Abstract
Introduction
Bedside nurses in the intensive care units are exposed to multiple challenges in their regular practice and recently have taken in ventricular assist device care in Lebanon since its introduction as a fairly new practice.
Objectives
To explore the experiences of nursing staff who work in Lebanese hospitals with Left Ventricular Assist Devices (LVAD).
Methods
This study employed a qualitative phenomenological research design, where semi-structured interviews were carried out among fifteen LVAD nurses in an acute care hospital.
Results
The qualitative data analysis produced six main themes. The first theme prevalent was “LVAD incompetence and shortage” and it reflected the deficit in properly structured training and the number of specialized LVAD nurses. The second theme that resulted from the analysis was titled, “Patient and family knowledge”, which indicated the misconceptions that families and patients usually hold about LVAD which usually sugarcoats the situation. This was followed by “Burden of complications”, “LVAD patient selection”, “Perception of the LVAD team as invulnerable”, and “High workload and patient frailty” which reflected the perspectives of LVAD nurses.
Conclusion
This study shows that the Lebanese LVAD nurses who participated in this study perceived inadequate competence, yet lacked proper training and induction. The nurses reported multiple challenges relating to care tasks, workload, and patient and family interactions which need to be addressed by coordinators.
Introduction
Heart failure (HF) is a persistent illness that affects about 6.5 million Americans and over 26 million individuals around the world (Karnik et al., 2019; Savarese & Lund, 2017). The worldwide increased prevalence of HF was sparked by an older demographic and extensive incidence of lifestyle factors (Savarese & Lund, 2017). Heart failure is a gradual condition, with around 5% of patients with HF experiencing an end-stage disease that is resistant to medical treatment. Individuals can control their HF with behavioral adjustments and medicine at first, but as their medical condition deteriorates, they will require more rigorous treatment to survive.
Individuals with severe heart failure who have undergone guideline-directed medical treatment (GDMT) should get ongoing inotropic assistance, according to the American College of Cardiology/American Heart Association and the Heart Failure Society of America, to enhance the quality of life and minimize symptoms. Inotropic assistance can be used to maintain patients while they wait for a heart transplant, mechanical assistance, or to return home. Due to the risk of severe hypotension, life-threatening dysrhythmias, or increasing renal failure, patients starting on inotropic support should be closely monitored (Polyzogopoulou et al., 2020).
Review of Literature
The significant frequency of illness and death linked with heart failure, as well as the deteriorated quality of life it causes, has driven the investigation of new therapies for patients with severe heart failure, such as Left Ventricular Assist Devices (LVADs). This is a battery-operated pump implanted inside the left ventricle of the heart to pump blood from the left ventricle to the rest of the body. It is a kind of mechanical cardiovascular assistance, that has become a regular therapeutic option for individuals with developed HF all around the globe (Severino et al., 2019). The care sophistication of patients with HF was enhanced by these technologies, which raised the nursing practice vigilance in the Intensive Care Unit (ICU) and Step-Down Unit (SDU) (Casida et al., 2019). Nonetheless, the adoption of LVAD treatment is supported by favorable clinical and lifelong results in these individuals. Patients who acquire these devices do so as part of a bridge-to-heart transplantation, a transplant alternative (destination treatment), or, in rare situations, a bridge-to-myocardial rehabilitation approach (Selzman et al., 2015).
Patients can be released from the hospital while on LVAD. Patients with persistent end-stage heart failure can benefit from LVAD assistance to lengthen their lives and enhance their quality of life. Pulmonary collapse, cardiac irregularity, right heart malfunction, arterial arrhythmia, renal failure, device malfunction, stroke (hemorrhagic or thrombotic), gastrointestinal bleeding, and drive-line infection are all possible complications. These are major issues that can have a detrimental influence on LVAD patients’ quality of life and outcomes. According to Kato et al. (2018), the current generations of LVADs have a significant effectiveness rate, but there are lifestyle problems as well as possible medical issues.
