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Ingadottir B, Thylén I, Ulin K, Jaarsma T. Patients are expecting to learn more: A longitudinal study of patients with heart failure undergoing device implantation. PATIENT EDUCATION AND COUNSELING 2020; 103:1382-1389. [PMID: 32122674 DOI: 10.1016/j.pec.2020.02.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To explore the educational expectations and experiences of patients with heart failure in relation to device implantation. METHODS In this longitudinal study, patients at six Swedish and Icelandic hospitals answered instruments about their knowledge expectations, before the device implantation, and about the knowledge they had received at two weeks, six months and 12 months after the procedure. Predictors for fulfillment of knowledge expectations were assessed with linear mixed model analysis. RESULTS Patients (N = 133, mean age 69.8 (±9.7) years, 80 % men) had high knowledge expectations, which for 83 % of them were unfulfilled. Predictors for fulfillment of knowledge expectations were access to knowledge from healthcare professionals (β 0.74, 95 % CI: 0.42-1.10), educational level (β -0.30, 95 % CI: -0.52 to -0.07) and knowledge expectations (β -1.03, 95 % CI: -1.30 to -0.80). Healthcare professionals were the main information source (89 %), 74 % of patients received written information, and 19 % had used the Internet. CONCLUSIONS Patients receive less knowledge than they expect, and individual factors and communication with healthcare professionals are related to their experience. Face-to-face is the most common method of delivering education. PRACTICE IMPLICATIONS Healthcare professionals should assess patients' expectations for information and consider implementing more diversity in their educational practices.
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Affiliation(s)
- Brynja Ingadottir
- Faculty of Nursing, School of Health Sciences, Univeresity of Iceland, Reykjavik, Iceland; Landspitali, the National University Hospital of Iceland, Reykjavik, Iceland.
| | - Ingela Thylén
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Kerstin Ulin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Medicine, Geriatrics and Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Julius Center, University Medical Center, Utrecht, the Netherlands
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Patient and Professional Factors That Impact the Perceived Likelihood and Confidence of Healthcare Professionals to Discuss Implantable Cardioverter Defibrillator Deactivation in Advanced Heart Failure: Results From an International Factorial Survey. J Cardiovasc Nurs 2019; 33:527-535. [PMID: 29727378 PMCID: PMC6200367 DOI: 10.1097/jcn.0000000000000500] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Supplemental digital content is available in the text. Background: Rate of implantable cardioverter defibrillator (ICD) implantations is increasing in patients with advanced heart failure. Despite clear guideline recommendations, discussions addressing deactivation occur infrequently. Aim: The aim of this article is to explore patient and professional factors that impact perceived likelihood and confidence of healthcare professionals to discuss ICD deactivation. Methods and Results: Between 2015 and 2016, an international sample of 262 healthcare professionals (65% nursing, 24% medical) completed an online factorial survey, encompassing a demographic questionnaire and clinical vignettes. Each vignette had 9 randomly manipulated and embedded patient-related factors, considered as independent variables, providing 1572 unique vignettes for analysis. These factors were determined through synthesis of a systematic literature review, a retrospective case note review, and a qualitative exploratory study. Results showed that most healthcare professionals agreed that deactivation discussions should be initiated by a cardiologist (95%, n = 255) or a specialist nurse (81%, n = 215). In terms of experience, 84% of cardiologists (n = 53) but only 30% of nurses (n = 50) had previously been involved in a deactivation decision. Healthcare professionals valued patient involvement in deactivation decisions; however, only 50% (n = 130) actively involved family members. Five of 9 clinical factors were associated with an increased likelihood to discuss deactivation including advanced age, severe heart failure, presence of malignancy, receipt of multiple ICD shocks, and more than 3 hospital admissions during the previous year. Furthermore, nationality and discipline significantly influenced likelihood and confidence in decision making. Conclusions: Guidelines recommend that healthcare professionals discuss ICD deactivation; however, practice is suboptimal with multifactorial factors impacting on decision making. The role and responsibility of nurses in discussing deactivation require clarity and improvement.
