1
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Atila N, Ozsaker E. Depression, anxiety, stress levels, and coping styles of caregivers of patients with left ventricular assist device. Perspect Psychiatr Care 2022; 58:2414-2422. [PMID: 35383942 DOI: 10.1111/ppc.13076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/15/2022] [Accepted: 03/21/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To determine the depression, anxiety, stress (DAS) levels, and coping styles of caregivers of patients with left ventricular assist device (LVAD). DESIGN AND METHODS The sample of the study consisted of 74 caregivers of patients with LVAD. Data were collected using Individual Data Form, DASS 21, and Coping Styles Scale. FINDINGS Depression was found in 67.6%, anxiety in 45.9%, and stress in 50% of the caregivers of patients with LVAD. A significant relationship was found between the sociodemographic characteristics of caregivers, some variables related to the patient and the care process, and coping styles with stress, and DAS levels of caregivers. PRACTICE IMPLICATIONS Considering the variables that may affect the DAS levels of the LVAD caregivers will improve the expected results from the LVAD.
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Affiliation(s)
- Necla Atila
- Intensive Care Unit, Cardiovascular Surgery Clinic, Ege University Hospital, Izmir, Turkey
| | - Esma Ozsaker
- Surgical Nursing Department, Faculty of Nursing, Ege University, Izmir, Turkey
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2
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Streur MM, Auld JP, Liberato ACS, Beckman JA, Mahr C, Thompson EA, Dougherty CM. Left Ventricular Assist Device Caregiver Experiences and Health Outcomes: A Systematic Review of Qualitative and Quantitative Studies. J Card Fail 2020; 26:713-726. [PMID: 32505816 DOI: 10.1016/j.cardfail.2020.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 05/22/2020] [Accepted: 05/27/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Knowledge synthesis is lacking regarding outcomes and experiences of caregivers of adult patients living with continuous flow left ventricular assist devices (CF-LVAD). The purpose of this systematic review was to summarize qualitative data related to the experience of caregivers of adult patients living with CF-LVAD as well as quantitative data related to health outcomes of caregivers. METHODS AND RESULTS Multiple databases were systematically queried for studies of qualitative experiences and quantitative health outcomes for caregivers of adult CF-LVAD recipients. Search dates were constrained to articles published between 2004 and August of 2018 because CF-LVADs were not routinely implanted before 2004. Two authors independently screened 683 articles; 15 met predetermined inclusion criteria. Eligible articles reported results from 13 studies. Of those, 8 used either qualitative or mixed methods and 5 used quantitative methods. Caregivers were primarily female (81%) and their mean age was 59 years. Qualitative studies revealed 3 overarching themes related to the caregiver role, coping strategies, and LVAD decisions. Quantitative studies revealed caregiver strain peaked between 1 and 3 months after implantation, anxiety and depression were relatively stable, mental health status improved, and physical health status was stable from before to after implantation. CONCLUSIONS CF-LVAD caregivers experience significant, sustained emotional strain for 3 months after implantation, reporting considerable stress in meeting their personal needs and those of their loved one.
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Affiliation(s)
- Megan M Streur
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington.
| | - Jonathan P Auld
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington
| | - Ana Carolina Sauer Liberato
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington
| | - Jennifer A Beckman
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington
| | - Claudius Mahr
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington
| | - Elaine A Thompson
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington
| | - Cynthia M Dougherty
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington
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3
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Kato NP, Jaarsma T, Casida JM, Lee CS, Strömberg A, Gal TB. Development of an Instrument for Measuring Self-Care Behaviors After Left Ventricular Assist Device Implantation. Prog Transplant 2019; 29:335-343. [DOI: 10.1177/1526924819874358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:Successful long-term left ventricular assist device (LVAD) therapy necessitates a high degree of self-care. We aimed to develop an instrument that measures self-care behaviors in adult patients living with an LVAD.Methods:We used the method to develop patient-reported outcomes recommended by the US Food and Drug Administration. Prior to developing the instrument, a literature review was conducted to generate items using the middle-range theory of self-care of chronic illness as a guiding framework. A 2-round Delphi method, involving 17 clinicians with expertise in heart failure and assist devices from the Netherlands, Israel, United States, Canada, and Japan, was used to generate and select items. In the first Delphi survey, the levels of importance, relevance, and clarity of items in the instrument were evaluated. The second Delphi survey was performed to gain consensus on the final selection of items. We also examined face validity.Results:A preliminary 37-item version of the Self-Care Behavior Scale was produced. The first panel judged 33 items as important and relevant, taking out 4 items due to vague wording and duplication and adding in 4 items. In the final 33-item version, 19 items address self-care maintenance behaviors, 10 items address self-care monitoring behaviors, and 4 items address self-care management behaviors. Patients (N = 25) did not have any difficulties understanding items and report any missing items.Conclusion:The 33-item Self-Care Behavior Scale for patients with heart failure having an LVAD has been developed and is ready for further psychometric testing.
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Affiliation(s)
- Naoko P. Kato
- Division of Nursing Science, Department of Social and Welfare Studies, Linköping University, Sweden
- Department of Therapeutic Strategy for Heart Failure, The University of Tokyo Graduate School of Medicine, Japan
| | - Tiny Jaarsma
- Division of Nursing Science, Department of Social and Welfare Studies, Linköping University, Sweden
| | - Jesus M. Casida
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Christopher S. Lee
- Oregon Health and Science University School of Nursing and Knight Cardiovascular Institute, Portland, OR, USA
- Boston College, Willian F. Connell School of Nursing, Chestnut Hill, MA, USA
| | - Anna Strömberg
- Division of Nursing Science, Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Sweden
| | - Tuvia Ben Gal
- Heart Failure Unit, Cardiology Department, Rabin Medical Center, Petah Tikva, Sackler School of Medicine, Tel Aviv University, Israel
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4
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Reiss N, Schmidt T, Langheim E, Bjarnason-Wehrens B, Marx R, Sindermann JR, Knoglinger E. Inpatient Cardiac Rehabilitation of LVAD Patients-Updated Recommendations from the Working Group of the German Society for Prevention and Rehabilitation of Cardiovascular Diseases. Thorac Cardiovasc Surg 2019; 69:70-82. [PMID: 31170737 DOI: 10.1055/s-0039-1691837] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cardiac rehabilitation physicians are faced to an increasing number of heart failure patients supported by left ventricular assist devices (LVAD). Many of these patients have complex medical issues and prolonged hospitalizations and therefore need special cardiac rehabilitation strategies including psychological, social, and educational support which are actually poorly implemented.Cardiac rehabilitation with clear guidance and more evidence should be considered as an essential component of the patient care plan especially regarding the increasing number of destination patients and their long-term follow-up.In this article the working group for postimplant treatment and rehabilitation of LVAD patients of the German Society for Prevention and Rehabilitation of Cardiovascular Diseases has summarized and updated the recommendations for the cardiac rehabilitation of LVAD patients considering the latest literature.