The requirement for registered nurses (RNs) practicing in ICU and SDU environments to exhibit proficiency in the treatment of these patients throughout the care process is a challenging issue. Bedside RNs caring for LVAD patients are supposed to comprehend and manage the device's mechanisms, as well as fulfill the patient's physical and affective requirements, handle palliative care requirements, and provide information. Remarkably, notwithstanding regulatory demands that each Ventricular Assist Device (VAD) nursing practitioner exhibit device care skills, there is a dearth of studies on bedside RN abilities with LVADs and related care coordination (Combs et al., 2021).
Regrettably, there are presently few studies on the treatment of patients with LVADs by bedside RNs especially in Lebanon. Gibson et al. (2013) for example, highlighted the perspectives of six bedside RNs caring for LVAD patients in critical care areas as “tough, challenging, and distinctive,” but no additional research has been done. Casida et al. (2019), investigated the methods by which ICU and SDU bedside RNs acquire and sustain LVAD care. They discovered that bedside RNs in these units employed a variety of tools and resources to gain initial and ongoing competency in the care of hospitalized patients with LVADs. This research investigated the bedside RNs’ competency and overall perspectives in managing hospitalized patients with LVADs to fill the gap in the literature.
Purpose of the Study
The study aimed to explore the experiences of nursing staff who work in Lebanese hospitals with Left Ventricular Assist Devices (LVAD).
Methods
Design
A phenomenological explorative qualitative methodology was adopted in this study, which emphasized the participants’ observations and experiences to comprehend the phenomena that transpire. The phenomenological method of Colaizzi focuses on human thoughts and feelings rather than personal characteristics and looks for commonalities among study participants (Shosha, 2012). The interpretive/constructivist epistemological technique was adopted in this study because the researchers wanted to look at the nurses’ experiences with LVAD care.
Setting
This study was conducted at an acute care hospital in Beirut. This is a large hospital facility that provides medical services to all its patients. This facility was selected due to its large LVAD services. The facility serves as a university hospital with a conducive environment for clinical learning and research.
Population and Sampling
The study's population involved nurses working in the ICU and SDU. This is to ensure that the participants have experience in LVAD care. To recruit the study participants, a purposive sample of fifteen bedside nurses providing LVAD care who met the study's eligibility standards and agreed to enroll voluntarily was used. The researchers had to recruit both eligible and approachable nurses because of the restricted number of bedside nurses who provide LVAD care qualified for research.
Inclusion /Exclusion Criteria
The inclusion criteria included nurses (a) who dealt with LVAD patients, and (b) who had at least one year experience. Bedside Nurses who have experience with less than 1 year of experience, LVAD coordinators, nurse managers, nurse educators, and case managers were excluded.
Data Collection Tool and Procedures
An interview guide that was developed by researchers, was used to collect data including the nurses’ age, gender, educational level, and years of experience. After filling out the demographic data form, nurses who were prepared to participate were asked to answer an open-ended questionnaire individually. To get the required information, semi-structured interviews were employed. Interviews took place in the hospital's nurses’ break room. The interviews were carried out in compliance with a written guide.
These discussions were performed to collect qualitative information regarding the nurses’ experiences caring for LVAD patients. The discussions’ location was carefully chosen to protect the participants’ comfort and secrecy and was mostly in a distinct area at their place of work. The session had been planned ahead of time and had a flexible timetable. The meetings were held on days and times that were suitable for the nurses, ensuring that they were not anxious or distracted. The researchers introduced their research and discussed the goal of the meeting during the session. The participants were told that this conversation was completely anonymous and that any transcripts released would not be identified by name but would be encoded for privacy. The subjects were informed that they might quit the research at any moment. The conversations were audio recorded and translated by a linguistics expert, but the participants were told that no one but the investigator would be allowed to listen to the live records and that they would be kept safe. The interviews were limited to approximately 30 min apiece to ensure that enough data was obtained. The data were then collated and a theme analysis was performed. The information was gathered using the following open-ended questions depicted in Table 1.
Semi-structured Interview Open-ended Questions (Interview Guide).
