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Objetivo: To identify how the clinical and educational nursing care based on the Theory of Human Becoming can contribute to the transcendence process of heart transplant patients in pursuit of good living., Method: Research-intervention developed with four heart transplant patients linked to a reference transplant hospital in Ceara. Data was collected through interviews in 2014 and analyzed using Parse's theoretical framework and pertinent literature., Resultados: Transplant patients revealed they gave living in such condition an ambiguous meaning, showing satisfaction and dissatisfaction. Dietary restrictions, difficulties with medication and curiosity about the transplant were identified as disharmonies involving the process. Care was developed focused on educating the transplant patients, approaching the themes healthy eating, organ rejection, immunosuppressant use and facts about heart transplantation., Conclusion: Educative care based on Parse favors the decision-making and autonomy of individuals regarding their health, contributing to transcendence in pursuit of good living.

Heart failure impacts a multitude of individuals each year. Treatment is based on the progression of the disease and severity of symptoms. Cardiac transplant is the gold standard treatment of advanced heart failure, although the availability of organs limits the number of transplants received each year. Postoperative care and monitoring for cardiac transplant is complex and requires specialized nurses and providers at transplant centers for successful outcomes. This article outlines cardiac transplant from preoperative care through transplant, as well as posttransplant monitoring and care including discharge. Special attention is focused on management in the intensive care unit setting and potential complications that can occur in the immediate postoperative period. Interventions for potential complications are also highlighted.

For more than 40 years, cardiac transplantation has been a treatment option for patients with severe heart failure in whom optimal medical management is no longer effective. Critical care nurses are integrally involved in the care of patients with severe heart failure who may benefit from cardiac transplantation and are in a special position to recognize potential candidates for transplantation. Understanding patient selection criteria, the evaluation process, and how patients are managed while awaiting transplantation is key to the knowledge and skills required. It is also important to understand the allocation of donor hearts as part of this process. The waiting period for a suitable donor heart can be long and a patient's condition may deteriorate, requiring an increase in pharmacologic bridges with intravenous inotropic agents or mechanical bridges with circulatory assist devices. Critical care nurses become important as a personal bridge to transplantation through their education of patients and families and helping them cope with their fears during the waiting period. Critical care nurses who possess knowledge of patient selection and organ allocation processes along with the skills of caring for this complex patient population can contribute to better outcomes for patients with heart failure who may be candidates for cardiac transplantation.

The study was aimed at evaluating the impact of educative health actions on nursing appointments with 18 transplanted heart clients, based on Orem's Theory. It was conducted in a Heart Transplant and Insufficiency Unit of a Public Health Institution in Fortaleza-CE. The data were collected by way of nursing appointments. 14 nursing diagnoses were identified in the first appointment and 7 in the last one. It was found out that the clients developed self-care skills with the implementation of educative health actions, tuming them into self-care agents, reaching a good level of health and well-being. On the other hand, it raised nurses' awareness of a systematic and efficacious management of the clinical monitoring of their clientele.

Cardiac transplantation is a recognized and lifesaving treatment for those unresponsive to all other available treatments (Hosenpud JD, Bennett LE, Kech BM, Boucek MM, Novick RJ. The registry of the International Society for Heart and Lung Transplantation: eighteenth official report-2001. J Heart Lung Transplant. 2001;20:805-815). The number of transplants performed in the United States grows steadily yearly with improving drugs for infection and rejection, the 2 most common medical complications and still the primary causes of death in long-term follow-up (Zugibe F, Costello J, Breithaupt M, Segalbacher J. Model organ description protocols for completion by transplant surgeons using organs procured from medical examiner cases. J Transplant Coord. 1999;9:73). Sometimes, getting the patient to the transplant process is in itself a struggle. As the need for heart transplants increase across the nation, donor hearts have not increased, even with more awareness in the medical community. Therefore, our struggle remains with keeping the patient alive, stable, and in the best position for transplantation when the perfect donor heart arrives. As critical care nurses, we see this bridge to transplantation in the form of pharmaceutical agents and/or mechanical assist devices (Scherr K, Jensen L, Koshal A. Mechanical circulatory support as a bridge to cardiac transplantation: towards the 21st century. Am J Crit Care. 1999;8:324-337). The patient waits patiently for a donor heart to be available, but is becoming weaker in the process. We wish to see those hearts come sooner and healthier. In truth, this in not usually seen. Sometimes the wish comes true, and with the help of nurses, doctors, ancillary departments, and even multiple hospital systems pulling together a miracle can still happen.

