Jayne James

Exploring the patient's experiences of learning to live with an implantable cardioverter defibrillator (ICD) from one UK centre: a qualitative study.

BACKGROUND: International expansion of indications for implantable cardioverter defibrillator (ICD) implant means increasing numbers of patients with devices worldwide. However, smaller numbers of patients with ICDs in the UK has meant that clinical expertise available to care for this specialized group is limited. Whilst North American patients’ experiences of living with an ICD are well documented, European perspectives remain underrepresented. AIM: The aim of this study was to explore and describe patients experiences around the time of their ICD device implant and after they returned home from one UK centre. METHODS AND RESULTS: Eligible patients were recruited from one regional cardiothoracic centre and interviewed in their own homes using semi-structured schedules. Analysis of data elicited three themes; non-individualised nature of information, adjustments to living with the device and future outlook. Unique findings identified were; (a) concealment of concerns and symptoms; (b) funding issues; and (c) unavailability of appropriate support and advice during and after time in hospital. CONCLUSION: Individualized care and support for these ICD patients appeared lacking according to respondents. Opportunities to discuss concerns appeared non-existent, which may indicate that UK patients are disadvantaged in the domain of psychological support compared with their European and North American counterparts. Findings remain tentative until explored with a larger, more representative and international sample.

The hidden contribution of the health care assistant: a survey-based exploration of support to their role in caring for the acutely ill patient in the general ward setting.

AIM To examine the feelings, support and feedback available to health care assistants (HCA) when caring for acutely ill ward patients. BACKGROUND The role of the HCA continues to evolve with increased responsibility for patient care. Contextual issues that affect their contribution to acute care management of the ward patient have been given limited attention. METHODS A survey of HCAs (n = 131) was conducted within two district general hospitals. RESULTS There were a number of emotions and stressors associated with the care of acutely ill patients. While normal hierarchical systems were in place in order to obtain help HCAs additionally bypassed these normal channels. Support mechanisms included registered nurses, ward doctors, peers and family. Feedback regarding performance was limited. CONCLUSION HCAs play a significant role in the care of the acutely ill patient. Feedback mechanisms need to be developed and associated emotions recognized. IMPLICATIONS FOR NURSING MANAGEMENT HCAs support needs to be more evident and clinical feedback mechanisms need to be reviewed in order to improve care delivery.

1353: A Pilot Postal Survey of Patients' Experiences Following Implantable Cardioverter Defibrillator (ICD) Implant

Purpose: Despite improving survival and some aspects of quality-of-life, implantation and activation of an ICD may cause adverse psycho-social impact including anticipation and fear of shocks, changes in relationship, resentment at imposed driving ban and employment concerns. Recent qualitative data from the UK and elsewhere suggests that service providers fail to address individualised needs of ICD patients. Thus a survey was designed with the purpose of identifying the scope of patient concerns and priorities and whether these changed over time. Method: A questionnaire was designed based on previous research findings. Questions related to: assessing the nature of preparation patients received prior to going home; identifying patients’ main concerns and whether, or how, these changed over time; assessing the physical, emotional and social responses to living with an ICD; discovering any gender differences regarding the process of adjustment and identifying any helpful interventions. Between February and July 2003, all patients receiving ICD follow-up care at one UK centre(ns134) were invited to participate in the study by means of a letter. Those who consented returned their questionnaire by post. Quantitative data were analysed using non-parametric tests in SPSS(version 11) software. Qualitative responses were collated and analysed using inductive content analysis. Results: 96 of the 134 questionnaires were returned providing a high response rate of 75%. 78 ( 1%) reported their gender, of which 66(85%) were male and had their ICD fitted over18months ago(65.6%). Most patients indicated that they received technical, safety and physical care information prior to discharge but fewer indicated that they were given the opportunity to explore feelings and concerns. Not being permitted to drive was the most frequently identified concern at the time of implant (67.7% ns65) closely linked with being dependent on others for transport (60.4% ns58). However, qualitative responses indicated that the overall greatest concern for patients revolved around device function and having a shock. Reported concerns altered considerably over time. No specific interventions were identified that helped although technical and medical staff at follow-up clinics were found to be supportive. Conclusion: These preliminary findings indicate that physical and technical aspects of care remain dominant over psycho-social needs. Additionally, this study indicates that patients’ needs change over time. Although only pilot data, results could be used to enlighten preparation information prior to implant and enhance discharge planning to ensure patients are made aware of and prepared for commonly identified concerns.

1367: Caring for and Supporting the Patient with an ICD—The Experiences of Partners in the United Kingdom

taking, review of body systems and physical examination. These latter elements of clinical assessment have traditionally been viewed as exclusively the remit of the medical profession. Indeed the four cornerstones of inspection, palpation, percussion and auscultation are not considered to be fundamental skills within the scope of nursing practice in the UK. The current climate within the health sector and government legislation has provided an opportunity for nurses to develop their roles. The cardiac field of nursing is no exception when considering the introduction and implications of the national service frameworks for heart disease. Implementation of which requires a shift in traditional professional boundaries if improvements in efficiency and quality are to be achieved. Method: It is recognised that education and training needs to be in place to support such initiatives. In particular post registration cardiac nurse education should be inclusive of history taking, clinical assessment, triage and prescribing. To meet this demand in the South Wales area, a degree level, 15 week module, in clinical assessment was devised. The planning team consisted of both lecturers in cardiac and critical care together with senior clinicians in practice. The module offered the opportunity for any practising registered nurse to gain skills in advanced clinical assessment Results: Two cohorts totalling 40 nurses have enrolled to date. Five were cardiac nurses working in the acute hospital environment. Preliminary review indicates that many of the assessment skills acquired during the module are not being utilised by these cardiac nurses in their everyday clinical practice. Conclusion: Despite a growing demand for cardiac nurses to attend such educational and training programmes, the application in practice is not realised. Reflecting a dichotomy between government proposals and the clinical reality of traditional role diversification. There has been no formalised evaluation as to the utilisation of these newly acquired skills within the clinical area following completion of the module. Before adoption of advanced clinical assessment as a fundamental skill for cardiac nurses, there must be evaluation of existing developments.