Data Analysis and Trustworthiness
To acquire data, the principal investigator performed semi-structured interviews with the nurses. The meetings were done one-on-one with each nurse so that they could talk openly about their encounters. The researcher kept on conducting interviews until data saturation was reached, which was after 15 interviews. At the outset of each interview session, the investigator identified herself, describing the study's purpose as well as the reasons for conducting the interviews. After that, written consent was obtained, and each conversation lasted approximately 30 min. After all of the interviews were finished, transcript axial coding was utilized to make data analysis smoother. The statements were then categorized into categories depending on the thoughts conveyed. These categories were then broken into more conceptual themes, which were split further into more precise sub-themes based on the specifics of the expressed context. Over multiple interviews, the goal of this qualitative study was to uncover relationships that contradict, support, and enrich each other. Because the themes are based on a structure that is compatible with the respondents’ perspectives, the thematic classification retains its impartiality.
To tackle the research questions, thematic analysis was employed to produce themes that reflected the viewpoints held by the nurses. Concurrent analysis was carried out to ensure that the conceptions created by the theme analysis were relevant and correct in light of these results, which reflected a real grasp of the perspectives of LVAD nurses. The researchers addressed all of the subjects in a comparable area at roughly the same time of day. Furthermore, all participants were asked the same set of questions, and the interviewer covered all of the related issues, with no material from the interviews hidden.
Rigor of Study
The credibility, transferability, conformability, and dependability criteria proposed by Guba and Lincoln were applied to assess the rigor of the data (Hsieh & Shannon, 2005). The study participants were informed about the interviews and related analyses, and their feedback was taken into account (member checks). The codes were provided to outside specialists to verify the coding procedure to assure credibility. Additionally, the researchers tried to provide a thorough description of the study's environment to increase transferability, which is the same as generalizability in that it suggests that the findings have applicability in different contexts. Two academics who specialize in qualitative research were given the transcription of a few interviews to verify the conformability of the research findings. They were asked to assess the precision of the data coding procedure. Eventually, an inquiry audit strategy was employed to guarantee dependability. A professor who was not involved in the study project was given access to the interviews and the analysis process, and he was asked to review the study's methodology and findings.
Ethical Considerations
The university's institutional review board (IRB) and acute care hospital authorities gave their formal consent to perform this research work. After being briefed about the study's objective, nurses gave their informed consent. Background information, the research purpose, participant advantages, and consequences of participation, as well as the author's contact information, were all included in the informed consent form. The investigator set the day and time for the interviews with the respondents and informed them in advance. Participants were approached individually, allowing them the opportunity to hear the instructions and complete the sociodemographic data form completely. Furthermore, the interview logistics were arranged, and the talks were carefully taped before the qualitative data were evaluated and grouped into themes. In addition, the LVAD facility obtained informed consent from participating nurses for this study. The investigator additionally assured the participants that the discussions were confidential that identifying information would not published, and findings would be shared in aggregate form. Finally, all study participants’ autonomy, anonymity, and confidentiality were protected throughout the research process.
Results
Sample Characteristics
The sample of this study was made up of 15 LVAD nurses who had been providing care for LVAD patients for at least 6 months. Nine (60.0%) of the nurses were males, while 6 (40.0%) were females. The age distribution of the sample was as follows; 5 (33.3%) nurses aged between 20 and 25 years old, 6 (40.0%) of them aged between 26 and 30, and 4 (26.7%) aged above 30 years of age. In addition, 7 (46.6%) of the nurses attained a bachelor's degree, while 8 (53.3%) attained a master's degree (Table 2).
Socio-Demographic Nurse Characteristics.
Study Themes
The thematic analysis produced six main themes. The first theme prevalent was “LVAD incompetence and shortage” and it reflected the deficit in properly structured training and the number of specialized LVAD nurses. The second theme that resulted from the analysis was titled, “Patient and family knowledge”, which indicated the misconceptions that families and patients usually hold about LVAD which usually sugarcoats the situation. This was followed by “Burden of complications”, “LVAD patient selection”, “Perception of the LVAD team as invulnerable”, and “High workload and patient frailty” which reflected the perspectives of LVAD nurses.
