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-related quality of life (HRQoL) of patients with pacemakers, as well as to determine the effects of a nurse-led intervention regarding health-related quality of life in the form of a self-care program for these patients. Descriptive designs were used to describe (I) quality of life (n=182) as well as (II) HRQoL (n=697) of pacemaker patients based on a nursing perspective. In order to describe the life situation of these patients from a deeper perspective (III) and examine the experiences of daily living with a pacemaker, patients (n=13) were interviewed and data were analyzed according to the grounded theory method, using constant comparative analysis. Finally (IV), 212 patients from three hospitals were allocated, using an experimental, multi-center, randomized design, to either a control (n=115) or an experimental group (n=97) to evaluate the effects of a nurse-led intervention, a 10-month self-care program, on the HRQoL of patients with pacemakers. The total QoL for patients with pacemakers was acceptable. Through application of Orem’s self-care theory, information, support and education can be provided in such a way that nursing care affects the entire QoL of patients with pacemakers. Measures should be taken on behalf women, those living alone, the elderly, blue-collar workers and retired persons, all of whom have a lower QoL (I, II). Experiences of daily living with a pacemaker generally indicate that patients with pacemakers can attain emotional stability and social participation under the condition that there is understanding, empathetic treatment and insight concerning the patient’s new situation (III). There were no significant differences in HRQoL when comparisons were made between the experimental and the control group. Two main findings for patients in the self-care program (experimental group) were: a significantly better HRQoL in terms of experiencing the symptoms that were the reason for pacemaker implantation as having decreased or disappeared, and a higher level of perceived exertion in a 1 1/2-minute stair test compared with patients who had standard checkups (control group) (IV). In order to increase the HRQoL of patients with pacemakers it is important that health care professionals support the patient in a kind and professional manner by providing clear, relevant information, and by planning a self-care program based on a nursing assessment of the patient’s needs using a comprehensive approach.