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Affiliation(s)
- Nils Reiss
- Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany
| | - Thomas Schmidt
- Schüchtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany.,Institute of Cardiology and Sports Medicine, German Sports University, Cologne, Germany
| | | | | | - Roger Marx
- MediClin Fachklinik Rhein/Ruhr, Essen, Germany
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5
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Standing HC, Exley C, MacGowan GA, Rapley T. ‘We’re like a gang, we stick together’: experiences of ventricular assist device communities. Eur J Cardiovasc Nurs 2018; 17:399-407. [DOI: 10.1177/1474515118754738] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Ventricular assist devices (VADs) are a relatively new development in the management of advanced heart failure. In the UK, VAD recipients comprise a unique group of less than 200 patients. This is the first paper to explore the experience of VAD communities, the extent to which communities are developed around the device, and how these influence the experience of living with the VAD. Methods: Qualitative interviews were conducted with 20 VAD recipients (implanted as a bridge to transplantation), 11 interviews also included the VAD recipients’ partners. Interpretive phenomenology was employed as the theoretical basis guiding the analysis of the interviews. Results: Four key themes emerged from the data: the existence of VAD communities; experiential knowledge and understanding; social comparisons; and the impacts of deaths within the VAD community. Many of the interviewees valued the VAD communities and the relationships they had formed with fellow recipients. The beneficial impacts of the VAD communities included offering recently implanted patients a realistic view of what to expect from life with a VAD; this could aid them in accepting and adapting to the changes imparted by the device. However, negative impacts of the VAD communities were also reported, in particular following deaths within the group, which were a source of distress for many of the interviewees. Conclusions: In general, the VAD communities appeared to be a beneficial source of support for the majority of interviewees. Consideration should be given to how these communities could be supported by clinicians.
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Affiliation(s)
| | - Catherine Exley
- Faculty of Health and Life Sciences, Northumbria University, UK
| | - Guy A MacGowan
- Department of Cardiology, Freeman Hospital, UK
- Institute of Genetic Medicine, Newcastle University, UK
| | - Tim Rapley
- Faculty of Health and Life Sciences, Northumbria University, UK
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6
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da Silva Barreto M, Garcia-Vivar C, Silva Marcon S. Methodological quality of Grounded Theory research with families living with chronic illness. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2018. [DOI: 10.1016/j.ijans.2018.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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7
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Quality of life of family caregivers of patients with a left ventricular assist device in Japan. J Cardiol 2018; 71:81-87. [DOI: 10.1016/j.jjcc.2017.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 05/17/2017] [Accepted: 06/06/2017] [Indexed: 01/31/2023]
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8
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Bidwell JT, Lyons KS, Mudd JO, Gelow JM, Chien CV, Hiatt SO, Grady KL, Lee CS. Quality of Life, Depression, and Anxiety in Ventricular Assist Device Therapy: Longitudinal Outcomes for Patients and Family Caregivers. J Cardiovasc Nurs 2017; 32:455-463. [PMID: 27811585 PMCID: PMC5413439 DOI: 10.1097/jcn.0000000000000378] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients who receive ventricular assist device (VAD) therapy typically rely on informal caregivers (family members or friends) to assist them in managing their device. OBJECTIVE The purpose of this study is to characterize changes in person-oriented outcomes (quality of life [QOL], depression, and anxiety) for VAD patients and their caregivers together from pre-implantation to 3 months post-implantation. METHODS This was a formal interim analysis from an ongoing prospective study of VAD patients and caregivers (n = 41 dyads). Data on person-oriented outcomes (QOL: EuroQol 5 Dimensions Visual Analog Scale; depression: Patient Health Questionnaire-8; anxiety: Brief Symptom Inventory) were collected at 3 time points (just prior to implantation and at 1 and 3 months post-implantation). Trajectories of change for patients and caregivers on each measure were estimated using latent growth modeling with parallel processes. RESULTS Patients' QOL improved significantly over time, whereas caregiver QOL worsened. Depression and anxiety also improved significantly among patients but did not change among caregivers. There was substantial variability in change on all outcomes for both patients and their caregivers. CONCLUSIONS This is the first quantitative study of VAD patient-caregiver dyads in modern devices that describes change in person-oriented outcomes from pre-implantation to post-implantation. This work supports the need for future studies that account for the inherent relationships between patient and caregiver outcomes and examine variability in patient and caregiver responses to VAD therapy.
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Affiliation(s)
- Julie T Bidwell
- Julie T. Bidwell, PhD, RN Predoctoral Fellow, Oregon Health & Science University School of Nursing, Portland. Karen S. Lyons, PhD, FGSA Associate Professor, Oregon Health & Science University School of Nursing, Portland. James O. Mudd, MD Associate Professor, Oregon Health & Science University Knight Cardiovascular Institute, Portland. Jill M. Gelow, MD, MPH Assistant Professor, Oregon Health & Science University Knight Cardiovascular Institute, Portland. Christopher V. Chien, MD Assistant Professor, Oregon Health & Science University Knight Cardiovascular Institute, Portland. Shirin O. Hiatt, MPH, MS, RN Research Associate, Oregon Health & Science University School of Nursing, Portland. Kathleen L. Grady, PhD, MS, RN, FAHA, FHSA, FAAN Professor, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Christopher S. Lee, PhD, RN, FAHA, FHFSA, FAAN Associate Professor, Oregon Health & Science University School of Nursing and Knight Cardiovascular Institute, Portland
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9
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Nicholas Dionne-Odom J, Hooker SA, Bekelman D, Ejem D, McGhan G, Kitko L, Strömberg A, Wells R, Astin M, Metin ZG, Mancarella G, Pamboukian SV, Evangelista L, Buck HG, Bakitas MA. Family caregiving for persons with heart failure at the intersection of heart failure and palliative care: a state-of-the-science review. Heart Fail Rev 2017; 22:543-557. [PMID: 28160116 PMCID: PMC5544594 DOI: 10.1007/s10741-017-9597-4] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Many of the 23 million individuals with heart failure (HF) worldwide receive daily, unpaid support from a family member or friend. Although HF and palliative care practice guidelines stipulate that support be provided to family caregivers, the evidence base to guide care for this population has not been comprehensively assessed. In order to appraise the state-of-the-science of HF family caregiving and recommend areas for future research, the aims of this review were to summarize (1) how caregivers influence patients, (2) the consequences of HF for caregivers, and (3) interventions directed at HF caregivers. We reviewed all literature to December 2015 in PubMed and CINAHL using the search terms "heart failure" AND "caregiver." Inclusion criteria dictated that studies report original research of HF family caregiving. Articles focused on children or instrument development or aggregated HF with other illnesses were excluded. We identified 120 studies, representing 5700 caregivers. Research on this population indicates that (1) caregiving situations vary widely with equally wide-ranging tasks for patients to help facilitate their health behaviors, psychological health and relationships, and quality of life (QoL); (2) caregivers have numerous unmet needs that fluctuate with patients' unpredictable medical status, are felt to be ignored by the formal healthcare system, and can lead to distress, burden, and reduced QoL; and (3) relatively few interventions have been developed and tested that effectively support HF family caregivers. We provide recommendations to progress the science forward in each of these areas that moves beyond descriptive work to intervention development and clinical trials testing.
