Examining the Experience of IV Drug Users with Infective Endocarditis

As the No. 1 hospital for heart care, ranked by U.S. News & World Report, Cleveland Clinic performs many valve replacement surgeries for patients with infective endocarditis. “With the opioid epidemic, we started seeing more patients,” says Jennifer P. Colwill, DNP, APRN-CNS, CCNS, PCCN, Clinical Nurse Specialist for Cleveland Clinic’s Heart, Vascular and Thoracic Institute. “I noticed that caregivers knew how to clinically manage people who inject drugs, but caregivers – including myself – had some discomfort or frustrations managing adults who were intravenous substance users on a day-to-day basis.”

Dr. Colwill collaborated with Minerva Sherman, MSN, APRN, ACNP, Nurse Practitioner on a team that evaluates patients preoperatively, to explore the experience of intravenous substance users with infective endocarditis. The purpose of the grounded theory study was to understand the process of opioid addiction, hospital admission and re-entry into society from the perspective of persons who inject drugs who have infective endocarditis.

“Discrimination and stigmatization of individuals who abuse intravenous substances have been reported by the healthcare community,” says Dr. Colwill. “Understanding the process of substance use/abuse and hospital admission in this subset of patients from a patient-centered perspective could be helpful in managing care, especially post-cardiac surgery.”

Dr. Colwill and Sherman asked open-ended questions to 11 participants in the qualitative study, who were recruited during the pre- or post-operative phase. The research team recorded and analyzed data, then coded data into themes to create a theoretical model about persons who inject drugs, the healthcare system and society as a whole.

Several themes emerged, including the self-perception of patients as addicts and the potential of infective endocarditis to serve as a catalyst for change. “It is a wake-up call for many patients – a moment when they evaluate where they are and feel like they really need to change,” says Dr. Colwill. “Healthcare providers taking care of these patients can capitalize on the moment and support patients by providing help and resources.”

Another theme concerned patients’ fear that they would relapse once discharged from the hospital. “As they go back into society – into the same places and circumstances that brought them to the hospital – many patients were afraid of relapsing back to using/abusing drugs,” says Dr. Colwill. “Nurses should work with community organizations and social workers to identify ways to break the cycle of intravenous substance use/abuse and intervene on behalf of patients.”

Dr. Colwill adds that conducting the research project was invaluable for her personally as a caregiver. “Sitting and listening to patient stories helped me grow as a person,” she says. “It was an important learning moment about unconscious bias in the way we approach and talk to patients – especially vulnerable patients.”