Factors influencing self-management in chronic obstructive pulmonary disease: an integrative review.

BACKGROUND: Chronic obstructive pulmonary disease is a common, chronic and burdensome condition requiring the individual to engage in a range of self-management strategies. The capacity to engage in self-management is dependent on a range of internal (e.g., personal) and external (e.g., health service) factors. OBJECTIVES: This paper seeks to define self-management, identify the determinants which influence the individual's ability to cope and adjust to living with chronic obstructive pulmonary disease in the community, and identify implications for clinical practice and research. DESIGN: Integrative review. DATA SOURCES: Medline, Embase, PubMed, CINAHL, Google Scholar. REVIEW METHODS: Integrative review using prospective research questions. Papers were included in the review if they were published in peer reviewed journals and written in English between 2000 and 2010. Articles were accepted for inclusion if they discussed the determinants that influenced self-management of chronic obstructive pulmonary disease in the community. Confirmation of results and discussion themes was validated by specialists in chronic obstructive pulmonary disease and complex care. FINDINGS: Self-management is less well characterised in chronic obstructive pulmonary disease compared with other chronic conditions. Functional limitation and the need to balance disease management with everyday life are the two key elements that patients face in managing their condition. Provider characteristics, socioeconomic status and health literacy are sparsely discussed yet are known to influence chronic obstructive pulmonary disease self-management. CONCLUSIONS: Chronic obstructive pulmonary disease self-management must be a key focus internationally as the disease incidence increases. Collaborative care is required between patients and health providers in order facilitate patients in confident management of their condition.

Implantable defibrillator recipients' responses to device implantation and design.

The implantable cardioverter defibrillator (ICD) is a surgically inserted device that follows a well-established pattern of technology innovation and rapid adoption without extensive clinical trials. Few devices are as obviously life-saving in potentially fatal situations and deliver such sudden and sometimes painful therapy. Although patients' quality of life and adjustment to the device both physically and psychologically are relatively well-documented, few studies have explored recipients' responses to the device itself or elicited their thoughts on the technological design. The findings presented here are from a prospective Australian study that surveyed 110 ICD recipients pre-insertion and at 3, 12, and 18 months post-insertion. Recipients' responses to the device and their thoughts on design were sought. Respondents were overwhelmingly willing to: 1) accept the ICD, 2) recommend it to others, and 3) welcome such innovations as warning tones, device-controlled drug delivery, and telephone interrogation of the device.

The impact of the implantable cardioverter defibrillator on quality of life.

The implantable cardioverter defibrillator may prolong survival and prevent sudden cardiac arrest in patients with ventricular arrhythmias. Whereas previous research focused on mortality, attention is now turning to the impact of the device on the recipient. We reviewed the literature on the effects of the implantable cardioverter defibrillator on recipients and their families; our aim was to consolidate our current understanding and guide further research in this area. We found a number of effects on which researchers agree. Primarily, recipients are happy to have the device and generally feel more confident. However, recipients experience many psychological reactions such as fear and anxiety that can be related to the unpredictable nature of the shocks. Recipients also are affected by intellectual changes. Both recipients and their families experience similar effects and use a range of coping mechanisms; the most effective is optimism. Only one nursing intervention has been investigated that directly addresses these effects. Areas that need more research are the effects of the implantable cardioverter defibrillator during childhood, adolescence, and pregnancy; the impact of vigilance on recipients and their families; costs; and nursing interventions. More consistent, standardized quality-of-life measures are needed so that comparisons can be made between samples.