Nursing Research Proposal: Kidney Transplant Recipients' Feelings

This research proposal explores the feelings and perceptions of kidney transplant recipients regarding the discharge education they receive from healthcare settings. It aims to highlight the challenges faced by these patients, identify motivating factors for compliance, and gather suggestions for improving the delivery of discharge education. Employing a qualitative research design with semi-structured interviews, the study seeks to provide valuable insights into the patient experience, which can inform the revision of organizational policies and the training of healthcare professionals to ensure optimal patient outcomes. Data will be analyzed using Graneheim and Lundman's Content Analysis Method to ensure credibility, confirmability, and dependability of the findings.

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Nursing Research Proposal
Name of student:
Name of university:
Author note:

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Table of Contents
Introduction................................................................................................................................3
Literature review........................................................................................................................3
Research question.......................................................................................................................5
Significance of study..................................................................................................................6
Methodology..............................................................................................................................7
Expected outcomes.....................................................................................................................9
References................................................................................................................................11

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Research proposal- Being a kidney transplant recipient: A qualitative research on their
feelings regarding discharge education
Introduction
Transplantation is an innovative and progressive field of healthcare practice that has
attracted considerable attention in the recent few years. Since the first kidney transplantation
was carried out five decades back, success and expertise in this area have grown with an
exponential curve. For patients who are suffering from end-stage kidney diseases, kidney
transplantation is the choice of treatment, bringing in opportunities for better quality of life.
For a considerable section of the population, kidney transplantation is followed by chances to
resort back to a healthy life with suitable modifications made in daily activities of living
(Amrouche et al. 2017). Kidney transplantation requires the patient to undergo lifelong
treatment, and care is to be provided to ensure that regularly follow up is done. Researchers
point out that kidney transplantation needs constant supervision. This implies that healthcare
professionals have the responsibility of providing adequate education to patients at the time
of discharge in order to ensure that the patient outcomes are desirable. Discharge education
ensures lifelong medication treatment and prevention from coexisting morbidities. In
addition, self-care strategies also make up an important part of the discharge education
(Ghadami et al. 2012). The proposed research proposal aims to highlight the feelings of
kidney transplant recipients, that is the patients, regarding discharge education, received.
Literature review
According to Patzer et al., (2012) kidney transplant requires a treatment which is
long-term in nature and follow up is essential to ensure that patients do not suffer from
morbidities. Patients undergoing transplantation require support in the fields of motivation,
skills and knowledge. A rich pool of literature highlights that a number of key challenges are

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faced while providing education to patients prior to the commencement of the surgery
process and at the time of discharge. Education might be a tricky process and need an
organized combination of scholastic activities for fostering changes in health behaviour.
Education at the time of discharge mainly revolves around administration of the medication
guidance, management of new life roles, and management of the emotions and feelings.
Supporting patient through education is the most promising strategy to ensure that results of
the transplantation are directed towards clinical success.
Hwang and Yi (2015) have given a clear account on the hindrances faced in educating
patients at the time of discharge. These include lack of time for education during discharge;
excess of guideline materials; communicational challenges; lack of continuity in education,
cultural barriers; repetition of the academic concepts; low acceptibilty of the patients in their
self-care, and the level of depression of the patients. These factors significantly contribute to
poor satisfaction levels of patients after receiving education at the time of discharge. Since
the main aim of patient education for kidney transplantation is their adaptation to the changes
imposed by the surgical process, education has to be a continual process instead of a mere
passage of information. The education process is to be broken down into a series of steps
including inspection, assessment of scholarly needs, educational programming, educational
management, and assesment of education.
Urstad et al. (2012) had carried out qualitative research for evaluating awareness and
knowledge of life for patients after kidney transplantation. Sixteen participants provided data
through 6 weeks interview process. The key aim was to assess post transplantation education
program’s efficacy. The study disclosed new acquaintance regarding renal recipients’
requirement for individual relevance to the educational matter. In addition, they reported
cognitive difficulties along with a set of factors influencing learning at the time of discharge
as well as postoperative phase.

