Thesis (Ph. D.)--University of Technology, Sydney, 2001. / Bibliographic references: leaves [304]-318.

Thesis (Ph. D.)--State University of New York at Binghamton, Decker School of Nursing, 2005. / Includes bibliographical references.

The implantable cardioverter defibrillator (ICD) is a reliable, cost-effective implanted device designed to terminate life-threatening cardiac arrhythmias and prevent sudden death. The recent exponential increase in implantation rates emphasises the need for nurses, doctors and other clinicians to understand the experience of living with an ICD for patients and partners. Current knowledge of patient experiences is mostly derived from overseas studies of specific variables, including physical problems, psychosocial outcomes, ICD shocks and quality of life issues. Studies of partner experiences focus on psychosocial concerns. Using van Manen's (1990) hermeneutic phenomenological approach, this study describes the experience of living with an ICD for seven Australian patients and six partners. Experiential descriptions, obtained in tape-recorded conversational interviews, were subjected to three levels of analysis. The first descriptive analysis summarised individual experiences of living with an ICD. The second, thematic analysis phenomenologically described the collective lived experience of being a patient, and of being a partner. Each description identified a challenging and changing experience through the themes of Being Disrupted and Distressed, Reconstructing Life, Appreciating and Celebrating Life, and Accommodating the ICD. For the patient, various everyday interactions, events and activities meant either being able to trust the ICD as a reassuring protection or experiencing it as an inescapable intrusive object. For the partner, a trusting reliance on the ICD's protective security eased the vulnerability and onerous perceived responsibility for the patient's survival and well-being. Threats to the partner's restored sense of normality, security and hope occurred when the patient wanted the ICD removed or discontinued. The third hermeneutic analysis specifically explored how the ICD, as an implanted biomedical device, was perceived, embodied and comprehended by patients. This analysis disclosed the varied, ambiguous existential meanings derived from and accorded to the ICD's presence, power and potential. The interpretation concluded that the ICD was either embodied as a trusted and reassuring friend, or existentially rejected as an intruder that thwarted meaningful possibilities. Theoretical and practical implications of this understanding of living with an ICD included several recommendations for improving staff education, as well as practical interventions for informing and supporting patients and partners. A proposal for implementing these recommendations concluded with suggestions for future inquiries that would extend understanding of this increasingly common human phenomenon.

Thesis (Ph.D.)--York University, 2008. Graduate Programme in Psychology. / Typescript. Includes bibliographical references (leaves 123-161). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&res_dat=xri:pqdiss&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&rft_dat=xri:pqdiss:NR39008

The implantable cardioverter defibrillator (ICD) is a reliable, cost-effective implanted device designed to terminate life-threatening cardiac arrhythmias and prevent sudden death. The recent exponential increase in implantation rates emphasises the need for nurses, doctors and other clinicians to understand the experience of living with an ICD for patients and partners. Current knowledge of patient experiences is mostly derived from overseas studies of specific variables, including physical problems, psychosocial outcomes, ICD shocks and quality of life issues. Studies of partner experiences focus on psychosocial concerns. Using van Manen's (1990) hermeneutic phenomenological approach, this study describes the experience of living with an ICD for seven Australian patients and six partners. Experiential descriptions, obtained in tape-recorded conversational interviews, were subjected to three levels of analysis. The first descriptive analysis summarised individual experiences of living with an ICD. The second, thematic analysis phenomenologically described the collective lived experience of being a patient, and of being a partner. Each description identified a challenging and changing experience through the themes of Being Disrupted and Distressed, Reconstructing Life, Appreciating and Celebrating Life, and Accommodating the ICD. For the patient, various everyday interactions, events and activities meant either being able to trust the ICD as a reassuring protection or experiencing it as an inescapable intrusive object. For the partner, a trusting reliance on the ICD's protective security eased the vulnerability and onerous perceived responsibility for the patient's survival and well-being. Threats to the partner's restored sense of normality, security and hope occurred when the patient wanted the ICD removed or discontinued. The third hermeneutic analysis specifically explored how the ICD, as an implanted biomedical device, was perceived, embodied and comprehended by patients. This analysis disclosed the varied, ambiguous existential meanings derived from and accorded to the ICD's presence, power and potential. The interpretation concluded that the ICD was either embodied as a trusted and reassuring friend, or existentially rejected as an intruder that thwarted meaningful possibilities. Theoretical and practical implications of this understanding of living with an ICD included several recommendations for improving staff education, as well as practical interventions for informing and supporting patients and partners. A proposal for implementing these recommendations concluded with suggestions for future inquiries that would extend understanding of this increasingly common human phenomenon.

Thesis (Ph.D.)--York University, 2008. Graduate Programme in Psychology. / Typescript. Includes bibliographical references (leaves 99-127). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&res_dat=xri:pqdiss&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&rft_dat=xri:pqdiss:NR51759

Coincident with an increased use of cardiac rhythm management devices (CRMD) has been an increase in the number of pacemaker and cardioverter-defibrillator infections. CRMD endocarditis accounts for about 10% of all device-related infections, and cardiac infection caused by Candida sp. is a rare event. To date, only sporadic reports of this unusual and life-threatening event have been reported. By describing a case of CRMD-related Candida endocarditis and conducting a literature review, we provide a detailed characterisation of this unusual clinical entity with an emphasis on diagnosis, management and treatment. A case of CRMD-related Candida endocarditis is presented and a computer search for confirmed cases of CRMD-Candida endocarditis was conducted. Current recommendations for management and treatment were documented. From 1969 to 2009, 15 patients with CRMD-Candida endocarditis (12 pacemaker and three implanted cardioverter-defibrillator) were documented. All were males, non-albicans Candida sp. were frequently recovered, a major fungal embolus occurred in 27% of patients and two of 10 patients who received defined antifungal therapy and device explantation expired. CRMD Candida endocarditis is a rare and serious clinical event; isolates can include Candida albicans and other Candida sp., and treatment involves both targeted antifungal therapy and device removal.

