College of Nursing, Texas Woman's University, Denton, TX, USA.
J Cardiovasc Nurs. 2010 Sep-Oct;25(5):398-404. doi: 10.1097/JCN.0b013e3181d817b0.
Adolescents with implantable cardioverter defibrillators (ICDs) have unique psychosocial needs that are not currently addressed in the literature. To prioritize these issues into a concise cardiovascular nursing research agenda, the objective of this study was to identify current psychosocial issues in this population by obtaining expert consensus from experienced pediatric dysrhythmia clinicians.
A 3-round electronic Delphi study was conducted. A multidisciplinary purposive sample was drawn from 2 international organizations of pediatric and young adult cardiovascular caregivers who specialize in rhythm disturbances in this patient population. Round 1 included an open-ended question in which respondents were asked to provide as many psychosocial issues as desired, but at least 5. Round 2 included the 10 most frequent issues, which participants were asked to rank (1 = most important, 10 = least important). Round 3 included the collective ranking of the respondents using mean values; respondents were asked to indicate agreement/disagreement with the final ranking. If they disagreed, they were asked to re-rank the items.
The top 10 psychosocial issues identified by the panel included, in order of importance: fear of being shocked, sports participation/activity restrictions, feeling different from peers/peer acceptance, depression, adjustment problems, fear of death, medication noncompliance, acting out, body change/weight gain, and issues related to planning for adulthood. There was 90% agreement among the expert panel members. Ascertaining the opinions and consensus of pediatric cardiovascular dysrhythmia experts has led to the development of a concise research agenda for the psychosocial issues faced by children and adolescents with ICDs. The identification of these issues will allow nurse researchers to incorporate these findings into future studies in which interventions aimed at promoting positive adjustment to the ICD in the child and adolescent age group can be tested.
植入式心脏复律除颤器（ICD）的青少年有独特的社会心理需求，目前文献中尚未涉及。为了将这些问题纳入一个简洁的心血管护理研究议程，本研究的目的是通过从经验丰富的儿科心律失常临床医生那里获得专家共识，确定该人群目前的社会心理问题。
进行了三轮电子德尔菲研究。从 2 个国际儿科和青年心血管护理组织中抽取了多学科的目的抽样，这些组织专门研究该患者群体的节律紊乱。第 1 轮包括一个开放式问题，要求受访者尽可能多地提供社会心理问题，但至少 5 个。第 2 轮包括 10 个最常见的问题，参与者被要求对其进行排名（1=最重要，10=最不重要）。第 3 轮包括使用平均值对受访者的集体排名；要求受访者表示对最终排名的同意/不同意。如果不同意，则要求他们重新对项目进行排名。
专家小组确定的前 10 个社会心理问题按重要性顺序排列包括：害怕被电击、运动参与/活动受限、与同龄人不同/被同龄人接受、抑郁、适应问题、对死亡的恐惧、药物不依从、行为问题、身体变化/体重增加以及与成年规划相关的问题。专家组 90%的成员达成一致意见。确定儿科心血管心律失常专家的意见和共识，制定了一个简洁的研究议程，以解决儿童和青少年 ICD 患者面临的社会心理问题。这些问题的确定将使护士研究人员能够将这些发现纳入未来的研究中，从而可以测试旨在促进儿童和青少年群体对 ICD 进行积极调整的干预措施。
