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Flemme, Inger
Publications (10 of 20) Show all publications
Flemme, I., Johansson, I. & Strömberg, A. (2011). Living with life-saving technology: coping strategies in implantable cardioverter defibrillators recipients. Journal of Clinical Nursing, 21(3-4), 311-321
Open this publication in new window or tab >>Living with life-saving technology: coping strategies in implantable cardioverter defibrillators recipients
2011 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 3-4, p. 311-321Article in journal (Refereed) Published
Abstract [en]

Aims. To describe coping strategies and coping effectiveness in recipients with an implantable cardioverter defibrillator and to explore factors influencing coping.

Background. Implantable cardioverter defibrillators are documented as saving lives and are used to treat ventricular tachycardia and ventricular fibrillation. Despite the implantable cardioverter defibrillator not evidently interfering with everyday life, there is conflicting evidence regarding the psychosocial impact of an implantable cardioverter defibrillator implantation such as anxiety, depression, perceived control and quality of life and how these concerns may relate to coping.

Design. Cross-sectional multicentre design.

Methods. Individuals (n = 147, mean age 63 years, 121 men) who had lived with an implantable cardioverter defibrillator between 6-24 months completed the Jalowiec Coping Scale-60, Hospital Anxiety and Depression Scale, Control Attitude Scale and Quality of Life Index-Cardiac version.

Results. Implantable cardioverter defibrillators recipients seldom used coping strategies, and the coping strategies used were perceived as fairly helpful. Optimism was found to be the most frequently used (1·8 SD 0·68) and most effective (2·1 SD 0·48) coping strategy, and recipients perceived moderate control in life. Anxiety (β = 3·5, p ≤ 0·001) and gender (β = 12·3, p = 0·046) accounted for 26% of the variance in the total use of coping strategies, suggesting that the more symptoms of anxiety and being women the greater use of coping strategies.

Conclusions. Most recipients with an implantable cardioverter defibrillator did not appraise daily concerns as stressors in need of coping and seem to have made a successful transition in getting on with their lives 6-24 months after implantation.

Relevance to clinical practice. Nurses working with recipients with an implantable cardioverter defibrillator should have a supportive communication so that positive outcomes such as decreased anxiety and increased perceived control and quality of life can be obtained. Through screening for anxiety at follow-up in the outpatient clinic, these recipients perceiving mental strain in their daily life can be identified.

Place, publisher, year, edition, pages
Oxford: Blackwell Publishing, 2011
Keywords
anxiety, arrhythmia, coping, depression, implantable cardioverter defibrillator, nurses, nursing, perceived control, quality of life
National Category
Clinical Medicine
Identifiers
urn:nbn:se:hh:diva-15897 (URN)10.1111/j.1365-2702.2011.03847.x (DOI)000298793400003 ()21951323 (PubMedID)2-s2.0-84855345469 (Scopus ID)
Available from: 2011-08-14 Created: 2011-08-14 Last updated: 2018-03-22Bibliographically approved
Flemme, I., Hallberg, U., Johansson, I. & Strömberg, A. (2011). Uncertainty is a major concern for patients with implantable cardioverter defibrillators. Heart & Lung, 40(5), 420-428
Open this publication in new window or tab >>Uncertainty is a major concern for patients with implantable cardioverter defibrillators
2011 (English)In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 40, no 5, p. 420-428Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The study objective was to explore the main concern of individuals living with an implantable cardioverter defibrillator (ICD) and how they handle this in daily life. For improved management and follow-up, it is important to understand how the ICD affects the recipient's daily life. METHODS: A grounded theory method was used. Sixteen Swedish recipients (9 men) living with an ICD for 6 to 24 months were interviewed. RESULTS: The core category labeled, "Incorporating uncertainty in daily life," illuminates the main concern. To handle uncertainty, recipients used the following strategies: restricting activities, distracting oneself, accepting being an ICD recipient, and reevaluating life. CONCLUSION: Recipients were not paralyzed by uncertainty. Instead, they incorporated uncertainty in life by using strategies to handle their daily life. Questions, comments, and plans for supportive communication were provided, which can be used by healthcare professionals in cardiac rehabilitation.

