左心室辅助装置患者护理重要要素的认知：一项定性元分析
The Perceptions of Important Elements of Caregiving for a Left Ventricular Assist Device Patient: A Qualitative Meta-Synthesis.
作者信息
Magid Molly, Jones Jacqueline, Allen Larry A, McIlvennan Colleen K, Magid Katie, Thompson Jocelyn S, Matlock Daniel D
机构信息
Molly Magid High School Student, Colorado Academy, Denver.Jacqueline Jones, PhD, RN Assistant Professor, College of Nursing, University of Colorado, Aurora.Larry A. Allen, MD, MS Assistant Professor, Advanced Heart Failure Specialist, University of Colorado, Aurora.Colleen K. McIlvennan, DNP, ANP Assistant Professor, Heart Failure Advanced Practice Nurse, School of Medicine, Division of Cardiology, University of Colorado, Aurora.Katie Magid Brown University, Providence, Rhode Island.Jocelyn S. Thompson, MA Professional Research Assistant, Colorado Health Outcomes, School of Medicine, University of Colorado, Aurora.Daniel D. Matlock, MD, MPH Assistant Professor, Internist, School of Medicine, Division of General Internal Medicine, University of Colorado, Aurora.
出版信息
J Cardiovasc Nurs. 2016 May-Jun;31(3):215-25. doi: 10.1097/JCN.0000000000000242.
BACKGROUND
The use of a left ventricular assist device (LVAD) is becoming increasingly common in patients with end-stage heart failure. Many LVAD programs require patients to have a caregiver before receiving a device. There are few studies exploring the experience, burden, and impacts on caregivers of patients with LVADs.
OBJECTIVES
The aim of this study was to synthesize the qualitative literature regarding caregiver's perceptions about caring for an adult LVAD patient.
METHODS
We searched MEDLINE, CINAHL, PsychInfo, and Web of Science to find English articles on the topic of LVAD caregiver's perceptions. The articles were then synthesized using a formal process of qualitative meta-synthesis.
RESULTS
Eight articles met criteria for inclusion. The meta-synthesis across the articles resulted in 8 themes categorized under 3 domains. Many of the articles suggested a longitudinal process of caregiving with perceptions largely dependent upon the time of interview in relation to the LVAD. The first domain of caregiving is the "early" stage, covering the life before the LVAD through the procedure. This phase is characterized by the pre-LVAD "emotional rollercoaster," the decision seen as "no option," and the thought of "leave it [the LVAD] at the hospital." The second domain is the "middle" stage, covering the time frame after discharge from the hospital. This phase is characterized by fragility of the patient, recognition of a need to adapt, and a transformed life. The final domain is "late LVAD" and describes how late in the LVAD process the LVAD indication (bridge to transplant or destination therapy) brings in to focus what is important to caregivers.
CONCLUSIONS
Existing literature indicates that the LVAD caregiver experience is intense as well as burdensome and entails the need to adapt to a new life. Given the burdens caregivers experience, clinicians and future research should explore strategies to support these important individuals.
背景
左心室辅助装置（LVAD）在终末期心力衰竭患者中的应用越来越普遍。许多LVAD项目要求患者在接受装置前要有一名照顾者。很少有研究探讨LVAD患者照顾者的经历、负担及其影响。
目的
本研究的目的是综合关于照顾者对成年LVAD患者护理看法的定性文献。
方法
我们检索了MEDLINE、CINAHL、PsychInfo和科学网，以查找关于LVAD照顾者看法主题的英文文章。然后使用正式的定性元综合过程对文章进行综合。
结果
八篇文章符合纳入标准。文章间的元综合产生了8个主题，分为3个领域。许多文章表明，护理是一个纵向过程，其看法很大程度上取决于与LVAD相关的访谈时间。护理的第一个领域是“早期”阶段，涵盖LVAD植入前到手术过程的生活。这个阶段的特点是LVAD植入前的“情绪过山车”，决定被视为“别无选择”，以及“把它（LVAD）留在医院”的想法。第二个领域是“中期”阶段，涵盖出院后的时间段。这个阶段的特点是患者的脆弱性、认识到需要适应以及生活的改变。最后一个领域是“LVAD后期”，描述了在LVAD过程后期，LVAD的适应证（过渡到移植或目标治疗）如何使照顾者关注的重点变得清晰。
结论
现有文献表明，LVAD照顾者的经历既强烈又沉重，需要适应新的生活。鉴于照顾者所经历的负担，临床医生和未来的研究应探索支持这些重要个体的策略。
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