Self-care demands of persons living with an implantable left-ventricular assist device.

Heart failure (HF) is a growing public health problem affecting approximately 23 million people worldwide. Treatment options for advanced HF patients have moved beyond pharmacologic therapy to include left-ventricular assist devices (LVADs). Patients with an LVAD must manage a complex regimen of care. This article proposes the use of self-care deficit nursing theory (SCDNT) as a framework to identify and organize the care needs of patients with an LVAD from a nursing perspective. Within SCDNT, self-care refers to actions designed to meet self-care requisites to achieve regulatory goals. When formalized, self-care requisites have two components: the general action to be taken and a "factor" to be controlled. The reformulation of health-deviation self-care requisites common to LVAD patients are presented and may serve as an exemplar for other technology-assisted living situations. The strengths and limitations of using the SCDNT for patients with such complex needs, as well as implications for clinical practice, research, and advancement of nursing science, are examined. Keywords: self-care deficit nursing theory; left-ventricular assist devices; mechanical hearts; foundational knowledge; circulatory support; self-care demands Globally, heart failure (HF) is on the rise in contrast to other cardiovascular disorders. Approximately 23 million people worldwide are living with HF, and in the 3 years from 2002 to 2004, the incidence of new cases nearly tripled from 2 million to 5.7 million cases (Kalorama Information, 2002; World Health Organization, 2004). Although transplantation remains the "gold standard" treatment for advanced HF, this option is not available for many patients. There are not enough donor hearts available to meet the number of patients waiting for transplant, and there are increasing numbers of HF patients who do not qualify as candidates for heart transplantation. As a result, surgical implantation of a left-ventricular assist device (LVAD) is becoming increasingly prevalent as both a "bridge" to heart transplant and an alternative to transplant, referred to as "destination therapy." Regardless of the rationale for the device, implantation of an LVAD gives rise to a new, complex set of self-care demands that patients must meet to ensure their safety and health. HF patients learning to live with an LVAD require nursing assistance to meet these new demands. Unfortunately, to date, the majority of information on LVADs found in nursing journals is generally derived from other disciplines such as medicine, engineering, epidemiology, and psychology. Thus, the current body of knowledge lacks a nursing perspective to guide the scope of nursing practice in this patient population. The purpose of this article is to use the self-care deficit nursing theory (SCDNT; Orem, 2001) to identify and organize the nursing care needs of patients with an LVAD. Emphasis is given to formalizing the health-deviation self-care requisites (HDSCRs) of these patients. HDSCRs refer to actions that patients need to take to manage structural and functional deviations, the effects of those deviations, and the effects of medical diagnostic procedures and treatments (Orem,). Developing formalized expressions of the HDSCRs of LVAD patients is the proper work of nurse scientists and practitioners who understand the self-care deficit nursing theory and are able to use the theory to form concepts and categorize information relevant to discrete nursing situations. To date, the work of developing and organizing formalized expressions of self-care requirements for LVAD patients has not kept pace with the need to have this information available to practicing nurses. This article attempts to fill that gap in knowledge by providing valid expressions of HDSCRs presumed to be common to all LVAD patients. Nurses working with LVAD patients can use these HDSCRs as "guiding principles" for their actions. The article proceeds by first laying out foundational knowledge needed to develop the HDSCR of LVAD patients. …