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Ongoing research aims to assess the underlying factors that influence patient’s
perception and opinions about kidney transplant received at the time of discharge from the
care setting. Such research has mostly focused on quantitative methodologies, giving
negligible attention to the adequate exploration of patient’s feelings (Gordon and Wolf 2009).
Quantitative research, though has attempted to quantify the multidimensional aspects of
patient education, the drawback had mostly been associated with the inability to bring into
focus the feelings, attitudes and perceptions. In spite of consensus on the efficiency of
transplantation, common stressors have been reported by recipients. These mainly include
stress anxiety, issues related to gender bias and feelings of guilt. More qualitative studies are
therefore required to investigate the feelings and experience of surviving with a kidney
transplant after being educated by the care provider. Longitudinal and qualitative studies are
required for investigating the unique practical knowledge of patients and the individual
dissimilarities in the kidney transplantation process. Transplantation is more than just a
bodily experience. It importantly impacts the recipient as well as the family on the whole.
The psychological aftermath of transplantation together with the underlying instruments
would be better clarified if qualitative studies are carried out (Kamran 2014).
Research question
The prime focus of the proposed study would be on the evaluation of the kidney
transplant patient’s experience about their received education at the time of discharge from
care setting. Such an evaluation holds the potential to reveal concerns and factors driving
kidney transplant patient’s education in Singapore.
The research question that is to be addressed is “What are the feelings and perceptions
of kidney transplant recipients regarding discharge provided at by the healthcare setting?

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The objectives of the proposed research in alignment with the research question is as
follows-
• To explore the feelings and perceptions of kidney transplant recipients regarding
discharge education
• To highlight the challenges faced by kidney transplant recipients in receiving discharge
education
• To assess the motivating factors that drive compliance to kidney discharge education
among kidney transplant recipients
• To investigate the suggestions provided by the recipients regarding better delivery of
discharge education
Significance of study
The results of the study would highlight the performance of structured and
coordinated education provided by healthcare teams, especially nurses at the time of patient
discharge after kidney transplantation. The study would be highly beneficial in highlighting
the viewpoints and opinions of the patients regarding the positive as well as negative aspects
of the comprehensive education process undertaken. As a result, researchers can identify the
varied needs in the patient education process that are to be addressed in future for ensuring
optimal results. By delivering suitable education addressing the diverse needs of the clients,
reduction in imposed healthcare costs would be possible that is otherwise high due to poor
patient knowledge about self-care (Howell et al. 2012). The concerned committee can
consider revising organisational policies for redesigning patient education plan as deemed
appropriate for transplantation candidates. Adequate training would also seem crucial for

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being given to the care professionals who can engage in stronger educational sessions in
future (Tong et al. 2010).
Methodology
Research design- The proposed study would have a qualitative research design for
evaluating the feelings of kidney transplant recipient's regarding discharge education. A
qualitative study would be the suitable approach for defining patient’s experience of the
received education. According to LoBiondo-Wood and Haber (2017), humans present two
different operating systems. The first one is the subconscious method of operation that is the
instinctual observations made when data is available. The second operating system is more
methodical and evaluates all data sources before coming to a conclusion. Different forms of
research depend on the second operating system and ignore the instinctual nature of human
mind. Qualitative research, on the contrary, considers the instincts of humans and embraces
the data collected from this domain. Qualitative research methodology would be appropriate
as in-depth data can be extracted regarding the feelings and perceptions of participants, that is
the kidney transplant recipients.
The research would look deeper instead of analysing ranks, and record behaviours and
attitudes. Creation of openness is also a factor as participants can be encouraged to expand
their responses through qualitative research approach on a new research topic. The chosen
approach would also enable simulation of individual experiences of individuals. A
comprehensive depiction can be built regarding why patients are satisfied with their discharge
education and what suggestion they put forward (Parahoo 2014).
Research setting and sampling- The research setting would be a private hospital in
Singapore that is reputed for its services. The research participants would be those having
undergone a kidney transplant at the hospital. The first inclusion criteria would be that the