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Ingadottir B, Blondal K, Jaarsma T, Thylen I. Perceptions about traditional and novel methods to learn about postoperative pain management: a qualitative study. J Adv Nurs 2016; 72:2672-2683. [DOI: 10.1111/jan.13021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Brynja Ingadottir
- Divison of Nursing; Department of Social and Welfare Studies; Faculty of Medicine and Health Sciences; Linköping University; Sweden
- Landspitali - The National University Hospital of Iceland; Surgical Services and Faculty of Nursing; School of Health Sciences; University of Iceland; Reykjavik Iceland
| | - Katrin Blondal
- Landspitali - The National University Hospital of Iceland; Surgical Services and Faculty of Nursing; School of Health Sciences; University of Iceland; Reykjavik Iceland
| | - Tiny Jaarsma
- Divison of Nursing; Department of Social and Welfare Studies; Faculty of Medicine and Health Sciences; Linköping University; Sweden
| | - Ingela Thylen
- Department of Cardiology and Department of Medical and Health Sciences; Linköping University; Sweden
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Pasyar N, Sharif F, Rakhshan M, Nikoo M, Navab E. Iranian Patients' Experiences of the Internal Cardioverter Defibrillator Device Shocks: a Qualitative Study. J Caring Sci 2015; 4:277-86. [PMID: 26744727 PMCID: PMC4699505 DOI: 10.15171/jcs.2015.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 06/25/2015] [Indexed: 11/09/2022] Open
Abstract
Introduction: Implantable Cardioverter Defibrillator (ICD)
is a valuable treatment for the patients at risk of sudden cardiac death. In this method,
after diagnosis of pathological cardiac rhythms, shock is automatically applied to
normalize the rhythms. Shock is discharged when the patients are conscious, but the
patients’ experiences of shock have remained unknown. Thus, this study aimed to identify
and describe the patients’ experiences of shocks received from ICD. Methods: The present qualitative study was conducted through
thematic analysis and semi-structured interviews on 9 patients mean age 41.55 (1.57) with
ICD from November 2013 to July 2014. Data analysis was also performed simultaneously using
constant comparative analysis. Results: In this study, two main themes, namely "with a
parachute for life" and "Faced with nuisance", were obtained representing the patients’
experiences regarding ICD shock. With a parachute for life included subthemes, such as
"Rebirth", "Comforter and healing", and "Life assurance". In addition, "Faced with
nuisance" consisted of 2 subthemes of "Discomfort in moments of shock" and "Displeasure
after shock". Conclusion: This study provided a basis for evaluation of
patients nursing after discharge. By identification of the patients’ experiences regarding
shock, the present study can help the professional health staff to efficiently play their
roles and provide patients with holistic care. It can also be effective in designing
behavioral and cognitive interventional programs to change the patients’ attitude and
promote their adaptation with their conditions.
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Affiliation(s)
- Nilofar Pasyar
- Department of Medical Surgical Nursing, Student Research Committee, School of Nursing and Midwifery , Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farkhondeh Sharif
- Department of Psychiatric Nursing, Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahnaz Rakhshan
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Nikoo
- Department of Cardiology, Cardiovascular Research Center, School of Medicine , Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elham Navab
- Department of Critical Care Nursing and Management, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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Ingadottir B, Thylén I, Jaarsma T. Knowledge expectations, self-care, and health complaints of heart failure patients scheduled for cardiac resynchronization therapy implantation. Patient Prefer Adherence 2015; 9:913-21. [PMID: 26170641 PMCID: PMC4494625 DOI: 10.2147/ppa.s83069] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To describe what knowledge heart failure patients expect to acquire in relation to their upcoming cardiac resynchronization therapy (CRT) device implantation, to describe their self-care and health complaints, and to explore the relationship between knowledge expectations and self-care, health complaints, and background factors. PATIENTS AND METHODS Cross-sectional multicenter study with 104 patients scheduled for a first-time, elective CRT implantation in Swedish and Icelandic hospitals. Data were collected with the Knowledge Expectations of hospital patient Scale, European Heart Failure Self-care Behavior Scale, and Adjusted Postoperative Recovery Profile. RESULTS Patients expected most knowledge related to their disease and its treatment (median 4.0, interquartile range 0.13) and least on social issues (median 3.5, interquartile range 0.83). Their self-care was average (standardized mean 51.0±19.6) before the procedure. Patients had on average 8.2 (±4.7) health complaints and rated fatigue and sexual problems as the most severe. Age was independently associated with knowledge expectations (Expβ 0.049, P=0.033). CONCLUSION Heart failure patients waiting for a CRT device implantation have high expectations for multiple aspects of knowledge, including self-care issues, before their procedure. These expectations are similar to those of other surgical patients and they increase with age.
