Over 24,500 patients with recurrent ventricular dysrhythmia have received an internal cardioverter/defibrillator (ICD) since the Food and Drug Administration approved the device in 1985. Although the resultant survival rates for these patients are excellent, little is known about how patients and family members adapt and cope with implantable lifesaving technology. the primary aims of this project are to examine patient and family member coping with the ICD and to describe factors which predict the ICD patients' outcomes in terms of functional status and affective state and their family members' affective outcomes during the first nine months after insertion. A descriptive, longitudinal, prospective design will be used to examine ICD patient functional status (measured by the Heart Failure Inventory), affective state (Profile of Mood States) cognitive appraisal (Meaning in Illness Questionnaire) and coping behaviors (Jalowiec Coping Scale), preoperatively, and at one, three, six and nine months post-ICD insertion. Personality trait optimism (Life Orientation Tool) and cardiac function (ejection fraction) will also be examined in relationship to the patient outcomes. Family member coping behavior (Jalowiec Coping Scale), cognitive appraisal (Meaning in illness) and affective state (Profile of Mood States) will be measured preoperatively and at one, three, six, and none months post- ICD insertion. Family member trait optimism (LOT) and patient cardiac function will be examined in the relationship to family member affective state outcome. Perceptions about living with an ICD will be measured by separate patient and family interviews at one, three and nine months post-ICD implantation. A secondary aim of the project is to describe sensations experienced with a device discharge and factors related to these sensations. 225 ICD patient-family member dyads will be recruited from three sites. Data analysis will include descriptive statistics, multiple linear regression and content analysis of interviews. This study will generate information essential to the subsequent development of ICD patient and family interventions to improve both physical and psychosocial outcomes. Data from this study will lead directly to constructing and testing specific nursing interventions. This knowledge will be extremely useful to nursing practice and research as other types of implantable life-saving technology emerge in the future.

Agency
National Institute of Health (NIH)
Institute
National Institute of Nursing Research (NINR)
Type
Research Project (R01)
Project #
5R01NR003047-02
Application #
2257114
Study Section
Nursing Research Study Section (NURS)
Project Start
1993-02-01
Project End
1996-01-31
Budget Start
1994-02-01
Budget End
1995-01-31
Support Year
2
Fiscal Year
1994
Total Cost
Indirect Cost
Name
Emory University
Department
Type
Schools of Nursing
DUNS #
042250712
City
Atlanta
State
GA
Country
United States
Zip Code
30322
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Dunbar, S B; Kimble, L P; Jenkins, L S et al. (1999) Association of mood disturbance and arrhythmia events in patients after cardioverter defibrillator implantation. Depress Anxiety 9:163-8
Dunbar, S B; Jenkins, L S; Hawthorne, M et al. (1999) Factors associated with outcomes 3 months after implantable cardioverter defibrillator insertion. Heart Lung 28:303-15
Knapp, T R; Kimble, L P; Dunbar, S B (1998) Distinguishing between the stability of a construct and the stability of an instrument in trait/state measurement. Nurs Res 47:60-2
Dunbar, S B; Jenkins, L S; Hawthorne, M et al. (1996) Mood disturbance in patients with recurrent ventricular dysrhythmia before insertion of implantable cardioverter defibrillator. Heart Lung 25:253-61