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Affiliation(s)
- J Nicholas Dionne-Odom
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA.
| | - Stephanie A Hooker
- Department of Psychology, University of Colorado, Denver, Campus Box 173, PO Box 173364, Denver, CO, 80217, USA
| | - David Bekelman
- Veterans Affairs Eastern Colorado Health Care System, Department of Medicine, Anschutz Medical Campus, University of Colorado School of Medicine, 1055 Clermont Street, Research 151, Denver, CO, 80220, USA
| | - Deborah Ejem
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA
| | - Gwen McGhan
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA
| | - Lisa Kitko
- College of Nursing, Pennsylvania State University, 201 Nursing Sciences Building, University Park, PA, 16802, USA
| | - Anna Strömberg
- Department of Medical and Health Sciences, Division of Nursing, Campus University Hospital, Linköping University, Building 511-001, 581 85, Linköping, Sweden
| | - Rachel Wells
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA
| | - Meka Astin
- School of Public Health, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
| | - Zehra Gok Metin
- Department of Internal Medicine Nursing, Hacettepe University, 06100, Ankara, Turkey
| | - Gisella Mancarella
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA
| | - Salpy V Pamboukian
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, 1900 University Blvd, THT 321, Birmingham, AL, 35294, USA
| | - Lorraine Evangelista
- Program in Nursing Science, University of California, Irvine, 299E Berk Hall, Irvine, CA, 92697-3959, USA
| | - Harleah G Buck
- College of Nursing, University of South Florida, 12901 Bruce B. Downs Blvd. MDC22, Tampa, FL, 33612-4766, USA
| | - Marie A Bakitas
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, 2M019H, Birmingham, AL, 35294-1210, USA
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10
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Mitchell M, Coombs M, Wetzig K. The provision of family-centred intensive care bereavement support in Australia and New Zealand: Results of a cross sectional explorative descriptive survey. Aust Crit Care 2017; 30:139-144. [DOI: 10.1016/j.aucc.2016.07.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 07/21/2016] [Accepted: 07/25/2016] [Indexed: 10/21/2022] Open
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11
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van Manen MA. The Ventricular Assist Device in the Life of the Child: A Phenomenological Pediatric Study. QUALITATIVE HEALTH RESEARCH 2017; 27:792-804. [PMID: 28682718 PMCID: PMC5405822 DOI: 10.1177/1049732317700853] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
What is it like for a child to live with an artificial heart? The use of some medical therapies in children requires developmental considerations, is associated with psychosocial consequences, and calls for ethical sensitivities. A critical case is the ventricular assist device (VAD), a mechanical pump used to support the functioning of a failing heart. As a pediatric therapy, the device can be used as a temporary solution for poor heart function, a bridge to transplantation or recovery, or as a destination therapy. While the mechanical-technical operation of the VAD is well understood, the clinical-technical aspects of young people living with this device are largely unexplored. Drawing on interviews of school-aged children, the aim of this phenomenological study is to explore how a VAD may structure or condition a child's meaningful experience of their world outside the hospital. The driveline of an implanted VAD is the peripheral attachment, extruding through the skin to connect the controller-power supply. The materiality of the device may be interruptive, restrictive, and disturbing to the psycho-physical being and sense of self-identity of the child as a child. And while a child equipped with a VAD is not necessarily conspicuous among other children, the child may experience the device as an exposing presence, while living with the worry of a caregiver who takes on the role not simply of parent but of watchful health professional. A phenomenological understanding of the VAD should assist parents and caregiving health professionals knowing how to deal with specific issues arising in the life of the VAD child.
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12
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Egerod I, Andersson AE, Fagerdahl AM, Knudsen VE. Images of suffering depicted in diaries of family caregivers in the acute stage of necrotising soft tissue infection: A content analysis. Intensive Crit Care Nurs 2017; 41:57-62. [PMID: 28292567 DOI: 10.1016/j.iccn.2017.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 02/08/2017] [Accepted: 02/11/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Severe necrotising soft tissue infections (NSTI) are rare life threatening rapidly progressing bacterial infections requiring immediate diagnosis and treatment. The aim of the study was to explore the experience of family caregivers of patients with necrotising soft tissue infection during the acute stage of disease. METHODS Our study had a qualitative descriptive binational design using qualitative content analysis to explore diaries written by close family members (n=15). Participants were recruited from university hospitals in Denmark and Sweden. FINDINGS Three main categories emerged: Trajectory, Treatment, and Patient & Family. The first helped us construct an overview of the NSTI trajectory showing issues of importance to patient and family caregivers. The following categories were analysed further to describe four themes central to the family caregiver experience: craving information, needing to be near, suffering separation and network taking over. CONCLUSIONS Necrotising soft tissue infections are uncommon causing shock and concern. Centralised treatment might involve physical separation of patient and family during the acute stage of illness. Family accommodations near the patient and accessibility to adequate communication devices at the bedside are recommended. Health professionals need to keep in mind the importance of information and reassurance on the wellbeing of the family and ultimately of the patient.
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Affiliation(s)
- Ingrid Egerod
- University of Copenhagen, Rigshospitalet, Intensive Care Unit 4131, Blegdamsvej 9, Copenhagen, Denmark,.
| | - Annette E Andersson
- Institute of Health and care science, University of Gothenburg, Sweden; Department of Orthopedic Surgery, Sahlgrenska University Hospital, Mölndal, Sweden.
| | - Ann-Mari Fagerdahl
- Ann-Mari Fagerdahl: Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden.
| | - Vibeke E Knudsen
- University of Copenhagen, Rigshospitalet, Intensive Care Unit 4131, Blegdamsvej 9, Copenhagen, Denmark,.
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13
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The Perceptions of Important Elements of Caregiving for a Left Ventricular Assist Device Patient: A Qualitative Meta-Synthesis. J Cardiovasc Nurs 2017; 31:215-25. [PMID: 25882647 DOI: 10.1097/jcn.0000000000000242] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The use of a left ventricular assist device (LVAD) is becoming increasingly common in patients with end-stage heart failure. Many LVAD programs require patients to have a caregiver before receiving a device. There are few studies exploring the experience, burden, and impacts on caregivers of patients with LVADs. OBJECTIVES The aim of this study was to synthesize the qualitative literature regarding caregiver's perceptions about caring for an adult LVAD patient. METHODS We searched MEDLINE, CINAHL, PsychInfo, and Web of Science to find English articles on the topic of LVAD caregiver's perceptions. The articles were then synthesized using a formal process of qualitative meta-synthesis. RESULTS Eight articles met criteria for inclusion. The meta-synthesis across the articles resulted in 8 themes categorized under 3 domains. Many of the articles suggested a longitudinal process of caregiving with perceptions largely dependent upon the time of interview in relation to the LVAD. The first domain of caregiving is the "early" stage, covering the life before the LVAD through the procedure. This phase is characterized by the pre-LVAD "emotional rollercoaster," the decision seen as "no option," and the thought of "leave it [the LVAD] at the hospital." The second domain is the "middle" stage, covering the time frame after discharge from the hospital. This phase is characterized by fragility of the patient, recognition of a need to adapt, and a transformed life. The final domain is "late LVAD" and describes how late in the LVAD process the LVAD indication (bridge to transplant or destination therapy) brings in to focus what is important to caregivers. CONCLUSIONS Existing literature indicates that the LVAD caregiver experience is intense as well as burdensome and entails the need to adapt to a new life. Given the burdens caregivers experience, clinicians and future research should explore strategies to support these important individuals.
