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| 2. |
- Bolse, Kärstin, et al.
(författare)
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Life situation related to the ICD implantation : self-reported uncertainty and satisfaction in Swedish and US samples
- 2002
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Ingår i: European Journal of Cardiovascular Nursing. - Amsterdam : Elsevier. - 1474-5151 .- 1873-1953. ; 1:4, s. 243-251
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Tidskriftsartikel (refereegranskat)abstract
- 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-patient's 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.
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| 3. |
- Flemme, Inger, 1947-
(författare)
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Health-related quality of life in recipients with an implantable cardioverter defibrillator due to life-threatening arrhythmias : a 5 year follow-up
- 2004
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The general aim of this thesis was to describe self-reported health-related quality of life (HRQoL) in recipients with an implantable cardioverter defibrillator (ICD) due to life-threatening arrhythmias over a 5-year period. The design was prospective and longitudinal. Fifty-six patients participated in Paper I, and 35 of these patients, who had survived at least five years, were included in paper II. All patients had received their ICD as a form of secondary prevention. The Quality of Life Index-Cardiac version (QLI-C), Mishel Uncertainty in Illness Scale-Community version (MUIS-C), and multiple regression analysis were used. Higher scores indicate higher HRQoL and uncertainty. The questionnaires were completed on four occasions: before implantation, at three months and at 1 year and 5 years after implantation. ICD recipients were also asked how many shocks they had perceived. At the 5-year data collection, the average ICD recipient had lived with an ICD for 6 years and 9 months. In general HRQoL was lower at year 1 than at baseline (p = 0-033). A decrease in the socioeconomic domain was observed at year 1 (p = 0.006) but improved again at year 5 (p = 0.027) although it remained below the baseline value. ICD recipients' satisfaction with the family domain decreased from the time of the ICD implantation (p < 0.001) and from year 1 (p = 0.039) to year 5 after implantation. Uncertainty related to information had decreased at year 1 in relation to baseline (p < 0.001). A decrease in overall uncertainty was observed at year 5 in relation to year 1 (p = 0.009) as well as at year 6 in relation to baseline (p = 0.009). The longer the ICD recipient had lived with the device, the greater the risk of receiving a shock. However, ICD recipients who received shocks reported being less troubled by them over time. Uncertainty was identified as a predictor of Low HRQoL. The recipients reported a higher level of HRQoL at year 5 than at year 1. HRQoL was reasonably good 5 years after implantation, and the ICD recipients felt more secure and perceived their ICD as a lifesaver.
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| 4. |
- Flemme, Inger, et al.
(författare)
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Life situation of patients with an implantable cardioverter defibrillator : a descriptive longitudinal study
- 2001
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 10:4, s. 563-572
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Tidskriftsartikel (refereegranskat)abstract
- • The aim of this study was to describe changes in the life situation of patients with an implantable cardioverter defibrillator over a period of 1 year. A sample of 56 consecutive patients took part in the study.• Life situation was measured through uncertainty in illness, satisfaction, and fear of the life situation. Descriptive statistics were used to present results, and analytical statistics were used to map out changes over time.• Overall uncertainty showed a decrease over time. A statistically significant difference was found within the domain uncertainty related to information (P < 0.001).• Satisfaction increased within the domains health-functioning, socio-economic, psychological–spiritual, and family.• The ability to act within the domain health-functioning showed a statistical significance (P < 0.05).• The domain life changes within fear in the life situation decreased and showed a statistical significance (P < 0.05).• The overall life situation showed increased satisfaction as well as lower uncertainty and fear in the life situation.• The research indicates that patients need more information about changes in the life situation after the implantable cardioverter defibrillator-implantation. The study encourages more humanistic, holistic research about patients’ life situations as well as more education in teaching skills for health care personnel.
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| 5. |
- Flemme, Inger, 1947-, et al.
(författare)
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Living with life-saving technology : coping strategies in implantable cardioverter defibrillators recipients
- 2011
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Ingår i: Journal of Clinical Nursing. - Oxford : Blackwell Publishing. - 0962-1067 .- 1365-2702. ; 21:3-4, s. 311-321
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 6. |
- Flemme, Inger, 1947-, et al.
