Medical devices and attachment: holistic healing in the age of invasive technology

Nurse- and peer-led self-management programme for patients with an implantable cardioverter defibrillator; a feasibility study

Background

The prevalence of cardiovascular disease is increasing. Improved treatment options increase survival after an acute myocardial infarction or sudden cardiac arrest, although patients often have difficulty adjusting and regaining control in daily life. In particular, patients who received an implantable cardioverter defibrillator (ICD) experience physical and psychological problems. Interventions to enhance perceived control and acceptance of the device are therefore necessary. This paper describes a small-scale study to explore the feasibility and the possible benefits of a structured nurse- and peer-led self-management programme ('Chronic Disease Self-Management Program' – CDSMP) among ICD patients.

Methods

Ten male ICD patients (mean age = 65.5 years) participated in a group programme, consisting of six sessions, led by a team consisting of a nurse specialist and a patient with cardiovascular disease. Programme feasibility was evaluated among patients and leaders by measuring performance of the intervention according to protocol, attendance and adherence of the participating ICD patients, and patients' and leaders' opinions about the programme. In addition, before and directly after attending the intervention, programme benefits (e.g. perceived control, symptoms of anxiety and depression, and quality of life) were assessed.

Results

The programme was conducted largely according to protocol. Eight patients attended at least four sessions, and adherence ranged from good to very good. On average, the patients reported to have benefited very much from the programme, which they gave an overall report mark of 8.4. The leaders considered the programme feasible as well. Furthermore, improvements were identified for general self-efficacy expectancies, symptoms of anxiety, physical functioning, social functioning, role limitations due to physical problems, and pain.

Conclusion

This study suggests that a self-management programme led by a team consisting of a nurse specialist and a patient with cardiovascular disease seems feasible according to both patients and leaders. The programme may improve general self-efficacy expectancies, symptoms of anxiety, and quality of life (physical functioning, social functioning, role limitations due to physical problems, and pain) as well. Further investigation of the programme's effectiveness among a larger sample of ICD patients or other patient groups with cardiovascular disease, is recommended.

Development of the implanted devices adjustment scale

Advances in microelectronics have resulted in exponential growth in the number of implanted medical devices. Most people do well adjusting to their devices, but others show signs of depression and/or anxiety. The Implanted Device Adjustment Scale (IDAS) was developed to measure how well a person is adjusting to an implanted device. First, a pool of items was generated and reviewed by 2 panels of clinicians and psychometricians for content validity. The revised version was then administered to a small sample that provided information about problematic items. Finally, a convenience sample of 45 persons (66% males) with implanted devices (18 pacemakers only, 37 cardioverter/defibrillators) completed the revised IDAS twice. After deleting weak items, the Cronbach alpha was 0.90. No age, gender, or device differences were found. Test-retest reliability was 0.92. The IDAS may be useful to evaluate how well a person is adjusting to her/his device. This may lead to more timely and appropriate interventions to improve outcomes.

Body image changes associated with dual-chamber pacemaker insertion in women

PURPOSE

The study's purpose was to examine body image changes in subjects participating in a long-term multicenter pacemaker trial.

METHODS

At study closeout, 383 adults, all of whom had received a dual-chamber pacemaker, completed questionnaires evaluating what effect their pacemaker or pacemaker site and scar had on them or their spouses or significant others.

RESULTS

Most reported that their pacemaker did not change the way they or their spouses or significant others felt about their body (73.2% and 93.5%, respectively). Most (87.1%) denied feeling differently because of the pacemaker site and scar. Most were not concerned how their clothes fit or about wearing a swimsuit (92.0% and 90.7%, respectively). Women were more concerned about how the pacemaker site and scar made them feel about their body (P =.001), clothes fitting (P =.002), and wearing a swimsuit (P =.004). Men were more concerned with how their spouses or significant others perceived them postimplantation (P =.021).

CONCLUSIONS

Most subjects did not express undue concern about changes in body image.

