A webbased intervention for patients with an implantable cardioverter defibrillator, a qualitative study of nurses experiences

Abstract

Background: Implantable cardioverter defibrillator (ICD) therapy is the gold standard for prevention of sudden cardiac death. Patients generally adapt well to living with an ICD, but 20% have difficulties adjusting, with increased risk of anxiety and depression and decreased quality of life. New web‐based interventions engaging patients with an ICD might be efficient, but there is sparse knowledge on experiences with web‐based care from the perspective of cardiac nurses. Purpose: The aim of the studywas to explore cardiac nurses' experienceswith a web‐based intervention designed to empower patients with an ICD. Methods: We conducted a qualitative study based on semi‐structured interviews. The informants (n=9) were experienced cardiac nurses across 5 Danish university hospitals. They were delivering a comprehensive web‐based intervention for patients with an ICD, including patient education, chats, monitoring of anxiety and depression and a patient forum. The intervention was tested in a randomized controlled trial. The interviews were transcribed verbatim, coded and analyzed using qualitative content analysis with NVivo software. Results: We identified an overall theme: “Between traditional nursing and modern eHealth”. The theme emerged from six categories, each covering three or four subcategories (Figure 1). The categories were: (1) comprehensive intervention, (2) patient‐related differences in engagement, (3) following the protocol is a balancing act, (4) online communication challenges patient contact, (5) professional collaboration varies, and (6) an intervention with potential. Cardiac nurses were in general positive towards the concept of this web‐based intervention and believe it holds a large potential. On the other hand, they were challenged by not establishing a personal relation and by losing face‐to‐face contact with patients, which they found valuable for getting a feeling for patients' wellbeing and potential mental health issues. Ensuring face‐to‐face contact by either starting the intervention with a personal contact or including the possibility of video contacts might enhance the value of web‐based interventions from the perspective of cardiac nurses. The nurses found the intervention especially suitable for patients who had suffered a cardiac arrest. Conclusion: Specific training in eHealth communication is necessary as web‐based care entails a shift in nursing role and a new format of communication for cardiac nurses. Future evaluations of web‐based cardiac rehabilitation interventions in clinical practice are needed to assess the potential impact in “real‐life” cardiac care. (Figure Presented).