Friend or intruder? : living with an implantable defibrillator : patients' and partners' experiences

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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.
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