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The Return Home: VAD Patients Transitioning Home

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Pamela Combs, PhD, RN
Jewish Hospital
Louisville, KY, USA

How many times have we heard a VAD patient say "I just want to go home?" And we typically respond with an objective, well-scripted response as why the patient can't go home "now" but that indeed the team's plan aligns with their request. The key to the patient/caregivers' adjustment of living at home with the VAD involves processes, communication, extensive planning to name a few, but what is the return home experience like for the VAD patient?

Though the VAD team may celebrate the newly implanted VAD patient's discharge home, the work is only beginning.

In general, the VAD team's perspective regarding the VAD patient's outpatient life consists of clinic visits, telephonic triage, support meetings, and facetime monitoring. The patient's transition home involves a noticeable change in daily routine and resumption of activities. The patient arrives home with multiple VAD components, dressing supplies, and education manuals to name a few. Additionally, friends and family may look at the patient differently, may be afraid to touch the patient for example. To the converse, friends and family may think the patient is ready to do everything, that the patient should be immediately "fixed." An array of emotions exist with our patients returning home. A diary/journal may help the patient express their emotions. The team's Social Worker may plan to visit the newly implanted patients first time to clinic to assess their transition home. The VAD Coordinator may observe cues that indicate a difficult return home. This assessment should be at a high level immediately after discharge and should be discussed at the first clinic visit. Though home is the ultimate goal, assuring the transition is smooth as possible is crucial to enhance positive outcomes and a better quality-of-life.

There is no place like home, but it is important to remember that the patient returns home with a different outlook, physical status and daily life. Pay heed to this transition, offer time for the patient to discuss any concerns and offer problem solving to address any obstacles that may exist. For the return home is just the beginning. ■

Disclosure Statement: The author has no conflicts of interest to disclose.

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