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14
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Bruce CR, Minard CG, Wilhelms L, Abraham M, Amione-Guerra J, Pham L, Grogan SD, Trachtenberg B, Smith ML, Bruckner BA, Estep JD, Kostick KM. Caregivers of Patients With Left Ventricular Assist Devices. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.116.002879. [DOI: 10.1161/circoutcomes.116.002879] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 10/12/2016] [Indexed: 11/16/2022]
Abstract
Background—
How caregivers contribute to positive or negative outcomes for left ventricular assist device (LVAD) patients remains unclear. Our primary study objectives were to (1) identify caregiver support attributes through a retrospective chart review of social workers’ psychosocial assessments for LVAD patients and (2) determine how these attributes associated with patients’ post-LVAD placement mortality and Interagency Registry for Mechanically Assisted Circulatory Support–defined morbidity events.
Methods and Results—
We retrospectively reviewed and recorded social workers’ clinical assessments of adult patients implanted with durable continuous-flow LVADs as bridge to transplant, destination therapy, or bridge to decision from January 2010 to December 2014. Associations between caregiver characteristics and patient mortality and morbidity events were analyzed using Kaplan–Meier curves and Cox proportional hazards regression. Patient follow-up time was calculated as the time from hospital discharge until the earliest among death with LVAD, transplant, or the last day of the study (December 31, 2015). Patients were censored for death with LVAD at the time of transplant or the last day of the study. A total of 96 LVAD recipients were included in this study. Having a caregiver who understands the severity of the illness and options available to the patient (as determined and documented by the social worker;
P
=0.01), a caregiver who has identified a backup plan (
P
=0.02), and a caregiver who is able to provide logistical support (
P
=0.04) significantly mitigated risk of death. The risk of death for an LVAD patient was also significantly lower among those who have at least 1 adult child who lives within 50 miles (
P
=0.03) and those who have an extended family who can care for the patient (
P
=0.03). The risk of death was 3.1× more likely among patients who live alone compared with those who do not live alone (
P
=0.04). No caregiver characteristics were significantly associated with morbidity.
Conclusions—
This exploratory, hypothesis-generating study suggests that mortality after LVAD placement is impacted by caregiver understanding of patient severity of illness and caregiver presence. This study provides initial evidence to support further work in understanding the associations between caregivers and LVAD patients, as well as interventions that may improve patient outcomes.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT02248974.
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Affiliation(s)
- Courtenay R. Bruce
- From the Center for Medical Ethics and Health Policy (C.R.B., L.A.W., M.A., K.M.K.) and Dan L. Duncan Institute for Clinical and Translational Research (C.G.M.), Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist System, TX (C.R.B.); Houston Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center and J.C. Walter Jr. Transplant Center, Houston, TX (J.A.-G., L.P., S.D.G., B.T., B.A.B., J.D.E.); and Department of Bioethics, Cleveland Clinic, OH (M.L.S.)
| | - Charles G. Minard
- From the Center for Medical Ethics and Health Policy (C.R.B., L.A.W., M.A., K.M.K.) and Dan L. Duncan Institute for Clinical and Translational Research (C.G.M.), Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist System, TX (C.R.B.); Houston Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center and J.C. Walter Jr. Transplant Center, Houston, TX (J.A.-G., L.P., S.D.G., B.T., B.A.B., J.D.E.); and Department of Bioethics, Cleveland Clinic, OH (M.L.S.)
| | - L.A. Wilhelms
- From the Center for Medical Ethics and Health Policy (C.R.B., L.A.W., M.A., K.M.K.) and Dan L. Duncan Institute for Clinical and Translational Research (C.G.M.), Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist System, TX (C.R.B.); Houston Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center and J.C. Walter Jr. Transplant Center, Houston, TX (J.A.-G., L.P., S.D.G., B.T., B.A.B., J.D.E.); and Department of Bioethics, Cleveland Clinic, OH (M.L.S.)
| | - Mackenzie Abraham
- From the Center for Medical Ethics and Health Policy (C.R.B., L.A.W., M.A., K.M.K.) and Dan L. Duncan Institute for Clinical and Translational Research (C.G.M.), Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist System, TX (C.R.B.); Houston Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center and J.C. Walter Jr. Transplant Center, Houston, TX (J.A.-G., L.P., S.D.G., B.T., B.A.B., J.D.E.); and Department of Bioethics, Cleveland Clinic, OH (M.L.S.)
| | - Javier Amione-Guerra
- From the Center for Medical Ethics and Health Policy (C.R.B., L.A.W., M.A., K.M.K.) and Dan L. Duncan Institute for Clinical and Translational Research (C.G.M.), Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist System, TX (C.R.B.); Houston Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center and J.C. Walter Jr. Transplant Center, Houston, TX (J.A.-G., L.P., S.D.G., B.T., B.A.B., J.D.E.); and Department of Bioethics, Cleveland Clinic, OH (M.L.S.)
| | - Linda Pham
- From the Center for Medical Ethics and Health Policy (C.R.B., L.A.W., M.A., K.M.K.) and Dan L. Duncan Institute for Clinical and Translational Research (C.G.M.), Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist System, TX (C.R.B.); Houston Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center and J.C. Walter Jr. Transplant Center, Houston, TX (J.A.-G., L.P., S.D.G., B.T., B.A.B., J.D.E.); and Department of Bioethics, Cleveland Clinic, OH (M.L.S.)
| | - Sherry D. Grogan
- From the Center for Medical Ethics and Health Policy (C.R.B., L.A.W., M.A., K.M.K.) and Dan L. Duncan Institute for Clinical and Translational Research (C.G.M.), Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist System, TX (C.R.B.); Houston Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center and J.C. Walter Jr. Transplant Center, Houston, TX (J.A.-G., L.P., S.D.G., B.T., B.A.B., J.D.E.); and Department of Bioethics, Cleveland Clinic, OH (M.L.S.)
| | - Barry Trachtenberg
- From the Center for Medical Ethics and Health Policy (C.R.B., L.A.W., M.A., K.M.K.) and Dan L. Duncan Institute for Clinical and Translational Research (C.G.M.), Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist System, TX (C.R.B.); Houston Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center and J.C. Walter Jr. Transplant Center, Houston, TX (J.A.-G., L.P., S.D.G., B.T., B.A.B., J.D.E.); and Department of Bioethics, Cleveland Clinic, OH (M.L.S.)
| | - Martin L. Smith
- From the Center for Medical Ethics and Health Policy (C.R.B., L.A.W., M.A., K.M.K.) and Dan L. Duncan Institute for Clinical and Translational Research (C.G.M.), Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist System, TX (C.R.B.); Houston Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center and J.C. Walter Jr. Transplant Center, Houston, TX (J.A.-G., L.P., S.D.G., B.T., B.A.B., J.D.E.); and Department of Bioethics, Cleveland Clinic, OH (M.L.S.)
| | - Brian A. Bruckner
- From the Center for Medical Ethics and Health Policy (C.R.B., L.A.W., M.A., K.M.K.) and Dan L. Duncan Institute for Clinical and Translational Research (C.G.M.), Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist System, TX (C.R.B.); Houston Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center and J.C. Walter Jr. Transplant Center, Houston, TX (J.A.-G., L.P., S.D.G., B.T., B.A.B., J.D.E.); and Department of Bioethics, Cleveland Clinic, OH (M.L.S.)
| | - Jerry D. Estep
- From the Center for Medical Ethics and Health Policy (C.R.B., L.A.W., M.A., K.M.K.) and Dan L. Duncan Institute for Clinical and Translational Research (C.G.M.), Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist System, TX (C.R.B.); Houston Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center and J.C. Walter Jr. Transplant Center, Houston, TX (J.A.-G., L.P., S.D.G., B.T., B.A.B., J.D.E.); and Department of Bioethics, Cleveland Clinic, OH (M.L.S.)
| | - Kristin M. Kostick
- From the Center for Medical Ethics and Health Policy (C.R.B., L.A.W., M.A., K.M.K.) and Dan L. Duncan Institute for Clinical and Translational Research (C.G.M.), Baylor College of Medicine, Houston, TX; Bioethics Program, Houston Methodist System, TX (C.R.B.); Houston Methodist Hospital, Houston Methodist DeBakey Heart and Vascular Center and J.C. Walter Jr. Transplant Center, Houston, TX (J.A.-G., L.P., S.D.G., B.T., B.A.B., J.D.E.); and Department of Bioethics, Cleveland Clinic, OH (M.L.S.)