Place, publisher, year, edition, pages
St. Louis: , 2011
Keywords
Arrhythmia, Grounded theory, Implantable cardioverter defibrillator, Nursing, Qualitative research, Quality of life, Uncertainty
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:hh:diva-15144 (URN)10.1016/j.hrtlng.2011.02.003 (DOI)000294797200006 ()21459446 (PubMedID)2-s2.0-80052273206 (Scopus ID)
Available from: 2011-05-25 Created: 2011-05-25 Last updated: 2018-03-22Bibliographically approved
Flemme, I., Fridlund, B. & Strömberg, A. (2010). Living with life-saving technology: long-term follow-up of recipients with implantable cardioverter defibrillator. Paper presented at Svenska kardiovaskulära vårmötet (Göteborg 2009). Linköping: Linköpings universitet
Open this publication in new window or tab >>Living with life-saving technology: long-term follow-up of recipients with implantable cardioverter defibrillator
2010 (English)Conference paper, Published paper (Refereed)
Abstract [en]

The evidence that treatment of life-threatening arrhythmia (LTA) with an Implantable Cardioverter Defibrillator (ICD) can prolong life is convincing. Living with a lifelong heart disease will gradually influence the everyday life and encompasses some or all aspects of life. In order to influence health outcomes, the impact of the ICD must be considered in a broader context including not only the physical, but also the psychological and social functioning of the individual.The general aim of this thesis was to describe everyday life in recipients living with an ICD in a longterm perspective. The aim in Paper I was to describe changes in the life situation of recipients’ with an ICD over a period of 1 year. The aim in Paper II was to describe quality of life (QOL) and uncertainty in recipients who have an ICD and to predict QOL at long-term follow-up. Fifty-six recipients participated (I) and 35 of these recipients, who had survived at least five years, were further included (II). The Quality of Life Index-Cardiac version (I, II), Mishel Uncertainty in Illness Scale-Community version (I, II), Patient ICD Questionnaire (I) and multiple regression analysis (II) were used. Higher scores indicate higher QOL and uncertainty. The questionnaires were completed before implantation, three and twelve months after implantation (I) and also five years after implantation i.e. long-term follow up (II). At the long-term follow up, the average ICD recipient had lived with an ICD for six years and nine months (6.9 years). The results showed the overall QOL and QOL in the health/functioning domain were unchanged over time. QOL in the socio-economic (p= .002) and psychological/spiritual domains (p= .012) decreased in the first year. From baseline to long-term follow up, the QOL in the family domain (p= .011) and overall uncertainty (p= .002) decreased. Uncertainty related to the information decreased at year 1 in relation to baseline (p= .001).The aim in Paper III was to illuminate the main concern of recipients living with an ICD and how they handle this in their daily life. Sixteen recipients who had lived with an ICD between six to twenty-four months were interviewed. Data was collected and analysed in a simultaneous process according to guidelines for classical grounded theory. In the analysis, a substantive theory was generated explaining the main concern of ICD recipients and how they handle this in their daily life. The core category, labelled “Striving to resume command”, illuminates the main concern of ICD recipients. To manage this main concern, the recipients used the following strategies: Economizing resources, Distracting oneself, Submitting to one’s fate and Re-evaluating life.The aim in Paper IV was to explore relationships between OQL, coping strategies, anxiety, depression and perceived control in recipients living with an ICD and to compare those having received an ICD less or more than one year ago and those with a primary or secondary preventive indication. A cross-sectional, correlational, multicenter design was used, and 147 recipients who had lived with an ICD between six to twenty-four months completed Quality of Life Index-Cardiac version, Jalowiec Coping Scale, Hospital Anxiety and Depression Scale and Control Attitude Scale. The results showed that anxiety, depression and perceived control were predictors of QOL. Anxiety was also a predictor of coping with optimistic coping being the most used coping strategy. There was no relationship between QOL and coping. No differences were found in QOL, coping, anxiety, depression and perceived control between recipients implanted either on a primary or secondary preventive indication or having the device less or more than one year.In this thesis, it was concluded that the ICD recipients strived to resume command over their life (III) and the more control the recipients perceived the more satisfied they were with their QOL (IV) and the more symptoms of anxiety, depression and uncertainty they experienced the less satisfied they were with their QOL (II, IV). Coping strategies were used more frequently by ICD recipient perceiving more anxiety (IV). QOL was fairly good 6,9 years after implantation and ICD recipients felt less uncertain once they had passed the first year of their illness.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2010. p. 61
Series
Linköping University medical dissertations, ISSN 0345-0082 ; 1116
Keywords
Activities of daily living, Arrhythmias, cardiac therapy, Attitude to health, Defibrillators, Implantable psychology, Health status, Life change events, Quality of life, Uncertainty, Tachycardia, ventricular psychology, Tachycardia, ventricular therapy, Ventricular fibrillation therapy
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hh:diva-6125 (URN)978-91-7393-654-5 (ISBN)
Conference
Svenska kardiovaskulära vårmötet (Göteborg 2009)
Available from: 2010-10-14 Created: 2010-10-14 Last updated: 2018-03-23Bibliographically approved
Flemme, I., Hallberg, U., Johansson, I. & Strömberg, A. (2010). Living with uncertainty: main concern for recipients of implantable cardioverter defibrillator - a qualitative study. Paper presented at 10th Annual Spring Meeting of the Working Group on Cardvascular Nursing of the European Society of Cardiology, Geneva, 12-13 Mach 2010. Amsterdam: Elsevier
Open this publication in new window or tab >>Living with uncertainty: main concern for recipients of implantable cardioverter defibrillator - a qualitative study
2010 (English)Conference paper, Published paper (Refereed)
Abstract [en]

