Can nurses in cardiology areas prepare patients for implantable cardioverter defibrillator implant and life at home?

Abstract

This study explored nurses' confidence and competence in preparing patients for having an implantable cardioverter defibrillator implanted and for life at home after discharge. Whilst research has identified various physical and psychosocial effects to patients and their partners associated with device implant and subsequent lifestyle adjustments, no research has explored nurses' knowledge of the device or these effects. A survey was designed using a purposive sample of 152 nurses from cardiology areas in four large teaching hospitals and a 28-point postal questionnaire to explore knowledge of the device and its impact. Most subjects were not confident in their abilities to prepare patients for implant or life at home after implant. Knowledge of the device and its effects appeared poorly understood by all nurses, irrespective of additional qualifications, length of time since qualifying or area of work. Many participants were aware of the poor knowledge level of nurses and identified it as a weakness in current care practices. Lack of understanding may impair preparation of patients for implantation of or for living with an implantable cardioverter defibrillator, and feasible strategies to change this situation will require careful consideration and further investment.

Knowledge of Implantable Cardioverter Defibrillator Purpose and Function Among Nurses in the United States

“…Providing nurses with an opportunity to observe an ICD implantation procedure may be beneficial, particularly if coupled with relevant educational materials. The results of this study, as well as that of Tagney (2004), highlighted the brevity of hospital stay for patients who receive an ICD, which markedly limits the time nurses have to provide education. Some patient factors limit retention of information.…”

“…Nurses in this study performed similarly on the same questions to nurses in the United Kingdom. 7 On average, nurses in both studies answered 72% to 77% of the questions correctly. Nurses in the current study were knowledgeable about the basic aspects of ICD implantation, such as knowledge about the psychological impact on both the patient and the partner, factors that affect ICD recipient from retaining educational information, and some environmental hazards.…”

“…Ting and Lee 8 recently reported lower scores on factual elements regarding ICD implantation and care compared with both our study and Tagney's. 7 Most incorrect responses in that study occurred in questions about lifestyle changes, exercise and sex, driving, and safety related to electromagnetic interference. 8 Similarly, Ali et al 16 described critical care nurses' ICD knowledge in Egypt, noting a knowledge score of 59%.…”

“…Of 87 cardiology nurses who participated in the survey, 74% were not confident in preparing patients for an ICD implantation and 85% were not confident in preparing patients for living with the device after hospitalization. 7 Nurses lacked knowledge about the ICD device as well as the psychological impact that ICD recipients may experience. Recently, Ting and Lee 8 replicated this study with UK nurses, with correct responses to questions about the ICD ranging from 10% to 97%, with only 29% of questions being answered correctly.…”

Development and Testing of an Intervention to Improve Outcomes for Partners Following Receipt of an Implantable Cardioverter Defibrillator in the Patient

“…The recent Institute of Medicine Report on “The Future of Nursing: Leading Change Advancing Health” reaffirms the need for nursing’s involvement in managing chronic illness, coordinating care among clinicians and health care agencies, and preventing occurrences of acute care episodes and disease progression resulting in rehospitalization. 13 Tagney 14 reported that 85% of nurses caring for patients with an ICD in the hospital were not confident that they could prepare patients for living at home with an ICD; 37% did not understand ICD precautions after going home, and 64% were not aware of lifestyle changes required to live successfully with an ICD. In addition, Sears et al 15 reported that nurses and physicians understand concerns of patients and families after receiving an ICD, but fewer than 50% of providers had the necessary skills to assist patients in managing anxiety, fear and worry, depression, returning to a sexual relationship, overprotectiveness of the spouse, or daily activities such as driving issues.…”