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15
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Neoh K, Holmes S, Woods A, Rayment C. A Matter of Time: The Case of a Patient With a Left Ventricular Assist Device. J Pain Symptom Manage 2016; 52:752-755. [PMID: 27713034 DOI: 10.1016/j.jpainsymman.2016.05.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 04/27/2016] [Accepted: 05/27/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Karen Neoh
- Leeds Institute of Health Sciences, Leeds, United Kingdom.
| | - Sarah Holmes
- Bradford Marie Curie Hospice, Bradford, United Kingdom
| | | | - Clare Rayment
- Bradford Marie Curie Hospice, Bradford, United Kingdom
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16
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Cicolini G, Cerratti F, Pelle CD, Simonetti V. The Experience of Family Caregivers of Patients With a Left Ventricular Assist Device. Prog Transplant 2016; 26:135-48. [DOI: 10.1177/1526924816640648] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The purpose of this review is to understand the experience of caregivers of patients with left ventricular assist device (LVAD) and to evaluate how health professionals can support them properly. Background: Left ventricular assist device can improve quality of life, enhance functional status, and prolong survival in patients with advanced heart failure. Nonetheless, LVAD can adversely influence quality of life for their family caregivers. Methods: An integrative literature review was conducted using scientific databases between January to March 2015. Results: A total of 15 studies are included in the final review. Three major themes emerged “emotional distress,” “responsibility,” and “coping strategies” that characterize family caregivers’ experiences with care of patients with LVAD. Conclusion: Health care providers should understand the pivotal role of caregivers in promoting and maintaining patients’ well-being and be able to help the caregiver to moderate the impact being overloaded. Research should be addressed to create interventions that motivate the caregivers to engage in activities that promote their health.
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Affiliation(s)
- Giancarlo Cicolini
- Department of Medicine and Science of Aging, University “G. d’Annunzio” of Chieti, Chieti, Italy
- ASL02Abruzzo—Lanciano Vasto Chieti, Chieti, Italy
| | - Francesca Cerratti
- Department of Medicine and Science of Aging, University “G. d’Annunzio” of Chieti, Chieti, Italy
| | - Carlo Della Pelle
- Department of Medicine and Science of Aging, University “G. d’Annunzio” of Chieti, Chieti, Italy
| | - Valentina Simonetti
- Department of Medicine and Science of Aging, University “G. d’Annunzio” of Chieti, Chieti, Italy
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17
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Willemsen D, Cordes C, Bjarnason-Wehrens B, Knoglinger E, Langheim E, Marx R, Reiss N, Schmidt T, Workowski A, Bartsch P, Baumbach C, Bongarth C, Phillips H, Radke R, Riedel M, Schmidt S, Skobel E, Toussaint C, Glatz J. [Rehabilitation standards for follow-up treatment and rehabilitation of patients with ventricular assist device (VAD)]. Clin Res Cardiol Suppl 2016; 11 Suppl 1:2-49. [PMID: 26882905 DOI: 10.1007/s11789-015-0077-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The increasing use of ventricular assist devices (VADs) in terminal heart failure patients provides new challenges to cardiac rehabilitation physicians. Structured cardiac rehabilitation strategies are still poorly implemented for this special patient group. Clear guidance and more evidence for optimal modalities are needed. Thereby, attention has to be paid to specific aspects, such as psychological and social support and education (e.g., device management, INR self-management, drive-line care, and medication).In Germany, the post-implant treatment and rehabilitation of VAD Patients working group was founded in 2012. This working group has developed clear recommendations for the rehabilitation of VAD patients according to the available literature. All facets of VAD patients' rehabilitation are covered. The present paper is unique in Europe and represents a milestone to overcome the heterogeneity of VAD patient rehabilitation.
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Affiliation(s)
- Detlev Willemsen
- Schüchtermann-Klinik, Ulmenalle 5-11, 49214, Bad Rothenfelde, Deutschland.
| | - C Cordes
- Gollwitzer-Meier-Klinik, Bad Oeynhausen, Deutschland
| | - B Bjarnason-Wehrens
- Institut für Kreislaufforschung und Sportmedizin, Deutsche Sporthochschule Köln, Köln, Deutschland
| | | | - E Langheim
- Reha-Zentrum Seehof der DRV-Bund, Teltow, Deutschland
| | - R Marx
- MediClin Fachklinik Rhein/Ruhr, Essen, Deutschland
- Universität Witten/Herdecke, Witten, Deutschland
| | - N Reiss
- Schüchtermann-Klinik, Ulmenalle 5-11, 49214, Bad Rothenfelde, Deutschland
| | - T Schmidt
- Schüchtermann-Klinik, Ulmenalle 5-11, 49214, Bad Rothenfelde, Deutschland
| | - A Workowski
- Schüchtermann-Klinik, Ulmenalle 5-11, 49214, Bad Rothenfelde, Deutschland
| | - P Bartsch
- Schüchtermann-Klinik, Ulmenalle 5-11, 49214, Bad Rothenfelde, Deutschland
| | - C Baumbach
- Herz- und Gefäßzentrum Bad Bevensen, Bad Bevensen, Deutschland
| | - C Bongarth
- Klinik Höhenried, Bernried am Starnberger See, Deutschland
| | - H Phillips
- Reha Parcs Steinhof, Erkrath, Deutschland
| | - R Radke
- Christiaan-Barnard-Klinik, Dahlen-Schmannewitz, Dahlen, Deutschland
| | - M Riedel
- Klinik Fallingbostel, Bad Fallingbostel, Deutschland
| | - S Schmidt
- Gollwitzer-Meier-Klinik, Bad Oeynhausen, Deutschland
| | - E Skobel
- Rehaklinik "An der Rosenquelle", Aachen, Deutschland
| | - C Toussaint
- m&i Fachklinik Herzogenaurach, Herzogenaurach, Deutschland
| | - J Glatz
- Reha-Zentrum Seehof der DRV-Bund, Teltow, Deutschland
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18
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Smith EM, Franzwa J. Chronic outpatient management of patients with a left ventricular assist device. J Thorac Dis 2016; 7:2112-24. [PMID: 26793331 DOI: 10.3978/j.issn.2072-1439.2015.10.28] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The use of mechanical circulatory support (MCS) as treatment for advanced heart failure (HF) has grown exponentially over the past 15 years. The continuous flow left ventricular assist device (CF-LVAD) has become the most used form of MCS in advanced HF, especially since approval of use as destination therapy (DT) and with the lack of organ availability. Long-term survival has improved and diligent outpatient management is thus particularly critical to achieve optimal outcomes. This review will discuss outpatient management strategies for patients with HF and a left ventricular assist device (LVAD).