Orthotopic heart transplantation became more successful with the introduction of cyclosporine in the late 1970s. Although congestive heart failure has become a significant public health issue and the proportion of patients with advanced heart failure has increased, the number of heart transplants performed has not increased substantially in the past decade. Transplant waiting times have been related to many different factors. Unfortunately, implantation of ventricular assist devices (VADS) may provoke antibody responses. These result in the sensitization of patients and increased waiting time prior to transplantation. The purpose of this article is to explore etiologies of waiting times for pre heart transplant and left ventricular assist device pre heart transplant candidates, explain new theories of sensitization, define current methods to detect sensitization, and discuss nursing care implications.

This article addresses an overview of patient education required for the postoperative heart transplant patient. The overall purpose of patient education is to insure the patient and, when appropriate, his or her significant other(s) are provided with education to enhance knowledge, skills, and behavior change. Patient education needs are to be continually assessed, identified, and addressed. Education includes instruction in the specific knowledge and skills needed by the patient and his or her significant other(s) to meet the patient's needs. Health education of the postoperative heart transplant patients may add significant and sustained benefits to their recovery and compliance with regime while reducing costs.

While considerable progress is being made in the medical management of heart failure, mortality for this disease process continues to be significant. Cardiac transplantation becomes the treatment of choice for those with end-stage diseases that are acceptable candidates. While care of the cardiac transplant patient is similar to those recovering from cardiopulmonary bypass after sternotomy there are several issues unique to the cardiac transplant recipient. These include cardiac denervation, allograft dysfunction, management of arrhythmias, rejection, immunosuppression, and infectious complications. This article provides an overview of the postoperative management of the cardiac transplant recipient while in the intensive care unit. Additionally, a brief description of the surgical techniques employed and the physiology related to cardiac denervation are presented.

Pediatric nurse practitioners (PNP) confront numerous challenges when delivering care to infants, children, and adolescents who receive thoracic organ transplants. Today, thoracic organ transplantation is an acceptable and viable option for infants, children, and adolescents with end stage cardiac and pulmonary disease. Despite the plateau in the actual numbers of thoracic organ transplants performed annually in the United States, they are still being performed in a significant number. The care of children who receive transplants includes long-term use of immunosuppressants, dealing with infectious diseases, and utilizing principles of well child and family care. PNPs play a vital role in providing holistic care to infants, children, and adolescents who receive a thoracic organ transplant.

In 1984 "Baby Fae" was the first infant to receive a heart transplant from a baboon. Though she only lived 20 days, her legacy began the movement to advance pediatric heart transplantation so that children with lethal heart disease could live to experience childhood. Sixteen years later more than 4,500 pediatric heart transplants have been performed in children ages 0 to 18. The International Society for Heart and Lung Transplantation reports a 79% survival at 1 year. 70% survival at 2 years. and 67% at 5 years for all ages and diagnoses. This article provides an overview of pediatric heart transplantation.

The psychological distress of cardiac patients can complicate treatment or the recovery process. This case study presents a 47-year-old male recipient of an implantable cardioverter defibrillator who experienced multiple, consecutive shocks and subsequently developed anxiety and depressive difficulties. Psychological treatment to diminish these symptoms was employed. Despite declining cardiac function, the patient made significant progress in managing this negative affect. Subsequently, he was evaluated for cardiac transplant, and this treatment progress became critical evidence of his psychosocial suitability for transplant.

Heart transplantation presents an extremely stressful life transition for pediatric recipients and their families. The waiting period of the preoperative stage has been described as the most stressful aspect of the process. The stress and coping model of Lazarus and Folkman (1984) can be used as a conceptual framework for addressing stressors of pediatric transplant patients and their families. A case study of a preadolescent child awaiting heart transplantation in a hospital outside of a transplant center highlights common concerns, including feelings of isolation, depression, boredom, hopelessness, helplessness, exhaustion, lack of privacy, financial burdens, role strain, and family disruption. Psychosocial needs can be assessed and met, using a multidisciplinary approach. Because the preoperative stage can be stressful for nurses as well, the case study also explores the struggles of unit nurses trying to coordinate and manage the patient's care.

The denervated heart requires significant changes in planning and implementing care. The loss of direct neural compensation in response to the body's demands is replaced by the denervated heart's reliance on preload augmentation to maintain cardiac output, stimulation of cardiac adrenergic receptor sites to promote inotropic and chronotropic responses, and the nurse's knowledge of transplant physiology to choose and administer directacting cardiovascular pharmacologic agents to treat common posttransplant complications and to safely and effectively manage the patient's care.