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Patients with implantable cardioverter-defibrillators and their conceptions of the life situation: a qualitative analysis
Högskolan i Halmstad.
Högskolan i Halmstad.
Sahlgrenska Universitetssjukhuset.
Sahlgrenska Universitetssjukhuset.
Show others and affiliations
2000 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 9, no 1, 37-45 p.Article in journal (Refereed) Published
Abstract [en]

• The implantable cardioverter-defibrillator (ICD) is today widely used for the treatment of sudden cardiac near-death episodes as a result of malignant ventricular dysrhythmia.

• After examining the literature, only four descriptive studies, all carried out in the USA, with a qualitative analysis based on ICD-patients’ own perspectives on their life situation have been found.

•  The aim of this study was to describe how patients living with an ICD-device in south-western Sweden conceive their life situation.

•  As the focus was on patients’ conceptions seen from a holistic perspective, an analysis inspired by phenomenography was employed on a strategic sample of 15 ICD-patients.

• Six categories emerged: a feeling of safety, a feeling of gratitude, a feeling of being, having a network, having a belief in the future, and gaining awareness.

• Although the findings cannot be generalized because of the descriptive research design, they illuminate the beneficial as well as intrusive effects of such a device, and emphasize the need for support groups for patients and families as well as further education for personnel in hospital and primary health care.

Place, publisher, year, edition, pages
2000. Vol. 9, no 1, 37-45 p.
Keyword [en]
Coronary heart disease, implantable cardioverter de®brillator, life situation, phenomenography, qualitative analysis
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-51799DOI: 10.1046/j.1365-2702.2000.00335.xOAI: oai:DiVA.org:liu-51799DiVA: diva2:277432
Available from: 2009-11-18 Created: 2009-11-18 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Caring for patients with an Implantable Cardioverter Defibrillator: Experiences of patients and healthcare professionals
Open this publication in new window or tab >>Caring for patients with an Implantable Cardioverter Defibrillator: Experiences of patients and healthcare professionals
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: An Implantable Cardioverter Defibrillator (ICD) is a technical device used in the treatment of ventricular arrhythmias. After the implantation of an ICD the entire life situation can be affected with psychological and social consequences for the patient and his/her next of kin. The healthcare professionals play a vital role in providing educational information, support, and technical follow-up of the device. During recent years more and more hospitals have introduced a more team based organisation where the physicians collaborate with specialised ICD nurses.

Aim: The overall aim of the thesis was to explore how patients with an ICD experienced their life situation and howhealthcare professionals described their experiences of delivering care to ICD patients.

Methods: The design was descriptive, combining both quantitative and qualitative approaches, and the data was collected from Sweden and the USA. The Uncertainty of Illness Scale (MUIS-C) and Quality of life Index (QLI) instruments were used to determine the level of uncertainty and satisfaction with life (I), in-depth interviews with a phenomenographic approach was used to describe how Swedish and US patients living with an ICD conceived their life situation (II, III) and how healthcare professionals’ experienced delivering care to patients with an ICD, (IV). Finally, to explore clinical aspects of ICD care in Sweden, the Delivery of ICD Questionnaire (DOIQ) was used to describe the healthcare professionals’ experiences and a content analysis was used to describe the written educational information material provided to patients (V).

Results: There were no differences in uncertainty between pre and post ICD implantation either in Swedish or the US patients. Satisfaction with life was significantly higher among US patients compared to Swedish patients both before and after ICD implantation within the health-functioning, socio-economic and psychological-spiritual domains. The Swedish ICD patients experienced a significantly higher satisfaction with life within the socioeconomic domain after 3 months. (I). The patients felt safe in having an ICD implanted, but the conceptions varied from seeing the device as a life saver to being worried about what could happen. Gratitude at having an ICD varied from happiness at being alive to something that was alien and disturbed the patient. Being more or less dependent included how patient experienced feelings from well-being to grief. Having a network varied from having sufficient support to loneliness. Having a belief in the future ranged from having confidence to look forward to resignation. Gaining awareness described patients’ adaptation to living with an ICD and limitations due to the ICD (II). The patients also underwent a transition from becoming aware of the restriction in the life situation through a process of adaption and having trust in the ICD. This phase was followed by a reorientation phase where they adapted to their life situation and the patient and his/her family regained of their lives (III). The healthcare professionals strove to provide competent and individualised care and infuse confirmation to the patients in form of information, education and support. They gave the patients tools to handle their life situation, through existential support and mediating security (IV). Half of the hospitals had nurse-based clinic and others planned to introduce them. Three hospitals performed follow-up in the form of remote home monitoring. The nurse had specific ICD education from ICD companies and/or various university courses. In the educational information material the biophysical dimensions dominated while the emotional dimension was scarcely described, and the spiritual-existential was not referred to at all (V).

Conclusions: This thesis offers a further contribution to the scholarly discussion about the relationship between technology and human existence and how to cope with this transition. Our studies revealed that the embodiment of the ICD reflects a merger of experiences about its presence and potential from both patients’ and healthcare professionals’ perspective. This research hopefully encourages healthcare professionals to carefully reflect on what it is like to live with an ICD and to consider practice improvement for the patients’ and the next of kin.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2009. 58 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1142
Keyword
ICD-implantation, healthcare professional, life situation, organisation of care, experiences, satisfaction, uncertainty, clinical aspects
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-51808 (URN)978-91-7393-568-5 (ISBN)
Public defence
2009-10-30, Berzeliussalen, ingång 65, Campus US, Linköpings Universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2009-11-23 Created: 2009-11-18 Last updated: 2013-09-12Bibliographically approved
2. Living with an implantable cardioverter defibrillator: Swedish and US patients' experiences of their life situation
Open this publication in new window or tab >>Living with an implantable cardioverter defibrillator: Swedish and US patients' experiences of their life situation
2004 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

The general aim of this study was to describe changes in uncertainty and satisfaction as well as to explore how patients with an ICD experience their life situation over a two year period. The design was explorative and descriptive, combining both quantitative and qualitative approaches. Data were collected from two locations, Sweden and the US. The data collection methods employed were questionnaires, the Uncertainty in Illness Scale- Community version (MUIS-C) and the Quality of Life Index, (Cardiac III, Parts I, II). Interviews were based on a phenomenographic approach. Statistical analysis was chosen to describe the patients' life situation.

During the initial phase the patients went through a process of adaption and learning to trust the ICD as well as becoming aware of the restrictions in their everyday lives. This was followed by a reorientation phase during which they adapted to and accepted their new life situation, after which both the patient and his/her family regained trust. The present findings can facilitate life style modifications and ensure that the goal of care is to take account of the patients' and healthcare professionals' understanding of living with an ICD.

Publisher
41 p.
Series
Linköping Studies in Health Sciences. Thesis, ISSN 1100-6013 ; 66
Series
Omvårdnadsforskning vid Hälsouniversitetet i Linköping, 12
Keyword
CHD, . ICD-implantation, MUIS, life situation, QLI, phenomenography, satisfaction, uncertainty
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-24176 (URN)3763 (Local ID)91-7373-843-3 (ISBN)3763 (Archive number)3763 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2013-09-10

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