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Open Access Dissertation

Date of Award


Degree Type


Degree Name




First Advisor

April H. Vallerand, PhD, RN, FAAN


Left-ventricular assist devices (LVADs) have improved the quality of life for many patients with advanced heart failure. Past research focused on technology issues and survival rates, but patients' and caregivers' perspectives of living with an LVAD as a destination therapy (e.g., permanent alternative to transplant) was not explored. Roy's adaptation model provided a framework to guide an understanding of how participants adjusted and accepted living with destination therapy. A hermeneutic-phenomenology as described by van Manen was used to explore and describe the essence of destination therapy from patients' and caregivers' perspectives in order to understand the meaning of this experience. Data saturation was achieved with 14 participants (7 men as patients, 71-76 years old; 1 man and 6 women as caregivers, 50-74 years old), who lived with destination therapy at home. Data was collected using open-ended interviews, thematic analysis was ongoing, and final themes were consensually validated. Procedures to ensure trustworthiness are described. Themes were consistent with Roy's adaptation model. Participants illustrated a process of adjustment and eventually accepted the LVAD as part of their lives. Patients adjusted to the LVAD as part of their bodies, accepted the device as necessary to live, and exhibited an improved quality of life. Caregivers described persistent worry and stress and accepted caregiving as part of life. Dyadic perspectives reflected gratefulness for more time to live despite uncertainties about death and dying. Findings advance the knowledge of destination therapy management. These findings may direct a holistic approach to palliative and end of life care, and can heighten nurses' awareness about the process of adaptation as a vital component for the promotion and maintenance of health and well-being among this growing population.

Key words: left-ventricular assist devices, destination therapy, caregivers, hermeneutic phenomenology, Roy Adaptation Model.