Postoperative Stage

Posttransplant, patients can experience acute mental status changes (e.g., delirium) and side effects from immunosuppressant medications that can affect physical appearance, emotional functioning, and sleep and eating patterns. Any posttransplant medical complications are understandably stressful. Once patients are medically stable, patients and families commonly experience a "honeymoon" period, followed by the reality of living with a new chronic illness. Although families are hopeful about an eventual return to a "normal" life, they often experience anxiety about leaving the safety of the hospital environment, because posttransplant care can appear overwhelming. In a study in which parents of pediatric heart transplant recipients completed questionnaires, nearly 40% of parents indicated moderate to severe posttraumatic stress symptoms relating to communication about the child's illness, balancing of various role demands, emotional strain, and supervision of the child's medical care (Farley et al. 2007). Marital conflict may have arisen. Patients and families also may be disappointed by the perceived slowness of recovery from surgery and return to typical activities such as school.

Returning home and transitioning back to school can be stressful as well. Some patients have trouble abandoning their "sick role" and the accompanying special attention. Patients may resent the need for close monitoring and additional treatments. Although many patients are adherent to their medications immediately after transplant, nonadherence can develop as time passes and routine follow-up becomes less frequent. Donor-related issues may arise, and families may want to learn about the donor and make attempts to find out details about the donor's identity. As during previous phases of the process, parents and patients may feel sadness for or guilt about the donor family.

In this phase, the medical team's initial goal is to provide education about the posttransplant treatment regimen. The mental health consultant can play an important role by educating the family about possible emotional reactions of patients, parents, siblings, extended family members, and friends. For example, Wray and Radley-Smith (2005) reported that pediatric transplant patients experienced significantly higher problematic behaviors at home upon transition. Education about the emotional impact of immunosuppressant medications and how to manage behavioral changes is important. Additional studies showing decreased academic achievements following transplantation underscore the importance of strong school liaison and regular assessments of academic functioning during the transitional period of school reentry (Wray et al. 2001). The mental health consultant should also address any sibling-related issues (e.g., acting-out behaviors, emotional issues) that may arise due to disruptions in the typical family roles and structure.

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