
Watson J. Watson’s theory of human caring and subjective living experiences: carative factors/caritas processes as a disciplinary guide to the professional nursing practice. Texto & Contexto Enfermagem. 2007;16(1):129-135. Doi:10.1590/S010407072007000100016
Yoshimura Y, Umeshita K, Kubo S, et al. Anxieties and coping methods of liver transplant recipients regarding pregnancy and delivery. Journal of Advanced Nursing. 2016;72(8):1875-85. Doi: 10.1111/jan.12957.
Yoshikawa Y, Uchida J, Akazawa C, et al. Associations between physical and psychosocial factors and health-related quality of life in women who gave birth after a kidney transplant. International Journal of Women’s Health. 2018;12(10):299-307. Doi: 10.2147/IJWH.S152750.
Yoshikawa Y, Uchida J, Akazawa C, et al. Outcomes of and perspectives on pregnancy counseling among kidney transplant recipients. Transplantation Reports. 2019;4(1):100019. Doi: 10.1016/j.tpr.2019.100019
Fujita A, Hamada Y, Matsuura T. Mothers' Experiences With Pregnancy and Childbirth Following Pediatric Living Liver Transplant Donation: A Qualitative Descriptive Study. Transplant Proceedings. 2021;53(2):630-635. Doi: 10.1016/j.transproceed.2020.10.046.
Kallapur A, Jang C, Yin O, et al. Pregnancy care in solid organ transplant recipients. International Journal of Gynaecology & Obstetrics. 2021;10. Doi: 10.1002/ijgo.13819.
Yoshikawa Y, Uchida J, Kosoku A, et al. Pregnancy Counseling for Kidney Transplant Recipients. Clinics Mother Child Health. 2020;17:341. Doi: 10.35248/2090-7214.20.17.341.
Cimino FM, Snyder KA. Primary Care of the Solid Organ Transplant Recipient. American Family Physician. 2016;93(3):203-210.
Nielsen C, Agerskov H, Bistrup C, et al. Evaluation of a telehealth solution developed to improve follow-up after kidney Transplantation. Journal of Clinical Nursing. 2020;29(7-8):1053-1063. Doi: 10.1111/jocn.15178.
Yoshikawa Y, Uchida J, Kosoku A, et al. Childbirth and Care Difficulties of Female Kidney Transplantation Recipients. Transplant Proceedings. 2019;51(5):1415-1419. Doi: 10.1016/j.transproceed.2019.03.013.
