Health-related quality of life in patients with pacemakers. A descriptive and experimental study

Abstract

The general aim of this thesis was to describe and evaluate the health-relatedquality of life (HRQoL) of patients with pacemakers, as well as to determine theeffects of a nurse-led intervention regarding health-related quality of life in theform of a self-care program for these patients. Descriptive designs were used todescribe (I) quality of life (n=182) as well as (II) HRQoL (n=697) of pacemakerpatients based on a nursing perspective. In order to describe the life situation ofthese patients from a deeper perspective (III) and examine the experiences ofdaily living with a pacemaker, patients (n=13) were interviewed and data wereanalyzed according to the grounded theory method, using constant comparativeanalysis. Finally (IV), 212 patients from three hospitals were allocated, using anexperimental, multi-center, randomized design, to either a control (n=115) or anexperimental group (n=97) to evaluate the effects of a nurse-led intervention, a10-month self-care program, on the HRQoL of patients with pacemakers.The total QoL for patients with pacemakers was acceptable. Through applicationof Orem s self-care theory, information, support and education can be providedin such a way that nursing care affects the entire QoL of patients withpacemakers. Measures should be taken on behalf women, those living alone, theelderly, blue-collar workers and retired persons, all of whom have a lower QoL(I, II). Experiences of daily living with a pacemaker generally indicate thatpatients with pacemakers can attain emotional stability and social participationunder the condition that there is understanding, empathetic treatment and insightconcerning the patient s new situation (III). There were no significantdifferences in HRQoL when comparisons were made between the experimentaland the control group. Two main findings for patients in the self-care program(experimental group) were: a significantly better HRQoL in terms ofexperiencing the symptoms that were the reason for pacemaker implantation ashaving decreased or disappeared, and a higher level of perceived exertion in a 11/2-minute stair test compared with patients who had standard checkups (controlgroup) (IV).In order to increase the HRQoL of patients with pacemakers it is important thathealth care professionals support the patient in a kind and professional mannerby providing clear, relevant information, and by planning a self-care programbased on a nursing assessment of the patient s needs using a comprehensiveapproach.