RESUMO
This study sought to determine whether mood state and psychosocial adjustment four months after implantable cardioverter defibrillator (ICD) placement were better for patients and caregivers who received a program of psychosocial interventions than for those who received usual postoperative care and follow-up. Thirty-four adult ICD recipients (17 experimental and 17 control) and their significant other (SO) caregivers were randomly assigned to an experimental or control group. The intervention consisted of weekly, postoperative telephone follow-up, evaluation and counseling by a psychiatric liaison nurse, and participation in an ICD support group. There were no significant differences between treatment and control groups on the outcome measures of adjustment (Profile of Mood States, Psychosocial Adjustment to Illness Scale). Outcomes were not associated with age, ejection fraction, length of hospital stay or family income, and there were no differences in outcomes based on gender, employment status, thoracotomy versus non-thoracotomy procedure, or shocked versus unshocked status. The results do not indicate that the extra time spent to provide individualized attention to these ICD recipients and their SOs was advantageous for the outcomes measured. Adaptation to the device may occur over time regardless of intervention.
Assuntos
Transtornos de Adaptação/enfermagem , Afeto , Cuidadores/psicologia , Desfibriladores Implantáveis , Parada Cardíaca/terapia , Adaptação Psicológica , Transtornos de Adaptação/prevenção & controle , Idoso , Análise de Variância , Parada Cardíaca/enfermagem , Humanos , Pessoa de Meia-IdadeRESUMO
Patients with internal cardioverter-defibrillators experience many issues after implantation. One issue is operating a motor vehicle. This issue has many ethical, legal and quality-of-life concerns that must be addressed by the patient, health care providers, and society. The legal and ethical issues surrounding patients with internal cardioverter-defibrillators will be explored using an ethically based theoretical framework.
Assuntos
Arritmias Cardíacas/terapia , Condução de Veículo , Desfibriladores Implantáveis , Ética , Qualidade de Vida , Acidentes de Trânsito/estatística & dados numéricos , Condução de Veículo/legislação & jurisprudência , Feminino , Liberdade , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Ontário , Estados UnidosRESUMO
Analysis of one academic medical center revealed three distinct nursing practice environments distinguished by increasing levels of complexity, change, unpredictability, and uncertainty. Designing practice models to accommodate these conditions will facilitate more efficient and effective patient outcomes.
Assuntos
Centros Médicos Acadêmicos/organização & administração , Reestruturação Hospitalar , Modelos de Enfermagem , Ambiente de Instituições de Saúde , Humanos , Inovação OrganizacionalRESUMO
BACKGROUND: Patients often depend on life-saving technology as a permanent part of their lives. Sometimes these devices become defective and are recalled. OBJECTIVES: To investigate how the urgent device recall of three models of the Automatic Implantable Cardioverter Defibrillator (AICD) affected confidence in the device and the psychosocial responses of patients and their family member caregivers. METHODS: All patients (N = 31) and caregivers (N = 21) affected by the recall at one heart center completed a survey instrument consisting of a series of visual analog scales designed to measure confidence before and after learning of the recall, fear, anger, depression, anxiety, helplessness, loss of control, uncertainty, and confusion associated with having a recalled AICD. Surveys were completed immediately after being told of the recall and 1 month later. RESULTS: Confidence of patients decreased significantly from a mean of 87% to 74% when comparing perceptions of before learning of the recall to those immediately after (t30 = 3.65, p < 0.0005). For caregivers, mean confidence dropped from 92% to 73% (t19 = 5.0, p < 0.0005). Confidence remained significantly lower 1 month later. Caregiver scores were consistently, although not significantly, higher (less favorable) on the measures of emotional response than patient scores. Caregivers of patients who had received shocks from the AICD and those of patients who had the device for more than a year were generally more affected. CONCLUSIONS: Patient and caregiver confidence in the AICD was significantly reduced. Further research is needed to investigate the trends in the data from caregivers.
Assuntos
Cuidadores/psicologia , Desfibriladores Implantáveis , Falha de Equipamento , Pacientes/psicologia , Adulto , Idoso , Ansiedade , Segurança de Equipamentos , Medo , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To determine the driving behavior of patients following the placement of automatic implantable cardioverter defibrillators (AICDs). SUBJECTS AND DESIGN: Forty patients with AICDs (33 men, seven women; mean age, 62.7 years) responded to a questionnaire designed to ascertain driving behavior after hospital discharge. RESULTS: Despite medical advice never to drive again, 28 patients (70%) resumed driving, with the majority doing so by 8 months after AICD implantation. Of these, 11 (40%) identified themselves as the primary driver in their household. Fourteen (50%) drove daily. Two (7%) were driving and continued to drive during discharge of their AICDs. Twenty-five (91%) reported that they felt comfortable and safe while driving. CONCLUSION: A majority of patients with AICDs continue to drive after a proscription of this activity by health care workers.