Author ORCID Identifier

https://orcid.org/0009-0004-6236-777X

Date Available

12-20-2026

Year of Publication

2024

Document Type

Doctoral Dissertation

Degree Name

Doctor of Philosophy (PhD)

College

Nursing

Department/School/Program

Nursing

Advisor

Dr. Debra Moser

Co-Director of Graduate Studies

Dr. Mary Kay Rayens

Abstract

The implantable cardioverter defibrillator (ICD) is a battery-operated device implanted under the skin to monitor heart rate and rhythm, detecting and correcting dangerous dysrhythmias. It is the preferred choice for preventing both primary and secondary sudden cardiac death (SCD), reducing mortality by 50% compared to patients treated without an ICD. Due to the high prevalence of cardiovascular diseases and associated dysrhythmias, the demand for ICDs is growing each year. In the United States, about 75,000 adults receive an ICD annually. The presence of these devices, along with the uncertainties of living with a heart condition, can significantly affect mental health. About 20% of ICD recipients experience psychological distress and specific concerns related to their ICD. Miscommunication or misunderstandings can lead to fear, panic, and anxiety among ICD patients, with serious negative effects. Over 50% of ICD patients lack a clear understanding of their condition and often express dissatisfaction with the information provided by healthcare professionals regarding their device and treatment. Therefore, it is essential to clearly explain what patients can expect in their lives with an ICD during discussions before and after implantation, including the potential for anxiety symptoms. Effective nurse-patient communication has been shown to improve health outcomes by increasing patient satisfaction, enhancing understanding of health issues, and promoting better adherence to treatment plans through more personalized care. Evaluating nurse-patient communication among ICD recipients will provide an opportunity to identify factors that influence patients' psychological symptoms. Therefore, the purpose of this dissertation was to understand the effect of nurse-patient communication on anxiety symptoms among ICD recipients. The specific aims were: 1) test the psychometric properties of an instrument for assessing ICD device concerns among ICD recipients in the U.S.; 2) evaluate the effect of nurse and patient communication on anxiety among ICD recipients; and 3) synthesize and summarize the current literature about anxiety as a risk factor for mortality in ICD recipients.

Aim 1 was achieved by conducting a psychometric analysis of the Implantable Cardioverter Defibrillators Concerns questionnaire in order to assess the extent and severity of ICD recipients’ concerns. We used data from a cross-sectional observational study conducted to test the knowledge, attitudes, and perceptions of adult ICD recipients (N= 240). The tested instrument consisted of 20 items measured on a 5-point Likert-type scale. The items are scored from 0 (I am not worried at all) to 4 (I am very much worried), and there are 20 potential concerns on the scale, corresponding to a maximum potential severity score of 80. The instrument is valid and reliable in multiple populations including, the United Kingdom and Poland, with a Cronbach’s α= 0.94. The factor analysis revealed that a one-component solution was present within the scale, explaining 48% of the variance. In addition, the hypothesis test showed a positive and statistically significant correlation between the Brief Symptoms Inventory (BSI-6) measure of anxiety and the ICDC total score (r = 0.35, p < 0.001).

Aim 2 was achieved by conducting a secondary data analysis of a cross-sectional study of (N=200) patients with an ICD in order to evaluate the effect of nurse-patient communication on anxiety among ICD recipients. We have performed a simple logistic regression to distinguish whether nurse-patient communication is a predictor of anxiety among ICD recipients along with the covariates: age, gender, marital status, and health status. Simple logistic regression showed that patients aged 65 years and older are more likely to be anxious than younger patients p= .05 (OR, 2.478; CI, 0.998 – 6.15). In addition, patients who report good or very good health status are more likely to be anxious p= .008 (OR, 0.311; CI, 0.131 – 0.737). No other significant variables were shown, all relationships between discussion, gender, marital status, and anxiety remained not significant.

Aim 3 was achieved by conducting a systematic literature review to identify the role of anxiety as a risk factor for mortality among patients with ICDs. Three electronic databases were searched for peer-reviewed articles: (Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, and PsycINFO). Nine studies were found and included. The Socio-Ecological Model guided this review. Studies included in this systematic review concluded that anxiety may be relevant as a risk factor for increasing mortality among patients with an ICD.

In conclusion, this study has filled an important gap in the evidence of healthcare communication and psychological outcomes among ICD recipients. This comprehensive approach could lead to better support systems and communication strategies, ultimately improving both mental health and overall outcomes for ICD recipients. The findings emphasize the urgent need for routinely applied and interdisciplinary psychosocial aftercare for ICD patients. Therefore, it is necessary to ensure that ICD recipients receive the required interventions as early as possible in order to prevent any further permanent health issues associated with their devices or overall health. The next step in this area of research would be to conduct a randomized controlled trial with longitudinal follow-up to evaluate the impact of proper one-to-one communication that can help with anxiety symptoms. Additionally, to assess the feasibility of the communication strategies in decreasing anxiety among ICD patients.

Digital Object Identifier (DOI)

https://doi.org/10.13023/etd.2024.448

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Available for download on Sunday, December 20, 2026

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