Patients with Transistor Pacemakers : Their Problems in Adjusting to Daily Living

It was the purpose of this study to gain greater insights into the problems and needs of patients with artificial pacemakers. The problem was to find out in what ways the pacemaker affected the patients\u27 manner of living and what problems they had had in adjusting to a new way of life. The method of the study was the descriptive survey; an interview guide was the tool. Seven patients who had been electronically paced for periods of four weeks to two and one half years were interviewed in their homes. The ages of the three men and four women ranged from forty-nine to eighty-two years. The study revealed that all of the patients, six of whom had Stokes-Adams attacks of varying degrees and frequency and one with incapacitatingly slow pulse, had apparently accepted having the pacemaker as the only way out of their problem. The instructions received by the patients, as they recalled, were varied and vague. Three remembered specific instructions regarding taking their pulses. Examples of other instructions given were, Take it easy and Use your own judgment. The activities in which the patients participated varied widely. Six patients indicated considerable increase in their activities since being paced; only one indicated little or no change. All were relieved of Stokes-Adams attacks. Five patients found that their activities were limited by fatigue; one by blurring of vision and unsteadiness; the youngest denied any limitations. Three patients had done extensive traveling; two of whom had experienced pacemaker failure while on extended trips. These two were referred back to their respective hospitals for correction of the problem. Six of the seven patients visited their physicians regularly; one only when she felt she needed to do so. One who visited regularly at the time of interview had not done so before having experienced pacemaker failure. The two problems considered by six patients to be the major ones were financial concern and fear of pacemaker. All felt that expense was a particular problem. The patients felt that hospital personnel had helped them particularly by kindness, prayers of the nurses, and frank explanations of the physicians. Those things which they felt were not helpful to them varied greatly but tended to be related to tact on the part of hospital personnel, of understanding, gentleness and frank explanations. Suggestions were that hospital personnel should maintain the same kindness, cooperation and prayers, should show a little more feeling for the aged, and should give the patients frank explanations. Four of the seven patients experienced pacemaker failure which they attributed to insecure fixation of the activator, unperfected pacemaker, battery failure and tissue resistance. Two of the three patients having had pacemaker replacement with subsequent activators preset at a higher rate reported more energy and less fatigue. This they attributed to the increased rates of cardiac stimulation. In spite of experiencing pacemaker failure, two of the patients stated that they felt even more secure than before because of increased comfort and faith in the later model