Background:

the implantable cardioverter defibrillator is a sophisticated and multifunctional device to treat life-threatening arrhythmias. With increasing numbers of recipients implanted due to rapid technical development of devices and enlarged implantation indications, the consequences for recipients with an implantable cardioverter defibrillator daily life has attracted increased attention during the last decade.

Aim:

to illuminate the main concern of individuals living with an implantable cardioverter defibrillator and how they handle this in their daily life.

Design and method:

the grounded theory method was used. Sixteen Swedish recipients (9 men) who had lived with a defibrillator for 6 to 24 months were interviewed. Data was collected and analysed in a simultaneous process according to guidelines for classic grounded theory. 

Results:

in the analysis, a conceptual model was generated explaining the main concern of recipients with an implantable cardioverter defibrillator and how they handle this in their daily life. The core category, labelled "Living with uncertainty" illuminates the main concern of the recipients. To handle uncertainty the recipients used the following strategies: Restricting one’s activities, Distracting oneself, Accepting one’s fate and Re-evaluating one’s life.

Conclusions:

Recipients with an implantable cardioverter defibrillator were not paralyzed by the uncertainty they experienced. Instead, they handled the uncertainty by using different strategies which may produce a sense of perceived control to initiate a living process that facilitates physical and social activities.

Relevance to clinical practice:

this study suggests that nurses should support recipients with an implantable cardioverter defibrillator to handle uncertainty and contribute by optimizing the recipients sense of perceived control in daily life and thereby personal growth.

