Doctoral Dissertations

Orcid ID Todt

Date of Award


Degree Type


Degree Name

Doctor of Philosophy



Major Professor

Sandra Thomas

Committee Members

Lora Beebe, David Patterson, Samereh Abdoli


Infective endocarditis (IE) from intravenous drug use (IVDU) is an increasing problem in Appalachia. IE is an infection of the inner lining of the heart which may be contracted from body piercing, tattooing, or tooth brushing. In the person who uses IV drugs, the infection is generally needle borne. The Appalachian Region has been profoundly affected by the opioid crisis. Hospitalizations of Appalachians diagnosed with IE from IVDU are rising. Appalachians operate from a strong moral compass, gauging behavior as right or wrong. In the literature, health care provider attitudes towards patients with substance use disorder (SUD) are pejoratively negative, with nurses amongst the most punitive. In the patient diagnosed with IE, surgery is often needed to repair a failing heart. However, in patients who use IV drugs, surgery is only occasionally considered. Conversations of medical futility, resource allocation, and individual worth are occurring in the medical community and mainstream media. Notably absent from the literature and greater societal conversation is the voice of the nurse caring for this vulnerable population. The purpose of this study was to describe the meaning nurses ascribe to caring for patients diagnosed with IE from IVDU in Appalachia using the tenets of Merleau-Ponty’s existential phenomenology. The University of Tennessee Knoxville (UTK) Method developed by Thomas and Pollio (2002) guided this study. Nine nurses were interviewed using an unstructured phenomenological approach. Participants age ranged from 29 to 53 years with one to 31 years of nursing experience. Data analysis included reading and analyzing verbatim transcripts to formulate meaning units and global themes to construct a thematic structure that described the essence of the experience. An overarching polar theme of helplessness/hope permeated across the transcripts, as nurses struggled with a sense of futility in their care. Four figural themes arose from this central theme: (1) guarding/escaping; (2) responsibility and revulsion; (3) apathy/empathy; and (3) grief and sorrow/cold and unemotional. Study rigor was ensured by bracketing, peer debriefing, member checking, data saturation, and rich participant quotes to support the themes. Study findings add to addiction science literature with implications for nursing education, health policy, and nursing practice.

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