Dissertation/Thesis Abstract

Long-term adjustment and reimplantation surgery in patients with implantable cardioverter defibrillators
by Jakub, Karen E., Ph.D., The University of North Carolina at Chapel Hill, 2012, 102; 3549625
Abstract (Summary)

Implantable cardioverter defibrillators (ICD) are the standard of care for individuals with life-threatening cardiac arrhythmias. These devices treat arrhythmias by rapidly pacing or shocking the heart into a normal rhythm. Within the first year of implantation patients make physical, psychological, and social adjustments to living with a device. Yet, although patients are living with these devices for many years, the long-term consequences of implantation are only beginning to be explored. One aspect of living for many years with an ICD is the experience of defibrillator replacement. Patients are required to have a new device implanted every 4-7 years due to battery depletion. In addition, as ICD components age, surgery may be needed to repair or replace worn parts. Accordingly, the purpose of this study was to examine the long-term physical, psychological, and social consequences of living with an ICD and the experience of recurrent surgery for patients with ICDs. The focus of the study was to identify distinctive differences in this experience among various ages, and between men and women.

Twenty-three participants were recruited from a major regional hospital in North Carolina through the ICD device clinic. Ethnographic methods of participant observation, interviews, and medical record reviews were used to collect data over a one year period. Data were analyzed and interpreted using a with-in case and cross-case method, focusing on concepts generated from a variety of gender, chronic illness, and age-related theories. The findings concerning long-term adjustment to living with an ICD were characterized by both differences and similarities according to sex and age. Men exhibited more bravado than women and were more likely to engage in risk-taking behaviors. Women remained engaged in caring behaviors following implantation and surrounded themselves with other women as their support network. Young women were also concerned about childbearing once they had an ICD. Both men and women were concerned about reimplantations; the risks, technology reliability, financial strain, scarring, and continued follow-up for years to come. Their initial implantation caused concern and angst that diminished over time, thereby moving the focus away from the ICD to other aspects of their lives.

Indexing (document details)
Advisor: Sandelowski, Margarete
Commitee: Beeber, Linda, Esposito, Noreen, Mayer, Deborah, Mounsey, John P.
School: The University of North Carolina at Chapel Hill
Department: Nursing
School Location: United States -- North Carolina
Source: DAI-B 74/05(E), Dissertation Abstracts International
Source Type: DISSERTATION
Subjects: Nursing
Keywords: Age, Defibrillators, Gender, Long-term adjustment, Psychosocial, Reimplantation
Publication Number: 3549625
ISBN: 978-1-267-86136-8
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