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  • 1.
    Bolse, Kärstin
    et al.
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Flemme, Inger
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Ivarsson, Anita
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Jinhage, Britt-Marie
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Carroll, Diane
    Massachusetts General Hospital, Boston.
    Edvardsson, Nils
    Sahlgrenska University Hospital, Gothenburg.
    Hamilton, Glenys A.
    Massachusetts General Hospital, Boston.
    Fridlund, Bengt
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Life situation related to the ICD implantation: self-reported uncertainty and satisfaction in Swedish and US samples2002In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 1, no 4, 243-251 p.Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to describe changes in the life situation related to the ICD implantation of Swedish and US samples with regard to uncertainty and satisfaction. The life situation was measured by reference to the uncertainty caused by the condition and satisfaction with the life situation. Inferential statistics were used to analyse changes within and between the Swedish and US samples. Uncertainty showed a statistically significant difference between the Swedish and US samples before as well as after the ICD implantation. A higher level of uncertainty was indicated for the US sample prior to the ICD implantation and for the Swedish sample following the implantation. In the Swedish sample, satisfaction with life showed a statistically significant difference within the socio-economic domain, indicating a higher degree of satisfaction 3 months after implantation. Satisfaction within the domains of health and functioning, socio-economics and psychological-spiritual showed a statistically significant difference between the Swedish and US samples both before and after ICD implantation, indicating a higher degree of satisfaction in the US sample. The previous study shows that the ICD-patient's life situation is changed after the implantation and that it is necessary to provide the patient with information and education based on their own preconditions. The fact that US sample was investigated at a later stage after ICD implantation than the Swedish sample may have influenced the results of the study.

  • 2.
    Flemme, Inger
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Health-related quality of life in recipients with an implantable cardioverter defibrillator due to life-threatening arrhythmias: a 5 year follow-up2004Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    The general aim of this thesis was to describe self-reported health-related quality of life (HRQoL) in recipients with an implantable cardioverter defibrillator (ICD) due to life-threatening arrhythmias over a S-year period. The design was prospective and longitudinal. Fifty-six patients participated in Paper I, and 35 of these patients, who had survived at least five years, were included in Paper II. All patients had received their ICD as a form of secondary prevention. The Quality of Life Index-Cardiac version (QLI-C), Mishel Uncertainty in Illness Scale-Community version (MUIS-C), and multiple regression analysis were used. Higher scores indicate higher HRQoL and uncertainty. The questionnaires were completed on four occasions: before implantation, at three months and at 1 year and 5 years after implantation. ICD recipients were also asked how many shocks they had perceived. At the S-year data collection, the  average ICD recipient had lived with an ICD for 6 years and 9 months. In general, HRQoL was lower at year 1 than at baseline (p : 0.033). A decrease in the socioeconomic domain was observed at year 1 (p : 0.006) but improved again at year 5 (p : 0.027) although it remained below the baseline value, ICD recipients' satisfaction with the family domain decreased from the time of the ICD implantation (p < 0.001) and from year I (p : 0.039) to year 5 after implantation. Uncertainty related to information had  decreased at year 1 in relation to baseline (p < 0.001). A decrease in overall uncertainty was observed at year 5 in relation to year 1 (p : 0.009) as well as at year 5 in relation to baseline (p : 0.009). The longer the ICD recipient had lived with the device, the greatil the risk of receiving a shock. However, ICD recipients who  received shocks reported being less troubled by them over time. Uncertainty was identified as a predictor of low HRQoL. The recipients reported a higher level of HRQoL at year 5 than at year 1. HRQoL was reasonably good 5 years after implantation, and the ICD recipients felt more secure and perceived their ICD as a lifesaver.

  • 3.
    Flemme, Inger
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Living with life-saving technology: Long-term follow up of recipients with implantable cardioverter defibrillator2009Doctoral 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.

  • 4.
    Flemme, Inger
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Livssituationen hos patienter med ICD2009Conference paper (Refereed)
  • 5.
    Flemme, Inger
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Trygghet/säkerhet och livskvalité hos individer med ICD (implanterad hjärtdefibrillator) fem år efter implantationen2007In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 84, no 3, 230-238 p.Article in journal (Refereed)
    Abstract [sv]