The implantable cardioverter defibrillator (ICD) is a small medical device, implanted underneath the collarbone with wires leading from it to the heart. The device detects and terminates ventricular arrhythmias by delivering an electric shock, that otherwise would most likely lead to sudden cardiac arrest and sudden cardiac death. The ICD is perceived as the 'gold standard' treatment therapy for patients at risk of sudden cardiac death resulting from fast electrical rhythms (Bleasdale, Ruskin, O'Callaghan, 2005). However, ICD recipients have reported high levels of psychological distress such as anxiety and depression and a reduced quality of life (e.g. clinical review by Sears, Matchett & Conti, 2009). This thesis describes the development of a brief psychological intervention for patients living with an ICD based on the Medical Research Council's (2008) guidelines. The first stage in the development of the intervention was a qualitative study. Thirtysix ICD participants (ICD patients and partner) were recruited in south Wales. Semistructured interviews were conducted with each participant separately. Thirteen of the patients had not experienced an ICD shock. Transcripts were analysed by thematic analysis (Braun and Clarke, 2006) using a cognitive-emotional-coping framework. General findings revealed patients did not know how to regain normality after their ICD and highlighted common worries were identified. Accordingly, the intervention aimed to be a structured guide underpinned by cognitive behavioural theory. It aimed to address common worries and bridge the gap between hospital discharge and patient's 6-week follow up appointment. The intervention was tested using a pilot randomised control trial. Ninety-nine participants were randomised to an intervention or control group. Differences between groups at baseline were adjusted by analysis of covariance (ANCOVA) to control for differences at 3- and 6-months. Results revealed the intervention group reported improved levels of depression, increased levels of mild exercise and increased patient acceptance to the ICD compared to the control group at 6-months. The simplicity and cost-effectiveness of this intervention suggests that not only is it theory and evidenced based, but should be sustainable long term. The next stage would be to carry out a fully powered randomised control trial.

Encounters in which shared decision-making occur relies on patients and healthcare professionals establishing a partnership. Yet, little is known about the therapeutic relationship (TR) specifically for the implementation and use of patient decision aids (PDA) to facilitate shared decision-making. The aim of this thesis was to explore how the TR is considered when planning PDA implementation for patients eligible for or with an implantable cardioverter-defibrillator (ICD). Using Thorne's interpretive description approach, I conducted a secondary thematic analysis using transcripts with 17 healthcare professionals, ten patients and three family members. Findings were mapped to the TR elements. I identified three themes. First, Pieces of the puzzle: Elements of the TR revealed that while respect and therapeutic communication were identified as important for PDA implementation, other TR were either referred to implicitly or not at all. Second, Good intentions and challenges of establishing a TR revealed that healthcare professionals wanted to engage in TR but lacked time and felt discomfort navigating ICD decisions. Finally, in PDA as support for the TR, participants considered PDAs as being able to facilitate TR elements such as communication and respect, enhancing the consultation. In conclusion, there is a role for TR elements when planning PDA implementation. Further research is needed to explore the other therapeutic relationship elements of genuineness, manifesting a presence, active listening, and reciprocity.

Syftet med denna litteraturöversikt var att beskriva den hälsorelaterade livskvaliteten hos patienter med en implantable cardioverter defibrillator (ICD).  Studien genomfördes som en litteraturöversikt, där tolv vetenskapliga artiklar av kvantitativ karaktär analyserades och användes i studiens resultatdel.  Sökorden som användes var Defibrillators, Implantable, Quality of Life och health related. Inklusionskriterier var artiklar skrivna på engelska, peer-reviewed, publicerade från år 2000 och framåt samt deltagarna i dessa studier skulle vara 19 år eller äldre. I studien framkom det att ICD-patienter undvek specifika platser, objekt och fysiska aktiviteter relaterade till ICD:n. Också en oro över bilkörning framkom.  ICD-patienter utsätts för en förändring i livssituation och är i behov av stöd och individuell informationsgivning gällande deras medicintekniska anordning. Idag är största delen av forskning gjord på män, då implantationsfrekvensen är högre hos dessa. Vidare forskning är relevant och bör omfatta kvinnor, för att på så sätt kunna anpassa framtida vårdinsatser på ett individuellt plan. Vårdgivare behöver fördjupad kunskap inom detta område, då implantationsfrekvensen av ICD är ökande. Kunskap hos vårdgivare kan möjligtvis leda till en ökad hälsorelaterad livskvalitet inom denna patientgrupp. / The aim with this literature study was to describe the health related quality of life in patients with an implantable cardioverter defibrillator (ICD). The study was carried out as a literature study and twelve articles, which all were of quantitative character, were analyzed and constituted the result of the study. The search words that were used were Defibrillators, Implantable, Quality of Life and health related. The criteria of inclusion were articles in English, peer-reviewed, published in 2000 to present day and the participants in these studies had to be 19 years or elder. In the study it emerged that ICD-patients avoided specific places, objects and physical activities related to the ICD. Also a concern regarding driving appeared. ICD-patients are subjects of a change in their life situation and are in need of support and individual information regarding their medicine technical device. To this date, the majority of researches are conducted on men, because of the higher implant frequency within this gender. Further researches are of importance and shall enclose the female gender, to be able to adapt the contribution of nursing on an individual level. Health care providers are in need of deepened knowledge within this area, because of the rising frequency of implantation. This knowledge might lead to a increased health related quality of life within this patient group.