Date of Award

May 2020

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Nursing

First Advisor

Jennifer Doering

Committee Members

Jesus Casida, Julie Ellis, Erin Ruppel

Keywords

Destination Therapy, Left Ventricular Assist Device (LVAD), LVAD, Mechanical Circulatory Support (MCS), Quality of Life

Abstract

BACKGROUND: People with advanced heart failure experience persistently severe symptoms with increasingly impaired capacity and quality of life. Treatment options beyond palliative care are limited to heart transplantation or implantation with a mechanical pump that replaces the weakened heart’s function. The left ventricular assist device (LVAD) serves as a temporary bridge to transplant or bridge to recovery, or a permanent replacement as destination therapy (DT). While DT-LVAD recipients initially accept the device to extend life, there is a gap in understanding how DT-LVAD recipients define a life worth living, and how nursing and the health care team can help reach that goal.

PURPOSE: This study’s purpose is to determine the conceptual definition of “quality of life” in people with a DT-LVAD.

METHODS: A grounded theory study was conducted using a theoretical sample and open, selected and theoretical coding processes within the constant comparison method. Theoretical saturation was reached with 11 participants (age 32-79 years).

RESULTS: Normalizing emerged as the basic social process. Participants reported that a life supported by battery-powered equipment is still a normal, human experience. A process of acceptance and adjustment occurred to Normalize a machine-dependent life. Although extending life was the original LVAD objective, recipient goals and needs evolved over time. Dependence on a machine to extend life did not replace the need for a life worth living. The conceptual definition of quality of life when living with a DT-LVAD emerged as: I am able to live my life and do what I want, with some adjustments.

CONCLUSION: This conceptual definition of quality of life from the DT-LVAD recipient perspective enhances the health care team’s understanding and ability to improve DT-LVAD recipient lives. Life with an LVAD is not simply about survival; it is survival of quality that makes a difference and defines success.

Available for download on Friday, May 21, 2021

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