Place, publisher, year, edition, pages
Amsterdam: Elsevier, 2010
Series
European Journal of Cardiovascular Nursing, ISSN 1474-5151 ; Vol 9, nr 1 (supplement)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hh:diva-6122 (URN)10.1016/S1474-5151(10)60063-1 (DOI)
Conference
10th Annual Spring Meeting of the Working Group on Cardvascular Nursing of the European Society of Cardiology, Geneva, 12-13 Mach 2010
Available from: 2010-10-14 Created: 2010-10-14 Last updated: 2018-03-23Bibliographically approved
Årestedt, K., Ågren, S. A., Flemme, I., Moser, D. M. & Strömberg, A. S. (2010). Psychometric properties of the Swedish version of the Control Attitudes Scale (CAS) for patients with cardiac disease and their partners. Paper presented at ESC Congress, AUG 28-SEP 01, 2010, Stockholm, SWEDEN. European Heart Journal, 31(Supplement 1), 230-230
Open this publication in new window or tab >>Psychometric properties of the Swedish version of the Control Attitudes Scale (CAS) for patients with cardiac disease and their partners
Show others...
2010 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 31, no Supplement 1, p. 230-230Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Oxford: Oxford University Press, 2010
National Category
Nursing
Identifiers
urn:nbn:se:hh:diva-18895 (URN)10.1093/eurheartj/ehq287 (DOI)000281531901384 ()
Conference
ESC Congress, AUG 28-SEP 01, 2010, Stockholm, SWEDEN
Available from: 2012-06-27 Created: 2012-06-25 Last updated: 2018-03-22Bibliographically approved
Flemme, I., Johansson, I. & Strömberg, A. (2010). Quality of life and coping strategies in recipients with an implantable cardioverter defibrillator. Paper presented at 10th Annual Spring meeting in Cardiovascular Nursing, Geneva, 12-13 March 2010. Amsterdam: Elsevier
Open this publication in new window or tab >>Quality of life and coping strategies in recipients with an implantable cardioverter defibrillator
2010 (English)Conference paper, Published paper (Refereed)
Abstract [en]

Objectives:

To explore relationships between quality of life (QOL), coping strategies, anxiety, depression and perceived control in recipients living with an implantable cardioverter defibrillator (ICD) and compare those having received an ICD less or more than one year ago and those with a primary or secondary preventive indication.

Methods:

A cross-sectional, correlational design was used and 147 individuals (mean age 63 years, 121 men) who had lived with an ICD between 6 to 24 months completed Quality of Life Index-Cardiac version, Jalowiec Coping Scale, Hospital Anxiety and Depression Scale and Control Attitude Scale.

Results: 

A regression analysis showed that anxiety and depression were negatively correlated (ß=.16, p=0.025, ß=.30, p=0.012) respectively and perceived control was positively correlated (ß= .26, p=0.001) with overall QOL in ICD recipient 6-24 months after implant. A second regression analysis showed significant relationships between the dependent variable overall use of coping strategies and the anxiety (R2 adj = 0.213, F (4.132) = 10.186, p=0.001). More anxiety was correlated (β = 3.27, p=0.001) with increased use of coping strategies. Anxiety was quite common up to 2 years after ICD implant. Optimism was found to be the most frequently used coping strategy, but the recipients did not use a multitude of coping strategies. There was no relationship found between QOL and the use of different coping strategies. Time since implantation or the indication for receiving an ICD did not influence QOL, the use of coping strategies, symptoms of anxiety and depression or perceived control.

Conclusions:

Despite being a cost-effective, reliable and efficient implanted device for reducing the incidence of sudden cardiac death, the ICD can be associated with notable consequences in everyday life for the recipient. We suggest that follow-up with education and psychosocial support should be provided more intensively during the first six months after implantation and thereafter be tailored toward those recipients experiencing symptoms of depression and anxiety, a lower perceived control in life and a diminished QOL. By using screening tools to assess perceived control, anxiety and depression during follow up after implantation in the outpatient ICD clinic, recipients perceiving low control and mental strain in their everyday life can be identified and supportive interventions considered in order to increase their QOL. Coping strategies should be further explored in research and clinical practice in order to support ICD recipient to use the appropriate coping strategies.

Place, publisher, year, edition, pages
Amsterdam: Elsevier, 2010
Series
European Journal of Cardiovascular Nursing, ISSN 1474-5151 ; Volume 9, Issue 1, Supplement 1
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hh:diva-6124 (URN)10.1016/S1474-5151(10)60016-3 (DOI)
Conference
10th Annual Spring meeting in Cardiovascular Nursing, Geneva, 12-13 March 2010
Available from: 2010-10-14 Created: 2010-10-14 Last updated: 2018-03-23Bibliographically approved
Flemme, I. (2009). Living with life-saving technology: Long-term follow up of recipients with implantable cardioverter defibrillator. (Doctoral dissertation). Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Living with life-saving technology: Long-term follow up of recipients with implantable cardioverter defibrillator
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The evidence that treatment of life-threatening arrhythmia (LTA) with an Implantable Cardioverter Defibrillator (ICD) can prolong life is convincing. Living with a lifelong heart disease will gradually influence the everyday life and encompasses some or all aspects of life. In order to influence health outcomes, the impact of the ICD must be considered in a broader context including not only the physical, but also the psychological and social functioning of the individual.