    Hjärt-kärlsjukdomar (Holmberg, M, Holmberg, S coh Herlitz 1999) är den främsta orsaken till död i västvärlden. I Europa orsakas 40 % av alla dödsfall av hjärt-kärlsjukdomar. En hjärt- kärlsjukdom kan leda till livshotande rytmrubbningar (arytmier) som i sin tur kan leda till plötslig hjärtdöd. Implanterad hjärtdefibrillator (implantable cardioverter defibrillator, ICD) (Socialstyrelsen 2004) har utvecklats för att behandla livshotande arytmier. Att leva med en ICD (Luderitz et al. 1994) kan upplevas på olika sätt. En del individer lever ett normalt liv, ICD besvärar dem inte och de ser den som en livräddare. Andra förändras i sin personlighet efter implantationen (Charmaz 1987, Sauve 1995) och ICD utgör ett hinder för ett normalt liv. En individs livskvalité (Eckert och Jones 2002) påverkas inte bara av sjukdomen utan också av anpassningen till en förändrad livssituation som ett resultat av ICD. Studiernas syfte var att beskriva otrygghet/osäkerhet och livskvalité hos individer som har levt med ICD i minst fem år. Trettiofem ICD-bärare från sydvästra Sverige studerades under en 5-årsperiod med avseende på otrygghet/osäkerhet och livskvalité. Resultaten visar att otryggheten/osäkerheten var som högst ett år efter implantationen. Den totala livskvaliten och livskvaliten inom det socioekonomiska livsområdet var lägst ett år efter implantationen för att därefter åter öka fram till år fem efter implantationen. Livskvaliten inom familjelivet skattades högst från början, i förhållande till de andra livsområdena, men minskade sedan åter. Den skattades efter fem år fortfarande högt. Slutsatsen av studien är att ICD-bärare efter 5 år hade en rimligt god livskvalité med undantag från det första året. De kände sig tryggare/mindre osäkra med tiden och upplevde ICD som en livräddare

  • 6.
    Flemme, Inger
    et al.
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Bolse, Kärstin
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Ivarsson, Anita
    Sahlgrenska University Hospital, Gothenburg.
    Jinhage, Britt-Marie
    Sahlgrenska University Hospital, Gothenburg.
    Sandstedt, Bengt
    Sahlgrenska University Hospital, Gothenburg.
    Edvardsson, Nils
    Associate Professor, Sahlgrenska University Hospital, Gothenburg.
    Fridlund, Bengt
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Life situation of patients with an implantable cardioverter defibrillator: a descriptive longitudinal study2001In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 10, no 4, 563-572 p.Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe changes in the life situation of patients with an implantable cardioverter defibrillator over a period of 1 year. A sample of 56 consecutive patients took part in the study.

    Life situation was measured through uncertainty in illness, satisfaction, and fear of the life situation. Descriptive statistics were used to present results, and analytical statistics were used to map out changes over time.

    Overall uncertainty showed a decrease over time. A statistically significant difference was found within the domain uncertainty related to information (P < 0.001).

    Satisfaction increased within the domains health-functioning, socio-economic, psychological–spiritual, and family.

    The ability to act within the domain health-functioning showed a statistical significance (P < 0.05).

    The domain life changes within fear in the life situation decreased and showed a statistical significance (P < 0.05).

    The overall life situation showed increased satisfaction as well as lower uncertainty and fear in the life situation.

    The research indicates that patients need more information about changes in the life situation after the implantable cardioverter defibrillator-implantation. The study encourages more humanistic, holistic research about patients’ life situations as well as more education in teaching skills for health care personnel.

  • 7.
    Flemme, Inger
    et al.
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Edvardsson, Nils
    Sahlgrenska universitetssjukhuset, Göteborg.
    Dalman, Margareta
    Sahlgrenska universitetssjukhuset, Göteborg.
    Jinhage, Britt-Marie
    Sahlgrenska universitetssjukhuset, Göteborg.
    Hinic, Hansi
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Fridlund, Bengt
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Quality of life related to shocks in ICD-recipients: a 5-year follow-up2006In: 6th Annual Spring Meeting of the Working Group on Cardiovascular Nursing of the European Society of Cardiology and the Spring Meeting of the Norwegian National Society of Cardiovascular Nurses Bergen, Norway 5–6 May 2006, London: Sage Publications, 2006, S20-S20 p.Conference paper (Refereed)
    Abstract [en]