Theme 1: LVAD Incompetence and Shortage
The first theme that was prevalent from the process of thematic analysis reflected on how LVAD nurses felt that they needed structural empowerment and training, where they felt that they suddenly were prepared by a senior colleague who had experience with LVAD rather than receiving formal education and training on LVAD which made them feel insecure about their management despite their competence. As an illustration, one of the nurses stated, “…I have been working at the ICU for 2 years and suddenly the nurse manager tells me that I will be preparing to handle LVAD cases soon so one of my colleagues will be helping with it…I just observed while he worked at first and then very soon I started working while he helped…then I was all alone…it was scary at first” (N7). “…I did not receive formal training sessions… I was just told that I would be shown how to deal with this device and with time I would work with one of my colleagues to be an expert on it… with time I got to know my way around everything… we had a few presentations on the matter but I don’t feel it was enough… at last at the time… it made me feel like I am doing risky behavior…” (N14). “…my first experience with LVAD was very confusing I did not know all the complexities of it… with time all worked out but I truly needed more help and assistance…it was a new device. Highly critical patient…and I was very frightened…I had help from my colleague from my unit manager but formal training especially with other team members was well needed…” (N2). “…we are a small team and we need more nurses to be with us so that we can get all the help we need…LVAD cases are distributed among us only and this makes us take on long hours. and more shifts… we need more people to rotate…” (N15). “…The workload is too heavy for us to continue caring for LVADs alone. The hospital ought to consider appointing extra nurses and giving them the appropriate LVAD care training.. …” (N3).
Theme 2: Patient and Family Knowledge
During the interviews, the LVAD nurses expressed that one of the major challenges that they faced with LVAD care was the misconceptions patients and families had about LVAD, which put them in frequent positions of not only educator but rather in the position of delivering underwhelming news to the families. For instance, one of the nurses stated, “…the families usually think when their patient is on LVAD there will not be a chance of death and that they will live with good health…here is where we come in and tell them that it's not the case at least not usually…and here is when it gets very emotional and frustrating…” (N9). “…I don’t know how families and patients think that there is no margin of death and that this device will be the magic trick…and this is what we try to convey over and over again to them…it gets frustrating as to be in this position in front of them…especially when you communicate an undesirable outcome of the treatment…which was expected… Kind of…” (N1). “…Patients and families, especially those who intend to receive long-term independent care, should have a fundamental grasp of LVAD care. Because it is a new idea to them, it could be difficult for them to understand., it normally requires a great deal of time and effort. additionally, when tending to sufferers… I get frustrated from time to time, but I try to be as productive as I can.…” (N13). “…We need to take our time with the education and how to deal with the system because we have a lot of labor-intensive work, administrative work, and education for the patients and their families to handle. Arranging education for them also requires more management because they are frequently not very receptive, especially in the case of the patient…revise the driveline dressings…very complex…” (N10).
Theme 3: Burden of Complications
The LVAD nurses in this study also identified the complications that LVAD patients go through as a physiological and psychological burden for them, the patient, and their families. They felt that the readmission rates of patients with complications made them feel bad about their practice even though they already knew that complications were expected. One of the nurses, for instance, indicated, “…It upsets me to see a patient with an LVAD causing bleeding or thrombosis because …it makes me reflect on their situation and the suffering they went through to need this technology…I sometimes feel helpless when the challenges become too much, especially when I think of their families..…” (N8). “…You feel incredibly helpless and responsible when a patient with an LVAD is observed being discharged…stable… and then returns and is readmitted after being discharged. The patient and their family seem to be fatigued, and we are as well, so I feel horrible for them..…” (N1). “…You might still have a ton of work to do when problems unexpectedly develop, so you have to respond rapidly to try to keep the case alive while going into fight or flight mode…You execute it…but eventually, you run out of energy…You're exhausted…You were successful and grateful for the assistance…but you're exhausted..…” (N15). “…You are constantly on the lookout for any potential LVAD issues. The patient needs care, documentation, and possibly transfers…so you have to be on your toes and do a lot of running around if it happens…Although highly exhausting, when the patient is doing well…The effort is worthwhile.…” (N7).
