Organisation of care for Swedish patients with an Implantable Cardioverter Defibrillator, a national survey

• Background:ICD implantations have developed rapidly in recent years and is now an established arrhythmia treatment. The expanding indication for ICD implantation demands new competencies and resources in the ICD team members.Objectives:To describe the clinical aspects of Implantable Cardioverter Defibrillators (ICD) care in Sweden with focus on organisation, the role and education of nurses, patient information and education, and areas in need of improvement.Methods:Participants were recruited among physicians and nurses in all of the hospitals implanting ICDs (N=16). Data was collected by a questionnaire. The questionnaire was constructed based on a systematic literature review and then guided by an expert group with clinical and research expertise within the ICD area. The format was inspired by existing questionnaires on heart failure care. The questionnaire comprised of 23 questions, including both multiple choice questions and open questions. Additionally, all written educational materials provided to patients pre- and post-ICD implant were collected from all 16 hospitals. Deductive content analysis using Sarvimäki and Stenbock-Hult's five holistic dimensions was employed to ascertain how information was provided in brochures and information materials.Results:This study revealed variations in the organisation and follow-up of ICD patients between the different centres in Sweden. Half of the hospitals (n=8) had nurse-based outpatient clinics and several others planned to introduce them. Three hospitals carried out distance follow-ups by means of tele-monitoring. The nurses had received specific ICD education from ICD companies and/or various university courses. In all hospitals, ICD patients received verbal and written information both before and after implantation. The biophysical dimension dominated in the information material while the emotional, intellectual, and socio-cultural dimensions were scarcely described, and the spiritual- existential was not referred to at all. The majority of the ICD teams were in favour of the development of research and quality assurance by means of check lists, guidelines and the ICD-registry.Conclusion:Holistic care of ICD patients can be achieved by means of a multi-disciplinary ICD team and more patient-centred educational strategies. In Sweden, the organisation of ICD care and follow-up is developing towards more nurse-based clinics. The content of the written educational materials need to be more holistic, rather than mainly focusing on the biophysical and technical aspects of living with an ICD.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskap (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Health Sciences (hsv//eng)

Nyckelord

MEDICINE

MEDICIN

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