Psychosocial and sexual concerns of patients with implantable left ventricular assist devices: A pilot study

OBJECTIVE

We sought to determine the psychosocial and sexual concerns of patients discharged from the hospital with implantable left ventricular assist devices.

METHODS

Bridge-to-transplant patients with the Heartmate left ventricular assist device received a psychosocial and sexual survey at 1 month after discharge from the hospital. The survey consisted of 3 parts, with 5 questions in each category. The patients were asked to complete the survey by circling the responses and to provide more detailed answers when necessary.

RESULTS

There were 8 male patients who completed the questionnaire. Psychologically, all patients expressed a positive mood and found support from family or religious sources. The majority described a change in attitude and behavior. Socially, all patients described a change in lifestyle, as well as a change in the reaction of family and friends. No patient went back to work or had the desire to return to work until after transplantation. The minority of patients admitted to smoking or drinking. Sexually, the majority had the desire or participated in sexual activities. The majority of patients either used or were interested in using sexual stimulants. There were no mechanical problems with the left ventricular assist devices.

CONCLUSIONS

Psychosocial and sexual conditions are altered in patients with heart failure who are discharged with implantable left ventricular assist devices. At 1 month's time interval, there is an improvement in mood, an adjustment in lifestyle, and a positive shift in relations with family and friends. There is sexual desire, with interest in sexual-enhancing medication. The most common concern is related to the pump, such as the durability of the device or damage to the components.

Focused life stories of women with cardiac pacemakers

Biotechnical devices such as cardiac pacemakers are implanted into people to manage a range of disorders, yet comparatively little is known about the emotional impact of this experience. Women may have a unique response to implanted devices due to cultural messages about the masculinity of technology. In this qualitative study using Hall's focused life stories design, 11 women from teenagers to elders with permanent cardiac pacemakers were asked to describe their experiences using semistructured interviews. The themes that emerged are relinquishing care, owning the device, experiencing fears and/or resistance, imaging the body, normalizing, positioning as caretaker, finding resilience, and sensing omnipotence. Understanding what it means for women to live with an implanted biotechnical device may facilitate planning interventions to support their psychological and physiological health. Effective pacemaker function may depend, in part, on recipients' successful emotional attachment to the device.

Situating wound management: technoscience, dressings and 'other' skins

This paper addresses the notion of wound care as a technology of skin and other skins imbued with the combined power of technology and science. It presents the discourses of wound care evident in the accounts of patients and nurses concerning this care, and discussions about wounds in wound care interest groups, journals, and advertising material about wound care products. The discussion focuses on wounds and wound dressings as effects immanent in the power relations of discourses of wound care. These effects colour and influence nurses' responses to wounds and wound care products. Moreover, the discourses that portray these practices are evidence of the complex articulation between technoscience and gender. Nurses and patients are fascinated by wound technoscience and lured towards it by its potential for mastery and control over wounds. Such seductions are evident in the texts of nurses, patients, and pharmaceutical advertisements for wound care products. Finally, the ways that these representations are used to talk about and market wound care products are shown as exemplifying the finer points of wound management as a nursing technoscience.

An exploratory study of developmental growth in adults with heart failure

Persons with heart failure face a myriad of challenges due to the physical limitations imposed by the chronic illness. Despite these changes, each person must continue to face the developmental challenges of adulthood. This exploratory study was conducted to examine the impact that this chronic illness has on the developmental processes of adults. Methods triangulation was used to examine the content of unprompted, written goals and the results of surveys of life satisfaction and mood states of 138 persons with heart failure. Younger adults had higher anger, depression, and anxiety scores than older or middle-aged adults and had lower scores of life satisfaction. This may reflect the emotional reaction to the realization that their lives may be shortened by this chronic illness. Analysis of their goals reflected the developmental challenges described by Erikson. Despite severe physical limitations, these individuals demonstrated growth and achievement of developmental tasks by transcending usual time lines.