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Affiliation(s)
- Elisa M Smith
- 1 Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA ; 2 Cardiomyopathy Treatment Program, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Jennifer Franzwa
- 1 Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA ; 2 Cardiomyopathy Treatment Program, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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19
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Casida J, Wu HS, Harden J, Carie A, Chern J. Evaluation of the psychometric properties of self-efficacy and adherence scales for caregivers of patients with a left ventricular assist device. Prog Transplant 2015; 25:116-23. [PMID: 26107271 DOI: 10.7182/pit2015556] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT No published instrument has been designed to measure caregivers' self-efficacy for and adherence to the complex home-care regimen of patients with a left ventricular assist device (LVAD). OBJECTIVE To evaluate the psychometric properties of 2 newly developed instruments: the LVAD Caregiver Self-Efficacy Scale (LCSS) and the LVAD Caregiver Home Management Adherence Scale (LCAS). METHODS A multistage design was employed for this instrumentation study. Of the 125 LVAD caregivers recruited from online support groups, 98 (78.4%) provided complete data. Participants were predominantly female (80%), aged 18 to 79 years, from 4 regions of the United States. They completed the following instruments: LCSS, LCAS, General Self-Efficacy Scale (GSE), and the confidence and maintenance subscales of the Caregiver Contribution to Self-Care of Heart Failure Index (CC-SCHFI). Item analyses, factorial construct validity, convergent validity, and internal consistency reliability of the scales were evaluated. RESULTS The analysis of the LCSS (21 items) revealed a 2-factor solution, which consisted of a 17-item routine factor and a 4-item anticipatory factor. Convergent validity of the LCSS was supported by moderate correlations among LCSS, GSE, and CC-SCHFI-confidence. The analysis of LCAS (17 items) revealed a 1-factor solution. Its convergent validity was supported by moderate correlation between LCAS and CC-SCHFI-maintenance. Internal consistency reliability coefficients of the LCSS and LCAS were α = 0.93 and α = 0.96, respectively. These data suggest that the 2 instruments are adequately valid and reliable measures of self-efficacy and adherence in the context of LVAD patient care managed by home caregivers. Further research is needed to support the applicability of these instruments in other research and practice settings.
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Affiliation(s)
- Jesus Casida
- University of Michigan School of Nursing, Ann Arbor (JC, AC, JC), Goldfarb School of Nursing at Barnes-Jewish College, St Louis, Missouri (H-SW), Wayne State University College of Nursing, Detroit, Michigan (JH)
| | - Horng-Shiuann Wu
- University of Michigan School of Nursing, Ann Arbor (JC, AC, JC), Goldfarb School of Nursing at Barnes-Jewish College, St Louis, Missouri (H-SW), Wayne State University College of Nursing, Detroit, Michigan (JH)
| | - Janet Harden
- University of Michigan School of Nursing, Ann Arbor (JC, AC, JC), Goldfarb School of Nursing at Barnes-Jewish College, St Louis, Missouri (H-SW), Wayne State University College of Nursing, Detroit, Michigan (JH)
| | - Austen Carie
- University of Michigan School of Nursing, Ann Arbor (JC, AC, JC), Goldfarb School of Nursing at Barnes-Jewish College, St Louis, Missouri (H-SW), Wayne State University College of Nursing, Detroit, Michigan (JH)
| | - Joy Chern
- University of Michigan School of Nursing, Ann Arbor (JC, AC, JC), Goldfarb School of Nursing at Barnes-Jewish College, St Louis, Missouri (H-SW), Wayne State University College of Nursing, Detroit, Michigan (JH)
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20
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Kiernan MS, Joseph SM, Katz JN, Kilic A, Rich JD, Tallman MP, Van Buren P, Lyons JJ, Bethea B, Eckman P, Gosev I, Lee SS, Soleimani B, Takayama H, Patel CB, Uriel N. Sharing the care of mechanical circulatory support: collaborative efforts of patients/caregivers, shared-care sites, and left ventricular assist device implanting centers. Circ Heart Fail 2015; 8:629-35. [PMID: 25991805 DOI: 10.1161/circheartfailure.114.001767] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michael S Kiernan
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.).
| | - Susan M Joseph
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Jason N Katz
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Ahmet Kilic
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Jonathan D Rich
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Mark P Tallman
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Peter Van Buren
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - James J Lyons
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Brian Bethea
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Peter Eckman
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Igor Gosev
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Sangjin S Lee
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Behzad Soleimani
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Hiroo Takayama
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Chetan B Patel
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
| | - Nir Uriel
- From the Division of Cardiology, Tufts University School of Medicine, Boston, MA (M.S.K.); Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO (S.M.J.); Division of Cardiology, University of North Carolina, Chapel Hill (J.N.K.); Division of Cardiac Surgery, The Ohio State University, Columbus (A.K.) Division of Cardiology, Northwestern University, Chicago, IL (J.D.R.); Division of Clinical Cardiology and Advanced Heart Failure Management, Capital Cardiology Associates, Albany, NY (M.P.T.); Division of Cardiology, University of Vermont School of Medicine, Burlington (P.V.B.); Division of Cardiology, Vassar Brothers Medical Center, Poughkeepsie; NY (J.J.L.); Division of Cardiology, University of Texas, Southwestern Medical Center, Dallas (B.B.); Division of Cardiology, University of Minnesota, Minneapolis (P.E.); Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA (I.G.); Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids, MI (S.S.L.); Division of Cardiothoracic Surgery, Penn State Hershey Medical Center, Hershey, PA (B.S.); Division of Cardiothoracic Surgery, Columbia University, New York (H.T.); Division of Cardiology, Duke University, Durham, NC (C.B.P.); and Division of Cardiology, University of Chicago, IL (N.U.)
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Abstract
The number of heart failure (HF) patients living with a left ventricular assist device (LVAD) as destination therapy is increasing. Successful long-term LVAD support includes a high degree of self-care by the patient and their caregiver, and also requires long-term support from a multidisciplinary team. All three components of self-care deserve special attention once an HF patient receives an LVAD, including activities regarding self-care maintenance (activities related both to the device and lifestyle), self-care monitoring (e.g., monitoring for complications or distress), and self-care management (e.g., handling alarms or coping with living with the device). For patients to perform optimal self-care once they are discharged, they need optimal education that focuses on knowledge and skills through a collaborative, adult learning approach.