The general aim of this thesis was to describe everyday life in recipients living with an ICD in a longterm perspective. The aim in Paper I was to describe changes in the life situation of recipients’ with an ICD over a period of 1 year. The aim in Paper II was to describe quality of life (QOL) and uncertainty in recipients who have an ICD and to predict QOL at long-term follow-up. Fifty-six recipients participated (I) and 35 of these recipients, who had survived at least five years, were further included (II). The Quality of Life Index-Cardiac version (I, II), Mishel Uncertainty in Illness Scale-Community version (I, II), Patient ICD Questionnaire (I) and multiple regression analysis (II) were used. Higher scores indicate higher QOL and uncertainty. The questionnaires were completed before implantation, three and twelve months after implantation (I) and also five years after implantation i.e. long-term follow up (II). At the long-term follow up, the average ICD recipient had lived with an ICD for six years and nine months (6.9 years). The results showed the overall QOL and QOL in the health/functioning domain were unchanged over time. QOL in the socio-economic (p= .002) and psychological/spiritual domains (p= .012) decreased in the first year. From baseline to long-term follow up, the QOL in the family domain (p= .011) and overall uncertainty (p= .002) decreased. Uncertainty related to the information decreased at year 1 in relation to baseline (p= .001).

The aim in Paper III was to illuminate the main concern of recipients living with an ICD and how they handle this in their daily life. Sixteen recipients who had lived with an ICD between six to twenty-four months were interviewed. Data was collected and analysed in a simultaneous process according to guidelines for classical grounded theory. In the analysis, a substantive theory was generated explaining the main concern of ICD recipients and how they handle this in their daily life. The core category, labelled “Striving to resume command”, illuminates the main concern of ICD recipients. To manage this main concern, the recipients used the following strategies: Economizing resources, Distracting oneself, Submitting to one’s fate and Re-evaluating life.

The aim in Paper IV was to explore relationships between OQL, coping strategies, anxiety, depression and perceived control in recipients living with an ICD and to compare those having received an ICD less or more than one year ago and those with a primary or secondary preventive indication. A cross-sectional, correlational, multicenter design was used, and 147 recipients who had lived with an ICD between six to twenty-four months completed Quality of Life Index-Cardiac version, Jalowiec Coping Scale, Hospital Anxiety and Depression Scale and Control Attitude Scale. The results showed that anxiety, depression and perceived control were predictors of QOL. Anxiety was also a predictor of coping with optimistic coping being the most used coping strategy. There was no relationship between QOL and coping. No differences were found in QOL, coping, anxiety, depression and perceived control between recipients implanted either on a primary or secondary preventive indication or having the device less or more than one year.

In this thesis, it was concluded that the ICD recipients strived to resume command over their life (III) and the more control the recipients perceived the more satisfied they were with their QOL (IV) and the more symptoms of anxiety, depression and uncertainty they experienced the less satisfied they were with their QOL (II, IV). Coping strategies were used more frequently by ICD recipient perceiving more anxiety (IV). QOL was fairly good 6,9 years after implantation and ICD recipients felt less uncertain once they had passed the first year of their illness.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2009. p. 61
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1116
Keywords
Anxiety, arrhythmia, defibrillators, depression, grounded theory, perceived control, qualitative, quality of life, uncertainty
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hh:diva-2913 (URN)2082/3315 (Local ID)978-91-7393-654-5 (ISBN)2082/3315 (Archive number)2082/3315 (OAI)
Public defence
2009-05-28, Berzeliussalen, Campus US, Linköpings Universitet, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2009-09-02 Created: 2009-09-02 Last updated: 2018-03-23Bibliographically approved
Flemme, I. (2009). Livssituationen hos patienter med ICD. Paper presented at XI Svenska kardiovaskulära vårmötet, 22 - 24 april, Uppsala, 2009.
Open this publication in new window or tab >>Livssituationen hos patienter med ICD
2009 (Swedish)Conference paper, Published paper (Refereed)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hh:diva-6121 (URN)
Conference
XI Svenska kardiovaskulära vårmötet, 22 - 24 april, Uppsala, 2009
Available from: 2010-10-14 Created: 2010-10-14 Last updated: 2018-03-23Bibliographically approved
Flemme, I., Johansson, I. & Strömberg, A. (2009). Quality of life and coping strategies in recipients with an implantable cardioverter defibrillator.
Open this publication in new window or tab >>Quality of life and coping strategies in recipients with an implantable cardioverter defibrillator
2009 (English)Article in journal (Other academic) Submitted
Abstract [en]

