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.
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