Learning Objective #1: Analyze the relation between uncertainty and psychosocial adjustment among implantable cardioverter defibrillator recipients at 1 and 8 weeks post-discharge

Learning Objective #2: Identify implications for future research to study the linkage between uncertainty and psychosocial adjustment among implantable cardioverter recipients

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Background/Problem: Mishel's uncertainty in illness theory was the study's framework. The model theorizes that when a person cannot diminish uncertainty surrounding an illness, he will have difficulty adapting to that illness. Adaptation was conceptualized as psychosocial adjustment (PSA). Ambiguity and complexity are forms of uncertainty. Uncertainty has been documented among implantable cardioverter defibrillator (ICD) recipients; however, the relation between uncertainty and PSA had not been previously studied in this population. The purpose was to explore the relation between uncertainty and PSA at one week (S1) and eight weeks (S2) post-discharge following ICD implant. Twelve hypotheses were tested. Methods: A repeated measures, correlational survey design was used with 94 adult, first-time ICD recipients recruited from four New England hospitals. The Mishel Uncertainty in Illness Scale, Psychosocial Adjustment to Illness Scale Self-Report, and demographic questions were completed at S1 and S2. Data were analyzed using descriptive and inferential statistics including Pearson correlations and multiple regression analyses. Ancillary analyses of gender and age used independent t-tests and repeated measures analysis of variance. Results: All but two hypotheses were supported. ICD recipients with greater uncertainty had less overall PSA, less adjustment in the domestic and social environments and in sexual relationships, and had more psychological distress than those with less uncertainty at both surveys. Uncertainty was unrelated to vocational environment adjustment at either survey. Ancillary analyses revealed no gender differences among the main variables and showed younger (25 to 50 years) adults had less PSA than older (73 to 83 years) adults at both surveys. Conclusions: These findings provide evidence supporting a theoretical linkage between uncertainty and PSA among first-time ICD recipients in the first eight weeks post-discharge. Future research is needed using longitudinal designs exploring variables that mediate the relation between uncertainty and PSA in this population.