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Affiliation(s)
- Naoko Kato
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden
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Ågård AS, Egerod I, Tønnesen E, Lomborg K. From spouse to caregiver and back: a grounded theory study of post-intensive care unit spousal caregiving. J Adv Nurs 2015; 71:1892-903. [DOI: 10.1111/jan.12657] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Anne Sophie Ågård
- Department of Anesthesiology and Intensive Care; Aarhus University Hospital; Denmark
| | - Ingrid Egerod
- University of Copenhagen, Health & Medical Sciences; Copenhagen University Hospital Rigshospitalet; Trauma Center; Denmark
| | - Else Tønnesen
- Department of Anesthesiology and Intensive Care; Aarhus University Hospital; Denmark
| | - Kirsten Lomborg
- Faculty of Health Sciencies & Aarhus University Hospital; Aarhus University; Denmark
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McIlvennan CK, Jones J, Allen LA, Lindenfeld J, Swetz KM, Nowels C, Matlock DD. Decision-making for destination therapy left ventricular assist devices: implications for caregivers. Circ Cardiovasc Qual Outcomes 2015; 8:172-8. [PMID: 25759442 DOI: 10.1161/circoutcomes.114.001276] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Implanting centers often require the identification of a dedicated caregiver before destination therapy left ventricular assist device (DT LVAD) implantation; however, the caregiver experience surrounding this difficult decision is relatively unexplored. METHODS AND RESULTS From October 2012 through July 2013, we conducted semistructured, in-depth interviews with caregivers of patients considering DT LVAD. Data were analyzed using a mixed inductive and deductive approach. We interviewed 17 caregivers: 10 caregivers of patients living with DT LVAD, 6 caregivers of patients who had died with DT LVAD, and 1 caregiver of a patient who had declined DT LVAD. The themes identified, which could also be considered dialectical tensions, are broadly interpreted under 3 domains mapping to decision context, process, and outcome: (1) the stark decision context, with tension between hope and reality; (2) the challenging decision process, with tension between wanting loved ones to live and wanting to respect loved ones' wishes; and (3) the downstream decision outcome, with tension between gratitude and burden. CONCLUSIONS Decision-making surrounding DT LVAD should incorporate decision support for patients and caregivers. This should include a focus on caregiver burden and the predictable tensions that caregivers experience.
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Affiliation(s)
- Colleen K McIlvennan
- From the Section of Advanced Heart Failure and Transplantation, Division of Cardiology (C.K.M., L.A.A., J.L.), Colorado Cardiovascular Outcomes Research Consortium (C.K.M., L.A.A., D.D.M.) and Division of General Internal Medicine (C.N., D.D.M.), University of Colorado School of Medicine, Aurora; University of Colorado School of Nursing, Aurora (J.J.); and Division of General Internal Medicine, Mayo Clinic, Rochester, MN (K.M.S.).
| | - Jacqueline Jones
- From the Section of Advanced Heart Failure and Transplantation, Division of Cardiology (C.K.M., L.A.A., J.L.), Colorado Cardiovascular Outcomes Research Consortium (C.K.M., L.A.A., D.D.M.) and Division of General Internal Medicine (C.N., D.D.M.), University of Colorado School of Medicine, Aurora; University of Colorado School of Nursing, Aurora (J.J.); and Division of General Internal Medicine, Mayo Clinic, Rochester, MN (K.M.S.)
| | - Larry A Allen
- From the Section of Advanced Heart Failure and Transplantation, Division of Cardiology (C.K.M., L.A.A., J.L.), Colorado Cardiovascular Outcomes Research Consortium (C.K.M., L.A.A., D.D.M.) and Division of General Internal Medicine (C.N., D.D.M.), University of Colorado School of Medicine, Aurora; University of Colorado School of Nursing, Aurora (J.J.); and Division of General Internal Medicine, Mayo Clinic, Rochester, MN (K.M.S.)
| | - JoAnn Lindenfeld
- From the Section of Advanced Heart Failure and Transplantation, Division of Cardiology (C.K.M., L.A.A., J.L.), Colorado Cardiovascular Outcomes Research Consortium (C.K.M., L.A.A., D.D.M.) and Division of General Internal Medicine (C.N., D.D.M.), University of Colorado School of Medicine, Aurora; University of Colorado School of Nursing, Aurora (J.J.); and Division of General Internal Medicine, Mayo Clinic, Rochester, MN (K.M.S.)
| | - Keith M Swetz
- From the Section of Advanced Heart Failure and Transplantation, Division of Cardiology (C.K.M., L.A.A., J.L.), Colorado Cardiovascular Outcomes Research Consortium (C.K.M., L.A.A., D.D.M.) and Division of General Internal Medicine (C.N., D.D.M.), University of Colorado School of Medicine, Aurora; University of Colorado School of Nursing, Aurora (J.J.); and Division of General Internal Medicine, Mayo Clinic, Rochester, MN (K.M.S.)
| | - Carolyn Nowels
- From the Section of Advanced Heart Failure and Transplantation, Division of Cardiology (C.K.M., L.A.A., J.L.), Colorado Cardiovascular Outcomes Research Consortium (C.K.M., L.A.A., D.D.M.) and Division of General Internal Medicine (C.N., D.D.M.), University of Colorado School of Medicine, Aurora; University of Colorado School of Nursing, Aurora (J.J.); and Division of General Internal Medicine, Mayo Clinic, Rochester, MN (K.M.S.)
| | - Daniel D Matlock
- From the Section of Advanced Heart Failure and Transplantation, Division of Cardiology (C.K.M., L.A.A., J.L.), Colorado Cardiovascular Outcomes Research Consortium (C.K.M., L.A.A., D.D.M.) and Division of General Internal Medicine (C.N., D.D.M.), University of Colorado School of Medicine, Aurora; University of Colorado School of Nursing, Aurora (J.J.); and Division of General Internal Medicine, Mayo Clinic, Rochester, MN (K.M.S.)
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24
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Marcuccilli L, Casida JJ, Bakas T, Pagani FD. Family caregivers' inside perspectives: caring for an adult with a left ventricular assist device as a destination therapy. Prog Transplant 2015; 24:332-40. [PMID: 25488555 DOI: 10.7182/pit2014684] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Understanding the experience of caring for an adult with a left-ventricular assist device as a destination therapy (LVAD-DT) remains in its infancy. OBJECTIVE/DESIGN A hermeneutic-phenomenological inquiry guided by van Manen's methods was used to explore the LVAD-DT family caregiving experience.Participants/Setting-Seven family caregivers (1 man and 6 women) 50 to 74 years old who cared for an adult with an LVAD-DT in home settings. Recruitment and data collection occurred in an outpatient mechanical circulatory support center in the Midwest. METHODS Data were collected by means of face-to-face interviews using open-ended questions and 1 follow-up interview. Interviews were audio recorded and transcribed verbatim. Thematic analysis consisted of writing, rewriting, and reflecting across participants' data, which produced themes illustrating the experience and meaning of caring for an adult with an LVAD-DT. Themes were consensually validated. Procedures for trustworthiness are described. RESULTS Five main themes were identified from participants' experiences: (1) advanced heart failure is a life-changing event, (2) self-doubt about LVAD caregiving improves over time, (3) lifestyle adjustments come with time, (4) persistent worry and stress, and (5) caregiving is not a burden-it's a part of life. These main themes were elucidated by 8 subthemes in which participants described a process of adjustment despite persistent worry and stress and eventually accepted caregiving as part of their lives. Future studies are needed to explore caregiver burden, adaptation, and the effects of caregiving outcomes, such as emotional and physical health and overall quality of life.
