Patients' psychological adjustment to an implanted cardioverter defibrillator

• Main Author: Gross, Tera L
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01-01-2008
• Subjects: Cardiology; Clinical psychology; Defibrillators; Nursing; Patients
• ISBN: 9781109335828; 1109335822

This descriptive correlational design study examined the extent which age, sex, time since implantation, and shocks predicted patients’ psychological adjustment to an implanted cardioverter defibrillator (ICD). The holistic model of cardiovascular health (depicting how psychological factors, including anxiety and depression, can lead to physiological effects) was used as the conceptual framework for the study. Beery’s (2005) Implanted Device Adjustment Scale (IDAS), was used in a mail survey of 200 randomly selected patients implanted with an ICD at a large Midwestern academic medical center in 2007. A 50% response rate was achieved. IDAS total scores were calculated for all respondents. Possible scores on the IDAS range from 20-100, with higher scores indicating poorer adjustment. Actual scores ranged from 20 to 70 with a mean of 41.4 and standard deviation of 12.200. Spearman correlation coefficients showed patient adjustment improved as the time since implantation increased (p = .001). Spearman coefficients also showed better adjustment in older patients (p = .0007). A bivariate correlation coefficient calculation yielded no statistically significant results between shocks and IDAS scores. Multiple regression analysis showed age, time since implantation, and shocks were significant predictors of the IDAS score. The results showed that 23% of the variation in IDAS scores can be explained by age, time since implantation, and shocks. The model predicted for every year of increase in age, the IDAS score decreased by .3 points (p = .001). For every month since implantation, the IDAS score decreased by 1.1 point (p = .0016). If the patient received shocks, the score increased 10.4 points (p = .05). Narrative comments revealed participants were concerned about comfort of the device, information or education needed, pain, sense of security having the device, and ability to increase activity following device placement. These findings have several important implications for future research and creation of nursing interventions to support ICD patients.