Implantable cardioverter defibrillators
A CPD article improved Helen Ballantyne’s understanding of the effects of implantable cardioverter defibrillators on patients’ quality of life.
A CPD article improved Helen Ballantyne’s understanding of the effects of implantable cardioverter defibrillators on patients’ quality of life
What was the nature of the CPD activity, practice-related feedback and/or event and/or experience in your practice?
The article discussed the factors associated with health-related quality of life in patients with an implantable cardioverter defibrillator (ICD). In my practice, I discuss ICDs regularly with patients who have these devices and with those who may require them imminently. The article provided information that will enable me to ensure these discussions are person-centred.
What did you learn from the CPD activity, feedback and/or event and/or experience in your practice?
I learned that how patients view their ICD may differ, depending on their clinical history. Patients who have experienced a cardiac arrest often perceive their ICD to be a life-saving device and are grateful for it. In contrast, patients who have not experienced a cardiac arrest may resent their ICD, perceiving it as a reminder of their potentially declining heart function.
The article stated that there are significant differences in patients’ emotional and physical reactions to their ICD. Some patients may feel revived physically and mentally by the device, since it supports cardiac function and can improve quality of life. However, some patients who experience shocks from their ICD may develop physical symptoms, such as nausea and lethargy, and mental health symptoms, such as anxiety and depression.
There is evidence to indicate that patients who have higher levels of education tend to experience reduced mental health symptoms linked to their ICD. This may be because these patients are better placed to understand their device, so are less likely to be anxious about it. This demonstrates the importance of patient education about ICDs to reduce anxiety and potentially improve quality of life.
How did you change or improve your practice?
After reading the article, I made several changes to my practice. I ensure that the patient is at the centre of discussions about ICDs and avoid making assumptions about their reaction to the device.
During appointments with patients who have an ICD, I ensure that I ask if they have any concerns or questions about the device. Since patient education might reduce anxiety associated with an ICD, I make sure that individuals who may require an ICD receive written and verbal information about the device, as well as details of relevant websites and support groups.
I have lowered my threshold for offering patients who require an ICD, or who have the device, a referral to the psychological support team. Even if they do not report concerns, I inform them that this service is available.
How is this relevant to the Code? Select one or more themes: Prioritise people, Practise effectively, Preserve safety, Promote professionalism and trust
The article is relevant to The Code theme of prioritising people, which states that nurses must avoid making assumptions and recognise individual choice. It might be assumed that because an ICD has the potential to save a person’s life, it is an intervention they will feel grateful to receive.
The article taught me that this is not always the case, and that I should identify how each patient feels about their device, and support them in making decisions related to their treatment.
Helen Ballantyne is a staff nurse at Papworth Hospital NHS Foundation Trust, Cambridge
This reflective account is based on NS883 Wong F (2017) Promoting health-related quality of life in patients with an implantable cardioverter defibrillator. Nursing Standard. 31, 27, 53-62
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