Objectives: To explore relationships between quality of life (QOL), coping strategies, anxiety, depression and perceived control in recipients living with an implantable cardioverter defibrillator (ICD) and compare those having received an ICD less or more than one year ago and those with a primary or secondary preventive indication.

Methods: A cross-sectional, correlational design was used, and 147 individuals (mean age 63 years, 121 men) who had lived with an ICD between 6 to 24 months completed Quality of Life Index-Cardiac version, Jalowiec Coping Scale, Hospital Anxiety and Depression Scale and Control Attitude Scale.

Results: Anxiety, depression and perceived control were predictors of QOL. Anxiety was also a predictor of the use of coping strategies with optimism being the most used coping strategy. No relationship was found between QOL and the use of different coping strategies. No differences were found in QOL, coping, anxiety, depression and perceived control between ICD recipients having the device less or more than one year and treated either on a primary or secondary preventive indication.

Conclusions: Recipients with an ICD did not use a multitude of coping strategies, but anxiety increased the use of coping. Perceived control was the most influential predictor of QOL. Practice implications: Supportive long term follow up interventions should be tailored to the recipients that have problems adapting to the device and perceive poor control in everyday life and a decreased psychological well-being.

Keywords
Anxiety, arrhythmia, defibrillators, depression, perceived control, quality of life
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hh:diva-21448 (URN)
Available from: 2013-02-11 Created: 2013-02-11 Last updated: 2018-03-22Bibliographically approved
Flemme, I., Hallberg, U. & Strömberg, A. (2009). Striving to resume command - main concern for recipients of implantable cardioverter defibrillator.
Open this publication in new window or tab >>Striving to resume command - main concern for recipients of implantable cardioverter defibrillator
2009 (English)Article in journal (Other academic) Submitted
Abstract [en]

Background: Earlier studies have shown that individuals with implantable cardioverter defibrillator (ICD) experience fear, stress, anxiety, and depression in their daily life, but also feelings of gratitude, safety, and belief in the future. Uncertainty and restrictions in physical, psychological and social functioning are common responses to their experiences. Aim: The aim of the study was to illuminate the main concern of individuals living with an ICD and how they handle this in their daily life.

Method: Sixteen Swedish recipients (9 men) who had lived with a defibrillator for 6 to 24 months were interviewed during 2007. Data was collected and analyzed in a simultaneous process according to guidelines for classical grounded theory.

Results: In the analysis, a substantive theory was generated explaining the main concern of ICD recipients and how they handle this in their daily life. The core category, labelled “Striving to resume command” illuminates the main concern of ICD recipients. To manage this main concern, the recipients used the following strategies: Economizing resources, Distracting oneself, Submitting to one’s fate and Re-evaluating life.

Conclusions: Based on empirical data, a substantive theory was generated illuminating the main concern for ICD recipients and strategies they used to manage this in daily life. The theory deepens the understanding of the recipients´ striving to resume command over their lives in an ongoing adjustment process which they have to face. This knowledge has clinical relevance and suggests that nurses should support the ICD recipients in this respect and thereby contribute to optimizing their sense of control in daily life. Future research could focus on the role of family members of ICD recipients and in what way they can support rather than overprotect their closely related.

Keywords
Defibrillators, implantable, heart diseases, nursing, qualitative research, quality of life
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hh:diva-21446 (URN)
Available from: 2013-02-11 Created: 2013-02-11 Last updated: 2018-03-22Bibliographically approved

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