Inger Flemme

Living with life-saving technology - coping strategies in implantable cardioverter defibrillators recipients

AIMS To describe coping strategies and coping effectiveness in recipients with an implantable cardioverter defibrillator and to explore factors influencing coping. BACKGROUND Implantable cardioverter defibrillators are documented as saving lives and are used to treat ventricular tachycardia and ventricular fibrillation. Despite the implantable cardioverter defibrillator not evidently interfering with everyday life, there is conflicting evidence regarding the psychosocial impact of an implantable cardioverter defibrillator implantation such as anxiety, depression, perceived control and quality of life and how these concerns may relate to coping. DESIGN Cross-sectional multicentre design. METHODS Individuals (n = 147, mean age 63 years, 121 men) who had lived with an implantable cardioverter defibrillator between 6-24 months completed the Jalowiec Coping Scale-60, Hospital Anxiety and Depression Scale, Control Attitude Scale and Quality of Life Index-Cardiac version. RESULTS Implantable cardioverter defibrillators recipients seldom used coping strategies, and the coping strategies used were perceived as fairly helpful. Optimism was found to be the most frequently used (1·8 SD 0·68) and most effective (2·1 SD 0·48) coping strategy, and recipients perceived moderate control in life. Anxiety (β = 3·5, p ≤ 0·001) and gender (β = 12·3, p = 0·046) accounted for 26% of the variance in the total use of coping strategies, suggesting that the more symptoms of anxiety and being women the greater use of coping strategies. CONCLUSIONS Most recipients with an implantable cardioverter defibrillator did not appraise daily concerns as stressors in need of coping and seem to have made a successful transition in getting on with their lives 6-24 months after implantation. Relevance to clinical practice.  Nurses working with recipients with an implantable cardioverter defibrillator should have a supportive communication so that positive outcomes such as decreased anxiety and increased perceived control and quality of life can be obtained. Through screening for anxiety at follow-up in the outpatient clinic, these recipients perceiving mental strain in their daily life can be identified.

A psychometric evaluation of the four-item version of the Control Attitudes Scale for patients with cardiac disease and their partners

Background: The four-item Control Attitudes Scale (CAS) was developed to measure control perceived by patients with cardiac disease and their family members, but extensive psychometric evaluation has not been performed. Objective: The aim was to translate, culturally adapt and psychometrically evaluate the CAS in a Swedish sample of implantable cardioverter defibrillator (ICD) recipients, heart failure (HF) patients and their partners. Methods: A sample (n=391) of ICD recipients, HF patients and partners were used. Descriptive statistics, item-total and inter-item correlations, exploratory factor analysis, ordinal regression modelling and Cronbach’s alpha were used to validate the CAS. Results: The findings from the factor analyses revealed that the CAS is a multidimensional scale including two factors, Control and Helplessness. The internal consistency was satisfactory for all scales (α=0.74–0.85), except the family version total scale (α=0.62). No differential item functioning was detected which implies that the CAS can be used to make invariant comparisons between groups of different age and sex. Conclusions: The psychometric properties, together with the simple and short format of the CAS, make it to a useful tool for measuring perceived control among patients with cardiac diseases and their family members. When using the CAS, subscale scores should be preferred.

Life situation related to the ICD implantation; self-reported uncertainty and satisfaction in Swedish and US samples.

The aim of the study was to describe changes in the life situation related to the ICD implantation of Swedish and US samples with regard to uncertainty and satisfaction. The life situation was measured by reference to the uncertainty caused by the condition and satisfaction with the life situation. Inferential statistics were used to analyse changes within and between the Swedish and US samples. Uncertainty showed a statistically significant difference between the Swedish and US samples before as well as after the ICD implantation. A higher level of uncertainty was indicated for the US sample prior to the ICD implantation and for the Swedish sample following the implantation. In the Swedish sample, satisfaction with life showed a statistically significant difference within the socio-economic domain, indicating a higher degree of satisfaction 3 months after implantation. Satisfaction within the domains of health and functioning, socio-economics and psychological-spiritual showed a statistically significant difference between the Swedish and US samples both before and after ICD implantation, indicating a higher degree of satisfaction in the US sample. The previous study shows that the ICD-patients life situation is changed after the implantation and that it is necessary to provide the patient with information and education based on their own preconditions. The fact that US sample was investigated at a later stage after ICD implantation than the Swedish sample may have influenced the results of the study.

Living with uncertainty - main concern for recipients of implantable cardioverter defibrillator - a qualitative study.

Background:the implantable cardioverter defibrillator is a sophisticated and multifunctional device to treat life-threatening arrhythmias. With increasing numbers of recipients implanted due to rap ...

Quality of profile 1 and 5 years after ICD implantation

Purpose: To investigate the effect of specially selected music on the feeling of well-being, relaxing ability, reduction of anxiety and stress of adult, lightly sedated patients in a Cardiac Laboratory in relation to invasive cardiac procedures. Method and material: The study was divided into two phases: Study 1 enrolled 193 patients. One group (99 patients ) was exposed to specially selected music via ceiling suspended loudspeakers (superimposed on the usual sound environment ) during the cardiac procedure, and the other group (94 patients ) was exposed to the usual sound environment (basic sounds ). All patients were interviewed after the procedure about their experience of the sound environment and their feeling of well-being. Study 2 enrolled 163 patients. One group (79 patients ) listened to specially selected music via headphones before and after the invasive cardiac procedure. The other group(84 patients ) was not offered any music during these periods of time. All patients in study 2 listened to music during the procedure via ceiling suspended loudspeakers. Results: Study 1 showed that the majority of the patients(91%) in the music group found the sound environment pleasant (compared to 56% in the non music group). The patients in the non-music group were reluctant to accept the offer of music: only 34% would have accepted a hypothetical offer to listen to music. On the other hand 82% of the patients in the music group liked the music they heard very much. Although the music was just audible, 62% of the patients in the music group noticed the music. Study 2 showed that specially selected music before and after the procedure played via headphones had a positive effect on 82% of the patients in the music group. The patients expressed that the music made them feel less tense and anxious and diverted their mental focus to pleasant thoughts. Additionally the music made the waiting time pleasant and improved their feeling of wellbeing. Conclusions: Specially selected music has a positive influence on the feeling of well-being of patients in relation to cardiac procedures (before, during and after ). Based on the negative expectations and the positive experience of the patients with regard to music environment, we recommend that specially selected music should be a part of the sound environment in the Cardiac Laboratory without asking the patients for permission on beforehand. Furthermore we recommend that patients are offered specially selected music before and after the procedure.