The Lived Experience of Nurses Caring for Patients Diagnosed With Intravenous Drug Use–Associated Infective Endocarditis in Appalachia: A Phenomenological Study

Abstract

BACKGROUND: The number of patients admitted with infective endocarditis (IE) from intravenous drug use (IVDU) in Appalachia is increasing, a direct downstream effect of the opioid crisis. Extant literature highlights the pejorative attitudes health care workers have toward patients with substance use disorder, with nurses among the most punitive. Rather than describe attitudes, the purpose of this study was to describe the lived experiences of nurses caring for patients diagnosed with IE from IVDU in Appalachia. OBJECTIVE: To describe an unexplored phenomenon in Appalachia to inform nursing practice, nursing education, and health policy. METHOD: Qualitative phenomenological study using the University of Tennessee method based on the tenets of Maurice Merleau-Ponty. Nine nurses (ages 29-53 years) recruited using purposive and snowball sampling participated in unstructured phenomenological interviews. RESULTS: The essential meaning or central theme of the nurse experience working with these patients was a sense of hopelessness/hope, with four interrelated themes derived from the central theme: (1) guarding/escaping, (2) responsibility and revulsion, (3) apathy/empathy, and (4) grief and sorrow/cold and unemotional. Universally, nurses perceived caring for this population as futile, feeling a sense of powerlessness to change the outcome. CONCLUSIONS: These care experiences frustrated nurses, who described being physically and emotionally drained. To improve care delivery and improve patient outcomes, emphasis must be placed on nurse addiction education and standardizing nurse to patient with substance use disorder ratios to decrease work-related stress on nurses.

Effect of Implementing Educational Program on Nurses' performance and Clinical Outcomes for Patients with Acute Infective Endocarditis

“…As well, this finding was similar with Mary et al (2022) (38) , who conducted a study to determine the impact of the educational program on nurses. Also, this finding was in accordance with Kendrea et al (2021) (18) , who reported a continuous need for educational sessions about IE to improve care delivery and improve patient outcomes. Regarding duration of stay in the hospital, the majority of control group and more than two-third of study group stayed in the hospital 15 days or more this may be due to the long course of treatment, this study was in line with Van J. et al (2021) (39) , who reported that intravenous antibiotic endocarditis using a standardized protocol is effective in reduced length of hospital stay for endocarditis.…”

“…Because this age considered the effective time to learn and modify their practice through training and education to improve the sense of identity and develop successful intimate relations. This finding was matched with Kendrea et al (2021) (18) , who found that most of the studied nurses were <30years old. Also, this finding was similar with Elana et al (2016) (19) , who stated that the predominant age group of the studied nurses was between 20-30 years old, on the other hand this finding was in contrast with E Havers et al (2018) (20) , who reported that two-thirds of the studied subjects were more than 30 years.…”

Reducing nurse burnout when caring for patients with substance use disorder

“…Caring for patients with SUD can be challenging, demanding, and time-consuming, leading to feelings of helplessness, avoidance, and frustration in the nurses caring for them 5,6. Lack of knowledge of SUD treatment in non-behavioral health nurses may add to nurses' feelings of burnout 6.…”

“…In the study discussed in this article, nurses have reported discovering drugs or weapons in the patients' rooms, causing them to feel unsafe. Nurses may feel emotionally exhausted, frustrated, and unaccomplished because they feel unable to help patients 4-6. Lack of knowledge of substance use disorder (SUD) treatment among nonbehavioral health nurses may add to nurses' feelings of burnout 6.…”

“…Nurses may feel emotionally exhausted, frustrated, and unaccomplished because they feel unable to help patients 4-6. Lack of knowledge of substance use disorder (SUD) treatment among nonbehavioral health nurses may add to nurses' feelings of burnout 6. When nurses are antagonized and endangered, they can feel detached, disengaged, and burnt out, which leads to increased turnover 7.…”