James J E
Faculty of Health and Social Care, University of the West of England, Stapleton, Bristol, UK.
Intensive Crit Care Nurs. 1997 Dec;13(6):316-23. doi: 10.1016/s0964-3397(97)81048-8.
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.
植入式自动心脏复律除颤器（AICD）的引入显著降低了与心脏性猝死相关的死亡率（莫斯等人，1996年；麦卡锡，1997年；特拉佩等人，1997年）。对于患者及其家属而言，使用该设备的后果却鲜为人知。生物医学方面的影响使得该设备的成功与否主要依据身体适应性来衡量，关于AICD作为一种治疗手段的适用性、可靠性和有效性的数据也有所体现。目前同样重要的是，要深入了解这种治疗在情感和心理方面的后果，以及这些后果对治疗结果和医疗资源利用的影响。AICD患者描述了接受该设备后产生的许多强烈情绪，这些情绪在出院时往往会加剧，但其中缘由却知之甚少（詹姆斯，1997年a）。了解个人及其家庭对自身经历的看法至关重要，这样临床工作人员不仅能够满足这一群体的技术和安全需求，还能帮助他们适应携带AICD的生活。AICD患者的家属表示，在支持患者的过程中他们也产生了强烈的情绪，并描述了自身的需求和问题。然而，在AICD患者护理中，家属的影响以及对家庭的作用往往被低估。建议从单纯的个人主义方法转向以家庭为中心的方法，这样可以使家庭成员的作用得到认可、支持和发展。需要在这一领域开展定性研究，为临床护理实践提供参考，并有助于培养临床专业知识，以解决患者及其家庭面临的重要问题。这应能使他们在适当的支持下回归日常生活。需要对广泛临床领域的医护人员进行教育，以确保有扎实的知识基础，从而形成一种更全面的护理方法，这种方法应涵盖并认识到接受该设备所引发的感受和情绪。