(författare)
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Living with life-saving technology : long-term follow-up of recipients with implantable cardioverter defibrillator
- 2010
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Konferensbidrag (refereegranskat)abstract
- The evidence that treatment of life-threatening arrhythmia (LTA) with an Implantable Cardioverter Defibrillator (ICD) can prolong life is convincing. Living with a lifelong heart disease will gradually influence the everyday life and encompasses some or all aspects of life. In order to influence health outcomes, the impact of the ICD must be considered in a broader context including not only the physical, but also the psychological and social functioning of the individual.The general aim of this thesis was to describe everyday life in recipients living with an ICD in a longterm perspective. The aim in Paper I was to describe changes in the life situation of recipients’ with an ICD over a period of 1 year. The aim in Paper II was to describe quality of life (QOL) and uncertainty in recipients who have an ICD and to predict QOL at long-term follow-up. Fifty-six recipients participated (I) and 35 of these recipients, who had survived at least five years, were further included (II). The Quality of Life Index-Cardiac version (I, II), Mishel Uncertainty in Illness Scale-Community version (I, II), Patient ICD Questionnaire (I) and multiple regression analysis (II) were used. Higher scores indicate higher QOL and uncertainty. The questionnaires were completed before implantation, three and twelve months after implantation (I) and also five years after implantation i.e. long-term follow up (II). At the long-term follow up, the average ICD recipient had lived with an ICD for six years and nine months (6.9 years). The results showed the overall QOL and QOL in the health/functioning domain were unchanged over time. QOL in the socio-economic (p= .002) and psychological/spiritual domains (p= .012) decreased in the first year. From baseline to long-term follow up, the QOL in the family domain (p= .011) and overall uncertainty (p= .002) decreased. Uncertainty related to the information decreased at year 1 in relation to baseline (p= .001).The aim in Paper III was to illuminate the main concern of recipients living with an ICD and how they handle this in their daily life. Sixteen recipients who had lived with an ICD between six to twenty-four months were interviewed. Data was collected and analysed in a simultaneous process according to guidelines for classical grounded theory. In the analysis, a substantive theory was generated explaining the main concern of ICD recipients and how they handle this in their daily life. The core category, labelled “Striving to resume command”, illuminates the main concern of ICD recipients. To manage this main concern, the recipients used the following strategies: Economizing resources, Distracting oneself, Submitting to one’s fate and Re-evaluating life.The aim in Paper IV was to explore relationships between OQL, coping strategies, anxiety, depression and perceived control in recipients living with an ICD and to compare those having received an ICD less or more than one year ago and those with a primary or secondary preventive indication. A cross-sectional, correlational, multicenter design was used, and 147 recipients who had lived with an ICD between six to twenty-four months completed Quality of Life Index-Cardiac version, Jalowiec Coping Scale, Hospital Anxiety and Depression Scale and Control Attitude Scale. The results showed that anxiety, depression and perceived control were predictors of QOL. Anxiety was also a predictor of coping with optimistic coping being the most used coping strategy. There was no relationship between QOL and coping. No differences were found in QOL, coping, anxiety, depression and perceived control between recipients implanted either on a primary or secondary preventive indication or having the device less or more than one year.In this thesis, it was concluded that the ICD recipients strived to resume command over their life (III) and the more control the recipients perceived the more satisfied they were with their QOL (IV) and the more symptoms of anxiety, depression and uncertainty they experienced the less satisfied they were with their QOL (II, IV). Coping strategies were used more frequently by ICD recipient perceiving more anxiety (IV). QOL was fairly good 6,9 years after implantation and ICD recipients felt less uncertain once they had passed the first year of their illness.
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| 7. |
- Flemme, Inger, 1947-, et al.
(författare)
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Living with uncertainty : main concern for recipients of implantable cardioverter defibrillator - a qualitative study
- 2010
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Konferensbidrag (refereegranskat)abstract
- Background:the implantable cardioverter defibrillator is a sophisticated and multifunctional device to treat life-threatening arrhythmias. With increasing numbers of recipients implanted due to rapid technical development of devices and enlarged implantation indications, the consequences for recipients with an implantable cardioverter defibrillator daily life has attracted increased attention during the last decade.Aim:to illuminate the main concern of individuals living with an implantable cardioverter defibrillator and how they handle this in their daily life.Design and method:the grounded theory method was used. Sixteen Swedish recipients (9 men) who had lived with a defibrillator for 6 to 24 months were interviewed. Data was collected and analysed in a simultaneous process according to guidelines for classic grounded theory. Results:in the analysis, a conceptual model was generated explaining the main concern of recipients with an implantable cardioverter defibrillator and how they handle this in their daily life. The core category, labelled "Living with uncertainty" illuminates the main concern of the recipients. To handle uncertainty the recipients used the following strategies: Restricting one’s activities, Distracting oneself, Accepting one’s fate and Re-evaluating one’s life.Conclusions:Recipients with an implantable cardioverter defibrillator were not paralyzed by the uncertainty they experienced. Instead, they handled the uncertainty by using different strategies which may produce a sense of perceived control to initiate a living process that facilitates physical and social activities.Relevance to clinical practice:this study suggests that nurses should support recipients with an implantable cardioverter defibrillator to handle uncertainty and contribute by optimizing the recipients sense of perceived control in daily life and thereby personal growth.