    Purpose: The purpose of this study was to describe QoL in relation to shocks and uncertainty in ICD-recipients and to identify predictors of QoL over a 5-year period. Methods: The design was prospective and longitudinal. Thirty-five patients who had lived with the ICD for at least five years had taken part in the study. All recipients had received their ICD as a form of secondary prevention. The questionnaires Mishel Uncertainty in Illness Scale – community version (MUIS-C), Quality of Life Index – cardiac version (QLI-CV) were completed on three occasions: before implantation, at year 1 and at year 5 after implantation. Self-reported number of shocks between the implantation and year 1 and between year 1 and year 5 were described. Data were analyzed by descriptive as well as analytical statistics. Results: In general, QoL was lower at year 1 than before implantation (p = 0.033). A decrease in the socio-economic domain was observed at year 1 (p = 0.006) but improved again at year 5 (p = 0.027) although it remained below the value before implantation. ICD recipient’s satisfaction with the family domain decreased from the time before ICD implantation (p = < 0.001) and from year 1 (p = 0.039) to year 5 after implantation. A decrease in overall uncertainty was observed at year 5 in relation to year 1 (p = 0.009). The longer the ICD recipient had lived with the device, the greater the risk of receiving a shock. However, ICD recipients who received shocks reported being less troubled by them over time. Uncertainty was identified as a predictor of low QoL. Conclusion: The recipients reported a higher level of QoL at year 5 than at year 1. QoL was reasonably good 5 years after implantation and the ICD recipient felt more secure and perceived their ICD as a lifesaver.

  • 8.
    Flemme, Inger
    et al.
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Edvardsson, Nils
    Sahlgrenska universitetssjukhuset, Göteborg.
    Hinic, Hansi
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Dalman, Margareta
    Sahlgrenska universitetssjukhuset, Göteborg.
    Jinhage, Britt-Marie
    Sahlgrenska universitetssjukhuset, Göteborg.
    Fridlund, Bengt
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Quality of profile 1 and 5 years after ICD implantation2004Conference paper (Refereed)
    Abstract [en]

    Aim: Treatment with implantable cardioverter defibrillators (ICDs) increases survival in patients suffering from ventricular tachyarrhythmias. The physiologic effects of having an ICD implanted are well-known but there is still limited knowledge about quality of life (QoL), especially in a long-term perspective. Therefore, the aim of this prospective, follow-up study was to describe and compare uncertainty and QoL at year 1 and year 5 after implantation in patients living with an ICD.

    Methods: The Mishel Uncertainty in Illness Scale-community version (MUIS-C) and Quality of Life Index-cardiac version (QLI) was used for 35 patients, living with an ICD in average 6 years 9 months. Higher scores indicate higher uncertainty and QoL.

    Results: An improvement in uncertainty was found at year 5 compared to year 1 (p=0.009), and at year 5 compared to baseline (p = 0.009). Overall QoL decreased at year 1 compared to baseline (p = 0.033). QoL in the socioeconomic domain decreased at year 1 compared to baseline (p = 0.006), and increased at year 5 compared to year 1 (p=0.027). QoL in the family domain decreased at year 5 compared to year 1 (p=0.039), and at year 5 compared to baseline (p=<0.001).

    Conclusion: Patients with ICD feel better at year 5 than at year 1. The QoL is reasonable good 5 years after implant once they have passed the first years and adapted to lifestyle changes, and patients are more certain and perceive the ICD as a parachute of life. 

  • 9.
    Flemme, Inger
    et al.
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Edvardsson, Nils
    Division of Cardiology, Sahlgrenska University Hospital.
    Hinic, Hansi
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Jinhage, Britt-Marie
    Division of Cardiology, Sahlgrenska University Hospital.
    Dalman, Margareta
    Division of Cardiology, Sahlgrenska University Hospital.
    Fridlund, Bengt
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Long-term quality of life and uncertainty in patients living with an implantable cardioverter defibrillator2005In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 34, no 6, 386-392 p.Article in journal (Refereed)
    Abstract [en]

    Purpose: This study describes the quality of life (QOL) and uncertainty in patients who have an implantable cardioverter defibrillator (ICD) and predicts QOL at long-term follow-up.

    Methods: Long-term follow-up was defined as 6.9 years ± 1 year (range 4.11–8.7 years). QOL was measured with the Quality of Life Index, and uncertainty was measured with the Mishel Uncertainty in Illness Scale.

    Results: The overall QOL and health/functioning were unchanged over time. QOL in the socioeconomic (P = .002) and psychologic/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 uncertainty (P = .002) decreased. Uncertainty was a predictor of low QOL.

    Conclusion: QOL was reasonably good 6.9 years post-ICD implantation. Patients felt less uncertain once they had passed the first year of their illness.

  • 10.
    Flemme, Inger
    et al.
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Fridlund, Bengt
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Strömberg, Anna
    Hälsouniversitetet, Linköping.
    Living with life-saving technology: long-term follow-up of recipients with implantable cardioverter defibrillator2010Conference 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.

