Elsevier

Heart & Lung

Volume 29, Issue 2, March–April 2000, Pages 79-86
Heart & Lung

Issues In Cardiovascular Nursing
Domains of nursing intervention after sudden cardiac arrest and automatic internal cardioverter defibrillator implantation*,**

https://doi.org/10.1067/mhl.2000.105759Get rights and content

Abstract

Purpose: The purpose of the study was to explore individual and family experiences after sudden cardiac arrest and automatic internal cardioverter defibrillator implantation during the first year of recovery. This report specifically addresses the domains of concern expressed and helpful strategies used by participants that are relevant to the development of future intervention programs. Design: A grounded theory approach was used to gain an understanding of areas of concern of sudden cardiac arrest survivors and families that could be used when designing future nursing interventions. Semistructured interviews were conducted with both sudden cardiac arrest survivors and 1 family member each at 5 points during the first year of recovery (hospitalization; 1, 3, 6, and 12 months after hospitalization). Participants were asked to identify those specific areas that most concerned them and that they would like assistance with during the first year. A total of 150 interviews were conducted with 176 hours of data generated. Setting: The study focused on 10 northwest urban community medical centers and participants’ homes within a 50-mile driving distance from the medical centers. Sample: The sample included 15 first-time sudden cardiac arrest survivors (13 men and 2 women) and 1 family member each between the ages of 31 and 72 years. Results: Domains of concern identified by participants that can be used to design future nursing intervention programs included preventive care, dealing with automatic internal cardioverter defibrillator shocks, emotional challenges, physical changes, activities of daily living, partner relationships, and dealing with health care providers. Suggestions of helpful strategies used by participants during the first year are outlined. Implications: Domains of concern and helpful strategies identified by participants provide a framework for the development and testing of nursing intervention programs to enhance recovery following sudden cardiac arrest for survivors and their families. (Heart Lung® 2000;29:79-86.)

Section snippets

Design

This study was conducted as part of a larger study to describe individual and family experiences after SCA and ICD implantation during the first year of recovery. The grounded theory method was used to identify experiences of SCA survivors and their family members. SCA survivors and their intimate partners were prospectively followed from hospitalization through the first year. Data were collected from patients and 1 intimate partner at 5 times: hospital discharge, and then at 1 month, 3

DATA ANALYSIS

Although triangulation of methods was used to address the study purposes, this article will discuss only the findings from the qualitative analyses. Grounded theory16, 17 provided the basis for the qualitative data generation and analysis. Grounded theory methodology is derived from symbolic interactionism and is used to describe phenomena about which little is known. It is characterized by an inductive process approach conducted in a naturalistic setting, with an emphasis on dynamic realities.

Demographics

The mean age of the SCA survivors was 57 ± 11 years, and the mean age of family members was 53 ± 9 years. All SCA survivors experienced primary VF at the time of cardiac arrest and subsequently underwent ICD implantation during hospitalization. The average length of stay in the hospital was 22 days, with a range of 10 to 50 days. Four (27%) of 15 survivors had no prior history of cardiac disease before the occurrence of their cardiac arrest. Thirteen (87%) of 15 SCA survivors were men. Family

CONCLUSIONS

The goals of intervention programs for cardiac arrest survivors should focus on the provision of new information required to effectively manage illness at home, information regarding new behaviors that are required to live safely with the ICD, and methods to prevent complications. Although the technology surrounding implantation of the ICD has become simpler, the device itself has become more technologically complex. Anecdotal evidence suggests that standardized educational programs fall short

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*

Supported by a National Research Service Award, National Institute for Nursing Research, #F32NRO6537, and Hester McLaws Scholarship Funds from University of Washington School of Nursing.

**

Reprint requests: Cynthia M. Dougherty, PhD, ARNP, Research Assistant Professor, University of Washington School of Nursing, 1660 S Columbian Way, Mailstop (S-111-PC), Box 358280, Seattle, WA 98108-1597.

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