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Affiliation(s)
- Brynja Ingadottir
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
- Landspitali–The National University Hospital of Iceland, Reykjavik, Iceland
| | - Ingela Thylén
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
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Morken IM, Norekvål TM, Bru E, Larsen AI, Karlsen B. Perceptions of healthcare professionals’ support, shock anxiety and device acceptance among implantable cardioverter defibrillator recipients. J Adv Nurs 2014; 70:2061-2071. [PMID: 24506575 DOI: 10.1111/jan.12364] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 09/13/2013] [Accepted: 01/11/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Ingvild M. Morken
- Department of Cardiology; Stavanger University Hospital; Norway
- Department of Health Studies; University of Stavanger; Norway
| | - Tone M. Norekvål
- Department of Heart Disease; Haukeland University Hospital; Bergen Norway
- Institute of Medicine; University of Bergen; Norway
| | - Edvin Bru
- Department of Health Studies; University of Stavanger; Norway
- Norwegian Centre for Learning Environment and Behavioural Research in Education; University of Stavanger; Norway
| | - Alf I. Larsen
- Department of Cardiology; Stavanger University Hospital; Norway
- Institute of Medicine; University of Bergen; Norway
| | - Bjørg Karlsen
- Department of Health Studies; University of Stavanger; Norway
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Strömberg A, Fluur C, Miller J, Chung ML, Moser DK, Thylén I. ICD recipients' understanding of ethical issues, ICD function, and practical consequences of withdrawing the ICD in the end-of-life. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:834-42. [PMID: 24483943 DOI: 10.1111/pace.12353] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 10/22/2013] [Accepted: 01/01/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND The current international expert consensus statements recommend that clinicians should discuss elective implantable cardioverter defibrillator (ICD) deactivation before implantation of the device, and then consistently during the illness trajectory. However, no previous studies have investigated predictors of ICD patients' knowledge about end-of-life issues or whether knowledge influences patients' attitudes about deactivation. METHODS This nationwide survey study (n = 3,067) had a cross-sectional correlational design of self-reported data. Participants were recruited from the Swedish ICD and Pacemaker Registry and asked to complete a questionnaire about knowledge in relation to the ICD and end-of-life. RESULTS Only 79 respondents (3%) scored correctly on all 11 questions. The mean sample score was 6.6 ± 2.7 out of a maximum score of 11. A total of 835 participants (29%) had an insufficient knowledge when using the 25th percentile as a cutoff. Younger ICD recipients, those cohabiting, male participants, and those who had received shocks, had a generator replacement, or who had discussed illness trajectory with their physician were more likely to have sufficient knowledge on the end-of-life issues. Insufficient knowledge was associated with indecisiveness to make decisions about ICD deactivation in the end-of-life situations, and with favorable attitudes about replacing the ICD even if seriously ill or have reached an advanced age, and keeping the shock therapy of the ICD even in a terminal phase of life when dying from cancer or other serious chronic illnesses. CONCLUSION Insufficient knowledge is common among ICD recipients and is associated with attitudes and decisions that may result in a stressful and potentially painful end-of-life situation.
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Affiliation(s)
- Anna Strömberg
- Division of Nursing Sciences, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Department of Cardiology, County Council of Östergötland, Linköping, Sweden
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Fluur C, Bolse K, Strömberg A, Thylén I. Spouses' reflections on implantable cardioverter defibrillator treatment with focus on the future and the end-of-life: a qualitative content analysis. J Adv Nurs 2013; 70:1758-69. [PMID: 24321029 DOI: 10.1111/jan.12330] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2013] [Indexed: 12/01/2022]
Abstract
AIM To explore future reflections of spouses living with an implantable cardioverter defibrillator recipient with focus on the end-of-life phase in an anticipated palliative phase. BACKGROUND A history of or risk for life-threatening arrhythmias may require an implantable cardioverter defibrillator. Despite the life-saving capacity of the device, eventually life will come to an end. As discussion about preferences of shock therapy at end-of-life phase seldom takes place in advance, the implantable cardioverter defibrillator recipients may face defibrillating shocks in the final weeks of their lives, adding to stress and anxiety in patients and their families. DESIGN Qualitative study with in-depth interviews analysed with a content analysis. METHODS Interviews were performed with 18 spouses of medically stable implantable cardioverter defibrillator recipients during 2011-2012. RESULTS The spouses described how they dealt with changes in life and an uncertain future following the implantable cardioverter defibrillator implantation. Six subcategories conceptualized the spouses' concerns: Aspiring for involvement; Managing an altered relationship; Being attentive to warning signs; Worries for deterioration in the partner's health; Waiting for the defibrillating shock; and Death is veiled in silence. CONCLUSION Despite the partner's serious state of health; terminal illness or death and the role of the device was seldom discussed with healthcare professionals or the implantable cardioverter defibrillator recipient. Open and honest communication was requested as important to support coping with an unpredictable life situation and to reduce worries and uncertainty about the future and end-of-life.