Theme 4: LVAD Patient Selection
The LVAD nurses who took part in this research highlighted through the interviews that sometimes they feel that the LVAD selection process is not accurate enough, where they feel that certain patients should’ve not been selected due to health reasons or even socioeconomic reasons, making LVAD not the best treatment option for them. One of the participants, for instance, said, “…I think doctors ought to be more picky about who they put on LVADs.When a patient and his family opted to receive an LVAD, they were astonished by the costs associated with this course of therapy and had to seek assistance to pay for the associated costs…Because we are the ones who interact with the patient the most and must deal with their frustration, this occasionally puts us in their presence.…” (N11).
“…The doctor should be informed if the patient is unable to pay for the therapy and is unable to cooperate…I'm proposing that the doctor should take the patient's social standing into account in addition to their health when selecting a patient..…” (N11).
“…in general and most of the time the patients are feeling better on LVAD…some take more time than others… some end up dying due to the acuity of their case… but in general when LVAD has placed the patients’ case improves…but sometimes… in some cases, the patient feels worse than before and they were not educated by the physician that this might be the case so they are frustrated the family is frustrated and we are left in the fight alone… “ (N5).
Theme 5: Perception of the LVAD Team as Invulnerable
Moreover, the LVAD nurses who took part in this study expressed their thoughts regarding the patients’ and families’ perceptions of the LVAD team as having super curative powers. This has been highlighted by indicating that the families usually set unreasonable expectations from the team which leads to conflict and sometimes clash with them. For instance, one of the nurses stated, “…the patients and the families think we have super powers…they expect that once the patient is under our care they will directly be better…once the LVAD attached they think that the patient will magically be healthy…and when this is not the case they start blaming us for not providing proper care… “ (N14). “…Family members’ expectations and realities regularly diverge…They believe that if we cast a spell with our magic wand, the patient will be healed, and they can leave…They are unaware. how things are or how long it takes for something to have the desired effect.… “ (N9). “… The patient's family reacts when we leave the room because they believe we are just working with one patient…They are concerned and ask where you are going. But we did allow them to know that we also have other patients…then they start yelling about how long it takes us to finish jobs…” (N15). “…the patients’ family think that we can finish everything within minutes and they think that we don’t get tired…they even think that we have magical powers and that we don’t fail and that medicine does not fail…but the truth is…we do our best and sometimes our best is just not enough…” (N1).
Theme 6: High Workload and Patient Frailty
The final theme that was prevalent among the participating LVAD nurses related to the heavy workload that comes with the drear case of the patient, where they are usually very debilitated, they are put on LVAD and they need very demanding care, which is exhausting for the LVAD nurses. This theme reflects signs of burnout among LVAD nurses, for instance, one of the LVAD nurses expressed, “…I am very tired of the heavy-duty work…LVAD patients are usually really challenging to work with…many tasks and heavy efforts to be put into achieving good outcomes…I want the good outcomes of course but I need rest to keep going…” (N6). “…I'm exhausted, especially given the meager help we get…The LVAD procedure is challenging and necessitates managing multiple lines, catheters, dressings, and medications…the complexity, comorbidities…Sometimes everything becomes too much, and we require assistance….” (N6). “…usually LVAD patients are very weak and the cases are very heavy and to be able to handle the complexity of the LVAD, the patient's needs, and other high acuity cases as well is just so overwhelming….” (N12). “…LVAD patients are frail … I guess this is the word to use frail…this makes them demanding cases that need a lot of work to make the patient feel better…on top of this we do have the same experience with other ICU patients…this poses a high workload on us which needs more assistance to be done…but we do it alone and this is challenging…” (N4).
Discussion
This research paper discusses the findings of the study in general and compares our findings to those of earlier studies that looked at nurses’ experiences with left ventricular assistive device care. This is the first qualitative research in this area to investigate the perspectives of bedside nurses who provide LVAD care. Six themes have resulted from the thematic analysis in this study focusing on the lack of formal training in LVAD and nurses’ competence, expectation conflict between LVAD nurses and the patient's families, lack of proper knowledge among patients and families, discrepancies in the selection process, high workload and patient frailty.