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patients need to be ready for being discharged from the hospital after kidney transplantation.
Secondly, the age of the participants needs to be between 30-70 years. 10 participants are to
be recruited for the research of where the number of male and female participants would be
equal. The participant recruitment would be done through purposive sampling. A purposive
sampling is a form on non-probability sampling in which the patients are selected on the basis
of a set of features of a population and the study objective. The sampling form is known to be
selective and judgemental sampling. There are a number of merits of the purposive sampling
method. It is less time consuming and less costly as compared to other sampling methods.
Proper representation of a population is a key advantage as the sampling ensures that the
research is free from bias. An intensive study of the selected population is ensured by the
sampling method. Lastly, the study done with purposive sampling gives better and accurate
results is the researcher has the ability to demonstrate sound judgement (Moule, Aveyard and
Goodman 2016).
Data collection method- Data collection is to be done with the help of a semi-
structured in-depth interview conducted with the participants. The data collection tool would
be an open-ended questionnaire comprising of at least ten questions regarding the research
objective. The advantages of using open-ended are multifaceted. Such questions permit
respondents to provide more information regarding an understanding of the research subject,
feelings and attitudes. This allows the researchers to possess better access to the real feelings
of the respondents on the concerned research topic. A close-ended question does not enable
clear reflection on true feelings (Cannon 2015). The interviews are to be conducted in an
enclosed room for minimising disturbances. Patients are to be given a safe and comfortable
environment so that they are ready and at ease to participate in the interview optimally
(Parahoo 2014).

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The interview is to be carried out for 30-45 minutes for promoting in-depth
interviews. Throughout the process, the participants would be encouraged to engage in
effective communication with the researchers for promoting informal communication. The
responses are to be recorded in writing as well as through audio recording for future
references. A written informed consent is to be received prior to the commencement of the
interview. This is an ethical principle inevitable for primary research wherein the participants
are to be explained about the purpose of the research and the potential importance for clinical
practice Further the patients are to be given security that participant confidentiality would be
maintained (Tappen 2015).
Data analysis method- Data analysis is to be done with the help of Graneheim and
Lundman Content Analysis Method. Firstly, each of the interviews is to be carefully
analysed. Successively, the important education-related items are to be underlined. Net, the
existing primary contents are to be coded, and titles for the codes are to be provided. Finally,
the primary codes are to be made inclusive, and themes are to be classified. This would
enable the emergence of the results (Cannon 2015).
Three criteria of dependability, credibility and confirmability would be employed for
increasing rigour. Verbatim interviews are to be reviewed for ensuring detailed and rich data
extraction, allowing credibility. The researchers are to preserve all evidence of the research
steps for proving confirmability. The researchers are also to check dependability through
revision of the transcript (McPake, Burnapp and Fernandes 2009).
Expected outcomes
The core variable of the study would be discharged educational experiences provided
by nursing professionals. Themes identified might relate to communication between
provider-client, motivational factors, respect and empathy shown towards clients and nature

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of educational matter. Sub-themes might be emerging from the analysis that would support
the major themes identified. Individual educational experience on transplant related care and
support to enter a new phase in life would be crucial to be analysed (Vincenti et al., 2016).
The findings might show insufficient information about certain issues that are important for
nursing practice.
Ethical consideration:
A number of ethical considerations need to be maintained by the researchers. Firstly,
the researchers should clearly describe the rationale for conducting the research to the
participants so that they may have a clear idea about the topic which they are interviewing.
Secondly, before starting the interview sessions, the researchers should ask for informed
consent and document their consents to avoid any legal obligations. The third factor is that
the researchers should never disclose the identity of the patients to anyone and maintain strict
anonymity. The fourth factor would be that the researchers should maintain the
confidentiality and privacy of the patients. They should never sell the information or utilise
them in any other sectors. The entire information should be used strictly for academic
purposes and should never be commercialised. The participants should participate in the
interview form their own will and shold not be provoked by moneytary benefits. Lastly, the
research approach should be approved by the ethical committee.

