# A Thematic Qualitative Synthesis on the Lived Experiences of Patients With Left Ventricular Assist Devices: A Journey From Vulnerability to Resilience

## TL;DR

This study explores how patients with heart pumps cope emotionally and socially, showing a journey from feeling vulnerable to becoming resilient.

## Contribution

The paper provides a new qualitative synthesis of patient experiences with LVADs, emphasizing the role of ICU nurses in promoting long-term psychological resilience.

## Key findings

- LVAD patients experience a psychological journey from vulnerability to resilience, marked by themes of loss, fear, and meaning-making.
- Emotional instability and identity disruption begin in the ICU and must be addressed early to support adaptation.
- ICU nurses can improve patient outcomes by providing holistic care that includes psychological and social support from the start.

## Abstract

Left ventricular assist devices (LVADs) are increasingly used in managing advanced heart failure. While their clinical benefits are well documented, less is known about how patients experience living with such life‐sustaining devices. Understanding these experiences is essential for holistic, person‐centred nursing care.

To explore the lived experiences of LVAD recipients and examine how they cope with the emotional, psychological and social challenges of life with an LVAD.

A systematic search was conducted across Scopus, PubMed and ScienceDirect using predefined terms. The retrieved studies were reviewed and subjected to qualitative synthesis according to Thomas and Harden's methodology. Screening was performed in Covidence, critical appraisal utilised CASP criteria, coding was carried out in ATLAS.ti, and reporting followed ENTREQ guidelines.

Sixteen qualitative studies published between 2010 and 2024 were reviewed. Four analytical themes were identified: (1) Loss: The Failing Body, Stigma, and the Others, (2) Living with Fear and Uncertainty: And Now What? (3) Liminality: Stagnating Present and Ambivalence and (4) Moving Forward and Finding New Meaning in Life. These reflect a psychological and existential journey from vulnerability to resilience, aligning with Lazarus and Folkman's Transactional Model of Stress and Coping.

The synthesis offers novel insights into how LVAD patients cope with complex challenges and highlights underexplored domains such as stigma, identity disruption and meaning‐making.

Findings underscore the need for holistic, continuous care strategies that support both the technological and psychosocial adaptation of LVAD patients, beginning in the intensive care unit. ICU nurses are pivotal in initiating recovery by providing early psychological support, fostering patient empowerment and preparing individuals and their families for life after critical illness. Addressing emotional instability, identity disruption and fear during ICU admission and early discharge planning can promote resilience and smoother transitions. This review highlights the crucial role of ICU nurses not only in acute care delivery but also in shaping long‐term coping trajectories. Applying the Transactional Model of Stress and Coping offers a novel lens for guiding these interventions across the critical care continuum.

What is known about the topic
○LVAD therapy improves survival in patients with advanced heart failure, but it introduces significant psychosocial challenges.○Psychological distress, fear of device failure and social isolation are commonly reported but are often under‐addressed in clinical practice.○Critical care nursing focuses primarily on acute care, with limited attention given to long‐term psychosocial outcomes post‐ICU.
What this paper adds
○Offers a qualitative synthesis of LVAD patient experiences, revealing a journey from vulnerability to resilience.○Demonstrates that emotional instability, existential fear and disrupted identity begin during critical illness and must be addressed from the ICU onwards.○Highlights how ICU nurses can play a key role in psychological support, anticipatory guidance and preparing patients for life with an LVAD.○Proposes that holistic critical care—addressing spiritual, emotional and social needs—can improve long‐term adaptation and quality of life.○Recommends strengthening ICU discharge practices and follow‐up strategies to improve continuity of care and psychosocial recovery.

What is known about the topic
○LVAD therapy improves survival in patients with advanced heart failure, but it introduces significant psychosocial challenges.○Psychological distress, fear of device failure and social isolation are commonly reported but are often under‐addressed in clinical practice.○Critical care nursing focuses primarily on acute care, with limited attention given to long‐term psychosocial outcomes post‐ICU.

LVAD therapy improves survival in patients with advanced heart failure, but it introduces significant psychosocial challenges.

Psychological distress, fear of device failure and social isolation are commonly reported but are often under‐addressed in clinical practice.

Critical care nursing focuses primarily on acute care, with limited attention given to long‐term psychosocial outcomes post‐ICU.

What this paper adds
○Offers a qualitative synthesis of LVAD patient experiences, revealing a journey from vulnerability to resilience.○Demonstrates that emotional instability, existential fear and disrupted identity begin during critical illness and must be addressed from the ICU onwards.○Highlights how ICU nurses can play a key role in psychological support, anticipatory guidance and preparing patients for life with an LVAD.○Proposes that holistic critical care—addressing spiritual, emotional and social needs—can improve long‐term adaptation and quality of life.○Recommends strengthening ICU discharge practices and follow‐up strategies to improve continuity of care and psychosocial recovery.

Offers a qualitative synthesis of LVAD patient experiences, revealing a journey from vulnerability to resilience.

Demonstrates that emotional instability, existential fear and disrupted identity begin during critical illness and must be addressed from the ICU onwards.

Highlights how ICU nurses can play a key role in psychological support, anticipatory guidance and preparing patients for life with an LVAD.

Proposes that holistic critical care—addressing spiritual, emotional and social needs—can improve long‐term adaptation and quality of life.

Recommends strengthening ICU discharge practices and follow‐up strategies to improve continuity of care and psychosocial recovery.