title: Adaptation and coping in patients living with an LVAD: A metasynthesis.
abstract: OBJECTIVE
  To synthesize information supporting coping and adaptation of LVAD patients and to identify opportunities for future interventions.
  
  
  BACKGROUND
  Left Ventricular Assist Device (LVAD) patients demonstrate improvements in quality of life and functional status, but qualitative research has not been meaningfully integrated.
  
  
  METHODS
  Qualitative meta-synthesis using Lazarus and Folkmans' Transactional Model of stress and coping.
  
  
  RESULTS
  Four distinct stages of adaptation were identified: Pre-LVAD, Implant Hospitalization, Early Home Adaptation and Late Home Adaptation. Each stage includes tasks in physical, psychological and social domains. Two themes emerged: 1) Primary Appraisal: Every stage is a new challenge and 2) Secondary Appraisal: Routines are achievable, emotions are more difficult.
  
  
  CONCLUSIONS
  Emotional challenges including fear and anxiety related to life-limiting illness and changed social roles need to be honestly addressed. Individuals living with LVAD achieve a sense of independence, enjoy social interactions and meaningful activities through addressing practical and emotional problems to facilitate coping.
authors.affiliation: Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205, USA. Electronic address: Mabshir1@jhu.edu.
authors.forename: Martha
authors.initials: M
authors.lastname: Abshire
authors.affiliation: Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology, Sydney, Building 10, Level 6, Room 400, 235-253 Jones St, Ultimo, NSW 2007, Australia.
authors.forename: Roslyn
authors.initials: R
authors.lastname: Prichard
authors.affiliation: Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205, USA.
authors.forename: Mia
authors.initials: M
authors.lastname: Cajita
authors.affiliation: Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology, Sydney, Building 10, Level 6, Room 400, 235-253 Jones St, Ultimo, NSW 2007, Australia.
authors.forename: Michelle
authors.initials: M
authors.lastname: DiGiacomo
authors.affiliation: Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205, USA; Johns Hopkins University, School of Medicine, Baltimore, MD, USA.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Dennison Himmelfarb
mesh_terms: D000222:Adaptation, Physiological / Q000502:physiology*; D000223:Adaptation, Psychological; D004644:Emotions; D006333:Heart Failure / Q000523:psychology* / Q000628:therapy; D006353:Heart-Assist Devices / Q000523:psychology*; D006801:Humans; D036301:Qualitative Research; D011788:Quality of Life / Q000523:psychology*
keywords: Adaptation; Coping; Heart failure; LVAD; Left Ventricular Assist Device