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References
Amrouche, L., Aubert, O., Suberbielle, C., Rabant, M., Van Huyen, J.P.D., Martinez, F.,
Sberro-Soussan, R., Scemla, A., Tinel, C., Snanoudj, R. and Zuber, J., 2017. Long-term
outcomes of kidney transplantation in patients with high levels of preformed DSA: The
Necker high-risk transplant program. Transplantation, 101(10), pp.2440-2448.
Cannon, S., 2015. Introduction to nursing research. Jones & Bartlett Publishers.
Ghadami, A., Memarian, R., Mohamadi, E. and Abdoli, S., 2012. Patients’ experiences from
their received education about the process of kidney transplant: a qualitative study. Iranian
journal of nursing and midwifery research, 17(2 Suppl1), p.S157.
Gordon, E.J. and Wolf, M.S., 2009. Health literacy skills of kidney transplant
recipients. Progress in Transplantation, 19(1), pp.25-34.
Howell, M., Tong, A., Wong, G., Craig, J.C. and Howard, K., 2012. Important outcomes for
kidney transplant recipients: a nominal group and qualitative study. American Journal of
Kidney Diseases, 60(2), pp.186-196.
Hwang, Y.H. and Yi, M., 2015. Evaluation of an individualized education before discharge
and follow-up telephone consultation on self-efficacy for kidney transplant patients. Journal
of Korean Biological Nursing Science, 17(4), pp.331-340.
Kamran, F., 2014. Living with a kidney transplant: perceptions and experiences. Am J App
Psychol, 2(1), pp.5-12.
LoBiondo-Wood, G. and Haber, J., 2017. Nursing Research-E-Book: Methods and Critical
Appraisal for Evidence-Based Practice. Elsevier Health Sciences.

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McPake, D., Burnapp, L. and Fernandes, T., 2009. Caring for patients after kidney
transplantation. Nursing Standard, 23(19), p.49.
Moule, P., Aveyard, H. and Goodman, M., 2016. Nursing research: An introduction. Sage.
Parahoo, K., 2014. Nursing research: principles, process and issues. Palgrave Macmillan.
Patzer, R.E., Perryman, J.P., Pastan, S., Amaral, S., Gazmararian, J.A., Klein, M., Kutner, N.
and McClellan, W.M., 2012. Impact of a patient education program on disparities in kidney
transplant evaluation. Clinical Journal of the American Society of Nephrology, 7(4), pp.648-
655.
Tappen, R.M., 2015. Advanced nursing research. Jones & Bartlett Publishers.
Tong, A., Howell, M., Wong, G., Webster, A.C., Howard, K. and Craig, J.C., 2010. The
perspectives of kidney transplant recipients on medicine taking: a systematic review of
qualitative studies. Nephrology Dialysis Transplantation, 26(1), pp.344-354.
Urstad, K.H., Wahl, A.K., Andersen, M.H., Øyen, O. and Fagermoen, M.S., 2012. Renal
recipients’ educational experiences in the early post‐operative phase–a qualitative
study. Scandinavian journal of caring sciences, 26(4), pp.635-642.
Vincenti, F., Rostaing, L., Grinyo, J., Rice, K., Steinberg, S., Gaite, L., Moal, M.C.,
Mondragon-Ramirez, G.A., Kothari, J., Polinsky, M.S. and Meier-Kriesche, H.U., 2016.
Belatacept and long-term outcomes in kidney transplantation. New England Journal of
Medicine, 374(4), pp.333-343.