With an increasing amount of nurses dealing with patients who require treatment for end-stage cardiac disease, LVAD nurses are a distinct subset of nursing practitioners who are frequently called upon to assist with end-of-life decision-making and activities while working within a complex clinical context. LVAD patients can be divided into two categories: those who acquired the device as a bridge to a heart transplant and those who acquired it as a destination therapy. While both groups have a high mortality, the latter is more likely to survive for fewer than five years. Daily, LVAD nurses deal with this situation (Eshelman et al., 2009; Sandau et al., 2014).
The findings of this study demonstrated that bedside nurses in the ICU setting providing LVAD care have perceived inadequate levels of competency and positive attitudes when caring for LVAD patients. We discovered that bedside nurses believe that they were proficient in the treatment of patients with short-term LVADs, but that they needed additional training and support, as well as more LVAD nurses, to meet the demands of this heavy-duty care. This is consistent with previous studies, where RNs have been shown to have expertise in caring for patients with LVADs, however, need more training with short-term LVADs especially with patients who are hemodynamically stable and independent (Chmielinski & Koons, 2017). This is also consistent with Runyan et al. (2021), which found that nurses must be trained in LVAD principles and challenges, as well as the advantages of device implantation, daily care needs in the intensive care unit and post-intensive care unit, and outpatient preparedness. Nurses will be equipped to offer required treatment while also educating patients, families, and community healthcare professionals on how to offer proper post-hospital treatment.
Caregiving may be a very difficult experience. Caregiving has been related to stress, hopelessness, and isolation, as well as tiredness and sleep disturbances, elevations in circulatory cortisol, and the resulting losses in immunological function, illnesses, and early death (Liu et al., 2020). Practitioners tend to prioritize the needs of patients over their own, and caregiver illness has been related to poor clinical outcomes (Heaney et al., 2019). Caregiving for LVADs has been linked to an upsurge in depression, stress, and post-traumatic stress disorder (Streur et al., 2020). This is consistent with the results of our study, where nurses felt hopeless and distressed when their patients whom they cared for and did the best they could, were readmitted with complications. In previous research, caregiving was found to raise the risk of heart illness and high fatality among carers of patients with different forms of chronic medical diseases in investigations, where Bartfay (2022) examined care workers of patients with CF-LVAD (BTT designation) and care providers of individuals with an implanted cardioverter defibrillator in terms of physiological status and mental wellbeing results. CF-LVAD providers had higher physiological well-being, but worse mental well-being, greater depression frequency, and no huge disparity in anxiousness.
In addition, the thematic analysis revealed that nurses reported frustration from the side of patients and patients’ families due to their high expectations of the LVAD outcome. The nurses in our study expressed that patients and families felt that death was not an option which put them in the position of bad news bearers when educating them about various possible outcomes. The respondents in this research expressed a wide range of emotions among patients and families, comparable to the findings of Standing, Rapley et al. (2017). Frustration, gratitude, and remorse were among the sentiments voiced. Since 75.0% of patients hospitalized in the intensive care unit are unable to comment on their treatment choices, doctors and nurses should consult with the patient's relatives while making treatment decisions (Mattar et al., 2013). However, this study demonstrated that the majority of nurses in our study indicated that patients were allowed to decide on receiving the LVAD and exhibited a strong desire to live. These patients did not see death as an option, which was consistent with previous qualitative investigations (Dillworth et al., 2019; Marcuccilli et al., 2013).
We discovered some unfavorable and perhaps alarming viewpoints voiced by the participating nurses on patient/family preparedness and the identification of LVAD recipients after we moved outside the sphere of immediate patient care competency perspectives. The LVAD nurses, for instance, discovered that the patients/families are given a “sweetened” exposition before the device implantation since the team may do so. Bedside nurses are more likely to encounter critically ill patients, so they are not accustomed to patient populations who go home and remain in the community. One study indicated that their negative view is most likely the result of their limited experiences as per what is indicated in previous research (Combs et al., 2021). This is consistent with the nurses in our study who reported a lack of training and support to be included in the LVAD team and were suddenly trained on the use of the device. Weare et al. (2019), who documented ICU nurses’ unfavorable attitudes toward their patient group, suggested that continued training and assistance should help to mitigate these attitudes. However, LVAD teams do not devote enough time to this, preferring instead to educate the bedside RN about device characteristics like LVAD: (a) settings, (b) external component care, and (c) diagnostics (Casida et al., 2019). As a result, implementing a well-structured training and assistance plan that targets the learning requirements of RNs (who work all schedules) will boost their assurance and effectiveness (Morrow et al., 2019). Finally, the bedside nurses must be included as critical members of the LVAD team. Introducing the nurses to patient selection sessions, outpatient clinic appointments, and support networks will give them a broader viewpoint and a better understanding of the actual LVAD holistic management. These critical team members have a direct impact on the patient's treatment results, thus we refer to them as key players in LVAD outcomes (Kaiser, 2019).
