The psychological and emotional impact of living with an automatic internal cardioverter defibrillator (AICD): how can nurses help?

The introduction of the Automatic Internal Cardioverter Defibrillator (AICD) has greatly improved the mortality rates associated with sudden cardiac events (Moss et al 1996, McCarthy 1997, Trappe et al 1997). Little is known about the consequences of living with this device for patients and their families. Biomedical influences have resulted in the devices's success being measured on physical adaptation, with data on suitability, reliability, and efficiency of AICDs as a therapeutic measure. What seems to be of equal priority now is to obtain insights as to the emotional and psychological consequences of such treatment, and the effects these may have on outcomes and utilization of health-care resources. AICD patients have described many powerful emotions arising from receiving this device, which are often heightened at discharge, yet little is known of the reasons for this (James 1997a). It is essential that individuals' and their families' perceptions of their experiences are understood so that clinical staff can not only meet the technological and safety needs of this group, but also assist them to adjust to living with an AICD. Families of AICD patients report significant emotions arising from their support of AICD patients, and describe their own needs and problems. Nevertheless, the influence of, and the effects on the family are often underestimated within AICD patient care. A shift away from a purely individualistic approach towards a more family-centred approach is suggested, arguably enabling the role of family members to be recognized, supported and developed. Qualitative research in this area is needed to inform clinical nursing practice and assist in development of clinical expertise to address the important issues for patients and families. This should enable them to return to their everyday lives with appropriate support. Education of healthcare professionals in a wide variety of clinical areas is needed to ensure a sound body of knowledge, as a basis for development of a more holistic approach to care which encompasses and recognizes the feelings and emotions evoked from receiving this device.