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| 8. |
- Flemme, Inger, 1947-, et al.
(författare)
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Livskvalitet och upplevda chocker under ICD-behandling : en 5-års uppföljning
- 2004
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Konferensbidrag (refereegranskat)abstract
- ICD–behandling ökar överlevnaden hos patienter (pat), som har överlevt en malign ventrikulär tachyarytmi. Pats livskvalitet (QoL) har angivits variera betydande och långtidseffekterna är ännu mindre väl kända. Vi följde ett antal konsekutiva pat under minst 5 år med avseende på livskvaliteten.Metod. Pat undersöktes med MUIS-C (Mishel Uncertainty in Illness Scale – community version) och QLI-CV (Quality of Life Index – cardiac version) och multipel regressionsanalys användes hos 35 patienter. Formulären fylldes i vid tre tillfällen: före implantationen, efter 1 och 5 år. Pats egen uppfattning om antalet upplevda chocker oavsett anledning noterades.Patienter. Ur en grupp pat, som tidigare undersöktes efter 1 år, hade 39 pat överlevt med sin ICD i minst 5 år. Av dessa avböjde tre deltagande i uppföljningen utan orsak och en pga cancer. Alla pat hade fått sin ICD på indikationen sekundär prevention. Resultat. Under det första året rapporterade 13 pat totalt 79 chocker och 22 pat ingen chock. Tio pat hade ingen chock vare sig efter 1 eller 5 år, och deras QoL var likvärdig med dem som hade haft ≤5 chocker. Tre pat rapporterade ≥6 chocker och hade sänkt QoL. Mellan år 1 och 5 rapporterade 20 pat 94 shocker och 15 pat ingen shock. Det var ingen skillnad mellan pat med eller utan chocker i deras QoL år 5 vs. år 1. Pat med chocker blev mindre besvärade med tiden.QoL var generellt sänkt år 1 vs baseline. En försämring i den socio-ekonomiska domänen sågs år 1 men var förbättrad år 5. En försämring i familjedomänen var oförändrad vid 1 och 5 år vs. baseline. En förbättring av otrygghet noterades vid 5 år vs år 1.Konklusioner. Pat med ICD mådde bättre år 5 än år 1 efter implantationen. Livskvaliteten var rimligt god 5 år efter implantationen och pat kände sig mer trygga och upplevde sin ICD som en livräddare. Pat med många chocker under det första året mådde sämre än övriga. Under resten av observationsperioden var chocktätheten lägre, möjligen delvis pga farmakologisk behandling, och pat upplevde mindre besvär av chockerna.
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| 9. |
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| 10. |
- Flemme, Inger, et al.
(författare)
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Long-term quality of life and uncertainty in patients living with an implantable cardioverter defibrillator.
- 2005
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Ingår i: Heart & lung : the journal of critical care. - St. Louis, MO : Elsevier BV. - 0147-9563 .- 1527-3288. ; 34:6, s. 386-92
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: This study describes the quality of life (QOL) and uncertainty in patients who have an implantable cardioverter defibrillator (ICD) and predicts QOL at long-term follow-up. METHODS: Long-term follow-up was defined as 6.9 years +/- 1 year (range 4.11-8.7 years). QOL was measured with the Quality of Life Index, and uncertainty was measured with the Mishel Uncertainty in Illness Scale. RESULTS: The overall QOL and health/functioning were unchanged over time. QOL in the socioeconomic (P = .002) and psychologic/spiritual domains (P = .012) decreased in the first year. From baseline to long-term follow-up, the QOL in the family domain (P = .011) and uncertainty (P = .002) decreased. Uncertainty was a predictor of low QOL. CONCLUSION: QOL was reasonably good 6.9 years post-ICD implantation. Patients felt less uncertain once they had passed the first year of their illness.
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