A Nurse-Led Self-Management Support Intervention (ZENN) for Kidney Transplant Recipients Using Intervention Mapping: Protocol for a Mixed-Methods Feasibility Study

Abstract

BackgroundOptimal self-management in kidney transplant recipients is essential for patient and graft survival, reducing comorbidity and health care costs while improving the quality of life. However, there are few effective interventions aimed at providing self-management support after kidney transplantation.ObjectiveThis study aims to systematically develop a nurse-led, self-management (support) intervention for kidney transplant recipients.MethodsThe Intervention Mapping protocol was used to develop an intervention that incorporates kidney transplant recipients’ and nurses’ needs, and theories as well as evidence-based methods. The needs of recipients and nurses were assessed by reviewing the literature, conducting focus groups, individual interviews, and observations (step 1). Based on the needs assessment, Self-Regulation Theory, and the “5A’s” model, change objectives were formulated (step 2). Evidence-based methods to achieve these objectives were selected and subsequently translated into practical implementation strategies (step 3). Then, program materials and protocols were developed accordingly (step 4). The implementation to test the feasibility and acceptability was scheduled for 2015-2017 (step 5). The last step of Intervention Mapping, evaluation of the intervention, falls outside the scope of this paper (step 6).ResultsThe intervention was developed to optimize self-management (support) after kidney transplantation and targeted both kidney transplant recipients and nurse practitioners who delivered the intervention. The intervention was clustered into four 15-minute sessions that were combined with regular appointments at the outpatient clinic. Nurses received a training syllabus and were trained in communication techniques based on the principles of Solution-Focused Brief Therapy and Motivational Interviewing; this entailed guiding the patients to generate their own goals and solutions and focus on strengths and successes. Kidney transplant recipients were encouraged to assess self-management challenges using the Self-Management Web and subsequently develop specific goals, action plans, and pursuit skills to solve these challenges.ConclusionsThe Intervention Mapping protocol provided a rigorous framework to systematically develop a self-management intervention in which nurses and kidney transplant recipients’ needs, evidence-based methods, and theories were integrated.International Registered Report Identifier (IRRID)DERR1-10.2196/11856

Nurse-led Self-management Support After Organ Transplantation – Protocol of a Multicentre, Stepped-wedge Randomized Controlled Trial

“…The aim of the fourth session is to evaluate and discuss the goal attainment, relapse prevention and generalization of the learned skills to other situations. The development of the ZENN intervention and its use has been extensively described elsewhere (22).…”

“…Existing interventions have an insufficient tailoring to individual needs (18,22,56), therefore this intervention has the potential to make an important contribution to the lives of transplant recipients and approaches available to post-transplant professionals.…”

“…Another strength of the study is that we have broadened the target group to include other organ types, compared to the pilot study (22). In the initial pilot study, the target group consisted of kidney transplant recipients, but we believe and research has shown, that self-management support is important for all transplant recipients regardless of the organ (13,19,20).…”

“…Moreover, these intervention have not been able to demonstrate effectiveness (18). Patients after organ transplantation have specific needs in receiving self-management support, but the current healthcare system does not meet these needs (20)(21)(22)(23)(24). Patients wish to discuss medical, social and emotional issues, receive information about their disease and receive tailored instructions (20).…”

“…In response to the need for a more holistic, tailored and patient-centred approach to selfmanagement support among patients and communication skills training among nurses, we initiated a project to develop a self-management support intervention. Based on previous studies of our team (20, 22, 23), we developed a self-management (support) intervention which is called the ZElfmanagement Na Niertransplantatie (ZENN; Dutch acronym for self-management after kidney transplantation) intervention (22). This intervention included four key elements: (1) a general structure with room for individual tailoring, (2) a holistic approach, (3) shared-decision making between NP and patient, and (4) patient empowerment.…”