Strengths and Limitations
Our study's results are the first to document LVAD nurses’ experiences. Due to the exploratory research methodology, we were able to capture and document six different themes in LVAD therapy. The principal investigator and the research team generated the research tool and were highly qualified to conduct qualitative inquiries. This is considered a strength, which enabled nurses providing LVAD in critical care units to offer a complete record of their encounters. Despite this, our research contains some shortcomings. First, because of their employment conditions and time constraints, some nurses were reluctant to take part in the study. Second, the fact that respondents were chosen from a single hospital limits the study's generalizability. As a result, it's conceivable that other nurses at various centers might have different experiences for varied purposes. Third, it's difficult to distinguish between the nurses’ experiences with LVAD patients and all ICU patients as we only asked nurses who worked with LVAD patients in the intensive care unit. Fourth, the nurses’ tiredness can have an adverse effect on their involvement because some of the interviews were done at the conclusion of their shifts. Finally, to reduce the possibility of interviewee responses being biased by interviewer actions, pre-interview team discussions were conducted in which presumptions regarding the subject matter were addressed and the interviewer's role was delineated focusing on the practice of critical reflexivity.
Conclusion and Recommendations
With advances in medical treatments and an aging society, the demand for mechanical support for the malfunctioning heart has risen, regardless of whether it is temporary after a heart attack or chronic in individuals with end-stage heart failure. The invention and improvement of ventricular assist devices (VADs), therapeutic technologies effective in sustaining the cardiac output of the damaged ventricle, has progressed significantly during the last several decades. However, very few studies have been conducted to address the needs and perceptions of bedside nurses providing LVAD care to these patients and even more, no such studies have been conducted in this area.
This study demonstrated that the participating bedside nurses providing LVAD care perceived an inadequate level of competence in managing the LVAD patient yet they felt anxious about certain aspects of care due to the lack of a structured training program and team induction. The study also revealed that the nurses faced various challenges mainly represented by the perceived psychological and physiological burden of LVAD complications, conflicts between the nurses’ workload and patient and family expectations, as well as perceived challenges relating to patient selection and family knowledge which leads to more conflict with the patient's expectations and decision of care.
Implication for Practice
Despite the constraints, our findings highlight the obstacles that bedside RNs face when caring for hospitalized LVAD patients and their relatives. Beyond the technical components, stakeholders, notably directors of LVAD programs, must now pay more attention to the demands of bedside RNs and tackle other areas like patient selection and consenting for placement procedures. Recognizing bedside RNs as valuable members of the larger team will only help LVAD caregivers receive better care.
As a result, a structured LVAD training and recruitment program should be developed on a national level to support the existing LVAD nurses and prepare them for a more formidable LVAD team. Patient and family education programs as well as selection programs regarding LVAD should be reviewed and standardized by the Ministry of Health to enhance care quality and the decision-making process.
Footnotes
Acknowledgments
The authors would like to thank the nurses who participated in this study for their giving time and effort where this study would not be completed without their valuable input. Thanking is also extended to hospital supervisors and administrators for permitting them to collect data. Special thanks are extended to the IRBs committees.
Author's Contribution
Design: SE, MF, and MN; Data collection: SE and MF; Data analysis: MS, MN, AR, and MF; Preparing the manuscripts for publication: IA, MJ, MK, MF, SA, and DM; and Revising the manuscript: MS.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