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25
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A comparison of the health status and psychological distress of partners of patients with a left ventricular assist device versus an implantable cardioverter defibrillator: A preliminary study. Heart Lung 2015; 44:27-32. [DOI: 10.1016/j.hrtlng.2014.10.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 10/16/2014] [Accepted: 10/16/2014] [Indexed: 11/19/2022]
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Brouwers C, Denollet J, Caliskan K, de Jonge N, Constantinescu A, Young Q, Kaan A, Pedersen SS. Psychological distress in patients with a left ventricular assist device and their partners: an exploratory study. Eur J Cardiovasc Nurs 2013; 14:53-62. [PMID: 24351334 DOI: 10.1177/1474515113517607] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Left ventricular assist device (LVAD) therapy is increasingly used in patients with advanced heart failure, and may have a significant psychological impact on both patients and their partners. Hence, we examined the distress levels of LVAD patients and their partners. METHODS Anxiety, depression and post-traumatic stress disorder (PTSD) were assessed at 3-4 weeks after implantation, and at 3 and 6 months follow-up in 33 LVAD patients (73% men; mean age=54±10 years) and 33 partners (27% men; mean age=54±11 years). RESULTS The prevalence of anxiety in LVAD partners was significantly higher compared to LVAD patients at baseline (48% vs. 23%, p=0.03) and 3 months follow-up (44% vs. 15%, p=0.02), but not at 6 months follow-up (p=0.43). No differences were found for depression and PTSD (ps>0.05). Scores between the LVAD patients and partners showed only a significant correlation at baseline between the anxiety, depression and PTSD score of the patient and the depression score of the partner (r anx=0.40, p=0.04; rdep=.40, p=0.04; r PSTD=0.46, p=0.05). Multivariable analyses showed no significant association between the role (patient vs. partner) and anxiety, depression and PTSD over time after correction for age, gender and clinical covariates. However, after correction for Type D personality and the use of psychotropic medication the LVAD partners showed significantly higher anxiety (F=6.95, p=0.01) and depression (F=3.94, p=0.04) scores over time compared to LVAD patients. CONCLUSION LVAD partners had significantly higher levels of anxiety than LVAD patients. Emotional distress of LVAD partners should gain more attention, as partners are an essential source of support for LVAD patients.
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Affiliation(s)
- Corline Brouwers
- CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, The Netherlands
| | - Johan Denollet
- CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, The Netherlands
| | - Kadir Caliskan
- Erasmus Medical Center, Department of Cardiology, Thoraxcenter, The Netherlands
| | | | | | | | | | - Susanne S Pedersen
- CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, The Netherlands
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Casey V, Crooks VA, Snyder J, Turner L. "You're dealing with an emotionally charged individual...": an industry perspective on the challenges posed by medical tourists' informal caregiver-companions. Global Health 2013; 9:31. [PMID: 23889860 PMCID: PMC3733688 DOI: 10.1186/1744-8603-9-31] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 07/03/2013] [Indexed: 11/29/2022] Open
Abstract
Background Patients engage in medical tourism when they privately obtain a medical care abroad. Previous research shows that many medical tourists travel abroad with friends and family members who provide support and assistance. Meanwhile, very little is known about this important stakeholder group, referred to here as caregiver-companions. In this article we examine the challenges that can be posed by caregiver-companions and the overall practice of informal caregiving in medical tourism from an industry perspective. Specifically, we report on the findings of interviews conducted with international patient coordinators (IPCs) who work at destination facilities. IPCs come into regular contact with caregiver-companions in their professional positions and thus are ideally suited to comment on trends they have observed among this stakeholder group as well as the challenges they can pose to medical tourists, health workers, and facilities. Methods We conducted 20 semi-structured interviews with 21 IPCs from 16 different facilities across nine countries. Topics probed in the interviews included caregiver-companion roles, IPCs’ and others’ interaction with caregiver-companions, and potential health and safety risks posed to medical tourists and caregiver-companions. Thematic analysis of the verbatim transcripts was employed. Results Although most participants encouraged medical tourists to travel with a caregiver-companion, many challenges associated with caregiver-companions were identified. Three themes best characterize the challenges that emerged: (1) caregiver-companions require time, attention and resources; (2) caregiver-companions can disrupt the provision of quality care; and (3) caregiver-companions can be exposed to risks. IPCs pointed out that caregiver-companions may, for example, have a negative impact on the patient through cost of accompaniment or inadequate care provision. Caregiver-companions may also create unanticipated or extra work for IPCs, as additional clients and by ignoring established organizational rules, routines, and expectations. Furthermore, caregiver-companions may be susceptible to stresses and health and safety risks, which would further deteriorate their own abilities to offer the patient quality care. Conclusions Although caregiver-companions can pose challenges to medical tourists, health workers, and medical tourism facilities, they can also assist in enhancing best care and offering meaningful support to medical tourists. If caregiver-companions are open to collaboration with IPCs, and particularly in the form of information sharing, then their experience abroad can be safer and less stressful for themselves and, by extension, for the accompanied patients and facility staff.
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Affiliation(s)
- Victoria Casey
- Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, Canada.
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28
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Gibson JA, Henderson A, Jillings C, Kaan A. Nursing Patients with Ventricular Assist Devices: An Interpretive Description. Prog Transplant 2013; 23:147-53. [DOI: 10.7182/pit2013766] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Context Although researchers have studied the experience of caring for patients with ventricular assist devices from the perspective of family caregivers, few reports address the experience of nursing patients with such devices. Objective To investigate the experience of nursing patients who have a ventricular assist device. Design A qualitative approach called interpretive description was used to conduct semistructured, 1-on-1 interviews. Participants Six registered nurses with a range of clinical experiences were interviewed in a 1-year period from 2009 to 2010. Data were transcribed and analyzed by the researcher in conjunction with a research team. Results Four distinct themes were interpreted from the interview data: exclusive knowledge, human connection, ethics, and interdisciplinary stress and technology. Conclusion Nursing patients who have a ventricular assist device is a complex experience. Nurses develop expert knowledge that is related to direct exposure to patients; this unique knowledge should be formally considered in team decision making. Nursing care of patients who have a ventricular assist device also has features that might result in overconnected nurse-patient relationships. Closely connected nurse-patient relationships intensified the emotional difficultly of experiences of exposure to illness or suffering, or exposure to an unpredictable dying trajectory. Nursing patients with ventricular assist devices can be difficult, and nursing leaders should be aware of the emotional reactions that can result from direct exposure to patients who might be perceived as very ill or suffering. Institutions with ventricular assist device programs should consider providing emotional support for health care workers who find this type of work emotionally difficult.
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Affiliation(s)
| | - Angela Henderson
- University of British Columbia School of Nursing, Vancouver, Canada
| | - Carol Jillings
- University of British Columbia School of Nursing, Vancouver, Canada
| | - Annemarie Kaan
- University of British Columbia School of Nursing, Vancouver, Canada
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29
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Bruce CR. A review of ethical considerations for ventricular assist device placement in older adults. Aging Dis 2013; 4:100-12. [PMID: 23696952 PMCID: PMC3659250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 01/11/2013] [Accepted: 01/14/2013] [Indexed: 06/02/2023] Open
Abstract
This article reviews some of the complex ethical issues that accompany the diffusion of ventricular assist devices (VADs) for heart failure patients, with a particular emphasis on issues unique to older adults. In doing so, the ethical issues are centered on three decision points: (a) patient selection; (b) informed consent (i.e., initiation of the device); and (c) end of life (i.e., deactivation of the device.) It is contended that, with the technological improvements in heart failure treatments and new indications, the decision making process for VAD placement and deactivation has become more clinically and ethically challenging, particularly for older adults. Areas for potential future research are identified.
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Affiliation(s)
- Courtenay R Bruce
- Center for Medical Ethics & Health Policy, Baylor College of Medicine & The Methodist Hospital System, Houston, TX 77030, USA
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Ben Gal T, Jaarsma T. Patients with a Left Ventricular Assist Device: the new chronic patient in cardiology. Eur J Cardiovasc Nurs 2012; 11:378-9. [DOI: 10.1177/1474515112441145] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Tuvia Ben Gal
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Norrköping, Sweden
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