  • 11.
    Flemme, Inger
    et al.
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Hallberg, Ulrika
    Nordiska hälsohögskolan, Göteborg.
    Johansson, Ingela
    Hälsouniversitetet, Linköping.
    Strömberg, Anna
    Hälsouniversitetet, Linköping.
    Living with uncertainty: main concern for recipients of implantable cardioverter defibrillator - a qualitative study2010Conference 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.

  • 12.
    Flemme, Inger
    et al.
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI), Group for Research on health promotion and disease prevention.
    Hallberg, Ulrika
    Nordiska hälsohögskolan, Göteborg.
    Johansson, Ingela
    Hälsouniversitetet, Linköping.
    Strömberg, Anna
    Hälsouniversitetet, Linköping.
    Uncertainty is a major concern for patients with implantable cardioverter defibrillators2011In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 40, no 5, 420-428 p.Article in journal (Refereed)
    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.

  • 13.
    Flemme, Inger
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad, Linköping, Sverige.
    Hallberg, Ulrika
    Nordiska hälsohögskolan, Göteborg, Sverige.
    Strömberg, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad, Linköping, Sverige.
    Striving to resume command - main concern for recipients of implantable cardioverter defibrillator2009Article in journal (Other academic)
    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.

  • 14.
    Flemme, Inger
    et al.
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Hallberg, Ulrika
    Nordiska hälsohögskolan, Göteborg.
    Strömberg, Anna
    Hälsouniversitetet, Linköping.
    Striving to resume command of one’s life: Voices from individuals living with an ICD2008Conference paper (Refereed)
    Abstract [en]

    The aim of this study was to gain a deeper understanding for the main concern of indivi­duals living with an implantable cardioverter defibrillator (ICD) and what they did to hand­le it. The study group consisted of 16 patients, who had experienced a cardiac arrest or life-threatening arrhythmias, with a mean age of 56 years. In-depth interviews, con­duc­ted 6-24 months after ICD implant, were analysed using the grounded theory method. Four emergent categories were labelled economizing resources, distracting oneself, sub­mitting to one’s fate and re­valuing life. The core category, striving to resume command of one’s life, describes the uncertain process of living with discomfort of not knowing. The participants economized with their limited resources by restricting and planning every day and distracted themselves by divert attention away from the problems at hand and en­gaged physically or mentally in something else. They felt omitted when they could not in­fluence their situation and what happened to them. They had no or little control over the disease and the device and must accept physical and social changes. As time had passed, they were grateful for having survived, felt secure and accepted the ICD treatment. How­ever, a subgroup that had experienced complications as ICD shocks had hard to accept the changed life situation.

  • 15.
    Flemme, Inger
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Hinic, Hansi
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Dalman, Margareta
    Kardiologkliniken, Sahlgrenska Universitetssjukhuset, Göteborg, Sverige.
    Jinhage, Britt-Marie
    Kardiologkliniken, Sahlgrenska Universitetssjukhuset, Göteborg, Sverige.
    Fridlund, Bengt
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Edvardsson, Nils
    Kardiologkliniken, Sahlgrenska Universitetssjukhuset, Göteborg, Sverige.
    Livskvalitet och upplevda chocker under ICD-behandling: en 5-års uppföljning2004Conference paper (Refereed)
    Abstract [sv]

    ICD–behandling ökar överlevnaden hos patienter (pat), som har överlevt en malign ventrikulär tachyarytmi. Pats livskvalitet (QoL) har angivits variera betydande och långtidseffekterna är ännu mindre väl kända. Vi följde ett antal konsekutiva pat under minst 5 år med avseende på livskvaliteten.

    Metod.   Pat undersöktes med MUIS-C (Mishel Uncertainty in Illness Scale – community version) och QLI-CV (Quality of Life Index – cardiac version) och multipel regressionsanalys användes hos 35 patienter. Formulären fylldes i vid tre tillfällen: före implantationen, efter 1 och 5 år. Pats egen uppfattning om antalet upplevda chocker oavsett anledning noterades.

    Patienter. Ur en grupp pat, som tidigare undersöktes efter 1 år, hade 39 pat överlevt med sin ICD i minst 5 år. Av dessa avböjde tre deltagande i uppföljningen utan orsak och en pga cancer. Alla pat hade fått sin ICD på indikationen sekundär prevention.  

    Resultat.  Under det första året rapporterade 13 pat totalt 79 chocker och 22 pat ingen chock. Tio pat hade ingen chock vare sig efter 1 eller 5 år, och deras QoL var likvärdig med dem som hade haft ≤5 chocker. Tre pat rapporterade ≥6 chocker och hade sänkt QoL. Mellan år 1 och 5 rapporterade 20 pat 94 shocker och 15 pat ingen shock. Det var ingen skillnad mellan pat med eller utan chocker i deras QoL år 5 vs. år 1. Pat med chocker blev mindre besvärade med tiden.