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Affiliation(s)
- Christina Fluur
- Department of Cardiology UHL, County Council of Östergötland, Linköping, Sweden
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Morken IM, Bru E, Norekvål TM, Larsen AI, Idsoe T, Karlsen B. Perceived support from healthcare professionals, shock anxiety and post-traumatic stress in implantable cardioverter defibrillator recipients. J Clin Nurs 2013; 23:450-60. [DOI: 10.1111/jocn.12200] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2012] [Indexed: 12/19/2022]
Affiliation(s)
- Ingvild M Morken
- Department of Cardiology; Stavanger University Hospital; Stavanger Norway
- Department of Health Studies; University of Stavanger; Stavanger Norway
| | - Edvin Bru
- Department of Health Studies; University of Stavanger; Stavanger Norway
- Centre for Behavioural Research; University of Stavanger; Stavanger Norway
| | - Tone M Norekvål
- Department of Heart Disease; Haukeland University Hospital; Bergen Norway
- Institute of Medicine; University of Bergen; Bergen Norway
| | - Alf I Larsen
- Department of Cardiology; Stavanger University Hospital; Stavanger Norway
- Institute of Medicine; University of Bergen; Bergen Norway
| | - Thormod Idsoe
- Centre for Behavioural Research; University of Stavanger; Stavanger Norway
- Norwegian
Institute of Public Health; Oslo Norway
| | - Bjørg Karlsen
- Department of Health Studies; University of Stavanger; Stavanger Norway
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Bolse K, Thylén I, Strömberg A. Healthcare professionals’ experiences of delivering care to patients with an implantable cardioverter defibrillator. Eur J Cardiovasc Nurs 2012; 12:346-52. [DOI: 10.1177/1474515112457133] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Kärstin Bolse
- Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden
- School of Social and Health Sciences, Halmstad University, Sweden
| | - Ingela Thylén
- Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden
- Department of Cardiology, Linköping University Hospital, Linköping, Sweden
- Molde University College, Faculty of Health Sciences, Molde, Norway
| | - Anna Strömberg
- Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden
- Department of Cardiology, Linköping University Hospital, Linköping, Sweden
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Salmoirago-Blotcher E, Crawford S, Tran C, Goldberg R, Rosenthal L, Ockene I. Spiritual well-being may buffer psychological distress in patients with implantable cardioverter defibrillators (ICD). J Evid Based Complementary Altern Med 2012; 17:148-154. [PMID: 23050210 DOI: 10.1177/2156587212447627] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Psychological distress is common in patients with implantable cardioverter defibrillators (ICDs) and has been associated with a worse prognosis. The authors examined whether spiritual wellbeing is associated with reduced psychological distress in patients with ICDs. The Functional Assessment of Chronic Illness Therapy-Spiritual Wellbeing (FACIT-SWB) questionnare and the Hospital Anxiety and Depression Scale (HADS) were used to measure spiritual wellbeing and overall psychological distress. Multivariate linear regression was used to explore the relationship between these variables.The study sample included 46 ICD outpatients (32 M, 14 F; age range 43-83). An inverse association between HADS and FACIT-SWB scores was found, persisting after adjustment for demographics, anxiety/depression, medications, therapist support, and functional status (F = 0.001; β= -0.31, CI: -0.44, -0.19). In conclusion, spiritual wellbeing was independently associated with lower psychological distress in ICD outpatients. Spiritual wellbeing could act as a protective factor against psychological distress in these high-risk patients.
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