The experiences of patients electrically shocked by an implantable cardioverter defibrillator: Findings from a descriptive qualitative study

BACKGROUND To date, few studies have explored cases of implantable cardioverter defibrillator (ICD) shock delivery with the intent of understanding patients' educational and supportive needs. AIMS AND OBJECTIVES To explore patient experiences as lived before, during and after one or more shocks. DESIGN A descriptive qualitative study carried out between 2016 and 2017. METHODS Semi-structured face-to-face audio-recorded interviews were performed and analysed using a content analysis methodology. RESULTS A total of 50 patients (average age = 68.3 years; largely male = 49; 98%) were interviewed. Four themes emerged: (a) "Feeling surprised vs. alerted by the changes inside me"; (b) "Living an intense, mono-dimensional vs. living a multidimensional storm experience", (c) "Facing the event vs. being supported"; and (d) "Living a drama vs. being used to it". CONCLUSIONS Findings suggest that ICD use can trigger negative physical and emotional effects in patients. Moreover, nurses should recognize patients' educational needs according to the stage of adaptation that each patient is experiencing with the aim of tailoring appropriate supportive interventions. RELEVANCE TO CLINICAL PRACTICE Therefore, it is necessary to consider the psychological needs of patients by integrating these into clinical care at different levels (emergency department, hospital ward, home). Specific structured support aimed at helping patients overcome intense negative experiences is suggested, especially in the first stage of the adaptation process. Nurses should also ensure that appropriate education programmes with adequate follow-up interventions are offered to improve the experience of living with an ICD. In addition, patient-reported outcomes should be routinely collected from patients with an ICD.