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Organisation of care for Swedish patients with an Implantable Cardioverter Defibrillator, a national survey
Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.ORCID iD: 0000-0002-7097-392X
Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.ORCID iD: 0000-0002-4259-3671
2011 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 17-18, 2600-2608 p.Article in journal (Refereed) Published
Abstract [en]

Aim: To describe the clinical aspects of Implantable Cardioverter Defibrillators (ICD) care in Sweden with focus on organisation, the role and education of nurses, patient information and education, and areas in need of improvement.

Background: ICD implantations have developed rapidly in recent years and is now an established arrhythmia treatment. The expanding indication for ICD implantation demands new competencies and resources in the ICD team members.

Methods: Participants were recruited among physicians and nurses in all of the hospitals implanting ICDs (N=16). Data was collected by a questionnaire. Additionally, all written educational materials provided to patients pre- and post-implant were collected from all 16 hospitals. Deductive content analysis using Sarvimäki and Stenbock-Hult’s five holistic dimensions was employed to ascertain how information was provided in brochures and information materials.

Results: Half of the hospitals (n=8) had nurse-based outpatient clinics and several others planned to introduce them. Three hospitals carried out distance follow-ups by means of telemonitoring. The nurses had received specific ICD education from ICD companies and/or various university courses. The biophysical dimension dominated in the information material while the emotional, intellectual, and socio-cultural dimensions were scarcely described, and the spiritual- existential was not referred to at all.

Conclusion: Holistic care of ICD patients can be achieved by means of a multi-disciplinary ICD team and more patient-centred educational strategies. In Sweden, the organisation of ICD care and follow-up is developing towards more nurse-based clinics.

Relevance to clinical practice: Development and implementation of structured care programmes with a more holistic approach, can improve future ICD care. The content of the written educational materials need to be more holistic, rather than mainly focusing on the biophysical and technical aspects of living with an ICD.

Place, publisher, year, edition, pages
Blackwell Publishing , 2011. Vol. 20, no 17-18, 2600-2608 p.
Keyword [en]
Implantable Cardioverter Defibrillator, care, nursing, organisation, follow-up, patient education
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-51807DOI: 10.1111/j.1365-2702.2010.03540.xISI: 000293748900024OAI: oai:DiVA.org:liu-51807DiVA: diva2:277457
Note
Funding agency|School of Social and Health Sciences, Halmstad University||Department of Medicine and Health Sciences, Division of Nursing Science, Linkoping University||Available from: 2009-11-18 Created: 2009-11-18 Last updated: 2013-09-12Bibliographically 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

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Bolse, KärstinJohansson, IngelaStrömberg, Anna

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