Modification of self-concept in patients with a left-ventricular assist device: an initial exploration.

AIMS AND OBJECTIVES To explore how patients with left-ventricular assist devices (LVAD) meet the health-deviation requisite of modifying self-concept to accept this form of treatment and restore normalcy. BACKGROUND LVAD are becoming a standard option to improve the quality of life for patients with advanced heart failure. Past research focused on technology issues and survival rates, but limited research has addressed the effect of LVADs on patients' perceptions of self. Orem's theory of self-care provides a framework to investigate how patients manage threats to self-concept to safely live with such a device. DESIGN Hermeneutic phenomenology based on van Manen's method. METHOD Data were collected using semi-structured interviews. Data saturation was achieved with nine participants (seven men; two women), 31-70 years of age who lived with a LVAD at home for at least three months. Thematic analysis was ongoing, and final themes were consensually validated. RESULTS Two themes constructed from the data were consistent with the requisite of modifying self-concept. First, Having a LVAD means living. Participants described they 'feel alive again', and they 'had the rest of [their] lives that they didn't have before'. The second theme: A desire to be 'normal' in public, arose from participants descriptions of how the LVAD brought unwanted attention to them and that their appearance was 'shocking' to others. CONCLUSION Participants accepted the LVAD as necessary to live making it easier for them to modify their self-concept and accept the changes to their bodies and daily lives. Attaining a sense of normalcy was more difficult in public and required additional lifestyle modifications. RELEVANCE TO CLINICAL PRACTICE Findings advance self-care knowledge in LVAD management and can heighten nurses' awareness about self-concept as a vital component for maintenance of health and well-being.