    QoL var generellt sänkt år 1 vs baseline. En försämring i den socio-ekonomiska domänen sågs år 1 men var förbättrad år 5. En försämring i familjedomänen var oförändrad vid 1 och 5 år vs. baseline. En förbättring av otrygghet noterades vid 5 år vs år 1.

    Konklusioner. Pat med ICD mådde bättre år 5 än år 1 efter implantationen.  Livskvaliteten var rimligt god 5 år efter implantationen och pat kände sig mer trygga och upplevde sin ICD som en livräddare. Pat med många chocker under det första året mådde sämre än övriga. Under resten av observationsperioden var chocktätheten lägre, möjligen delvis pga farmakologisk behandling, och pat upplevde mindre besvär av chockerna. 

  • 16.
    Flemme, Inger
    et al.
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Johansson, Ingela
    Hälsouniversitetet, Linköpings universitet, Division of Nursing Science, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Department of Cardiology UHL, County Council of Östergötland, Linköping, Sweden and Molde University College, Faculty of Health Sciences, Molde, Norway.
    Strömberg, Anna
    Hälsouniversitetet, Linköpings universitet, Division of Nursing Science, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University and Department of Cardiology UHL, County Council of Östergötland, Linköping, Sweden.
    Living with life-saving technology: coping strategies in implantable cardioverter defibrillators recipients2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 3-4, 311-321 p.Article in journal (Refereed)
    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.

  • 17.
    Flemme, Inger
    et al.
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Johansson, Ingela
    Hälsouniversitetet, Linköping.
    Strömberg, Anna
    Hälsouniversitetet, Linköping.
    Quality of life and coping strategies in recipients with an implantable cardioverter defibrillator2010Conference 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.

  • 18.
    Flemme, Inger
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad, Linköping, Sverige.
    Johansson, Ingela
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi, Linköping, Sverige.
    Strömberg, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad, Linköping, Sverige.
    Quality of life and coping strategies in recipients with an implantable cardioverter defibrillator2009Article in journal (Other academic)
    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.

  • 19.
    Fridlund, Bengt
    et al.
    Halmstad University, School of Social and Health Sciences (HOS).
    Lindgren, Eva-Carin
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Ivarsson, A.
    Sahlgrenska universitetssjukhuset, Göteborg.
    Jinhage, B.-M.
    Sahlgrenska universitetssjukhuset, Göteborg.
    Bolse, Kärstin
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Flemme, Inger
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Sandstedt, B.
    Sahlgrenska universitetssjukhuset, Göteborg.
    Mårtensson, J.
    Göteborgs Universitet.
    Patients with implantable cardioverter-defibrillators and their conceptions of the life situation: a qualitative analysis2000In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 9, no 1, 37-45 p.Article in journal (Refereed)
    Abstract [en]

    The implantable cardioverter-defibrillator (ICD) is today widely used for the treatment of sudden cardiac near-death episodes as a result of malignant ventricular dysrhythmia.After examining the literature, only four descriptive studies, all carried out in the USA, with a qualitative analysis based on ICD-patients' own perspectives on their life situation have been found.The aim of this study was to describe how patients living with an ICD-device in south-western Sweden conceive their life situation.As the focus was on patients' conceptions seen from a holistic perspective, an analysis inspired by phenomenography was employed on a strategic sample of 15 ICD-patients.Six categories emerged: a feeling of safety, a feeling of gratitude, a feeling of being, having a network, having a belief in the future, and gaining awareness.Although the findings cannot be generalized because of the descriptive research design, they illuminate the beneficial as well as intrusive effects of such a device, and emphasize the need for support groups for patients and families as well as further education for personnel in hospital and primary health care.

  • 20.
    Årestedt, K.
    et al.
    Linnéuniversitetet, Sweden.
    Ågren, S. A. Susanna
    Linköping University, Dept Med & Hlth Sci, Linköping, Sweden .
    Flemme, Inger
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Moser, D. M. Bedbra
    Univ Kentucky, Coll Nursing, Lexington, KY 40506, USA.
    Strömberg, A. S. Anna
    Linköping Univ, Dept Med & Hlth Sci, Linköping, Sweden .
    Psychometric properties of the Swedish version of the Control Attitudes Scale (CAS) for patients with cardiac disease and their partners2010In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 31, no Supplement 1, 230-230 p.Article in journal (Other academic)
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