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

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. AIMS: 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.

Resolving tensions in phenomenological research interviewing.

AIM: A discussion of five prevalent tensions in phenomenological interviewing and ways to diminish them. A rigorous interviewer training program for novices is presented, grounded in the philosophy of Merleau-Ponty, and delivered in the context of a transdisciplinary phenomenology research group that provides constructive critique and mentoring. DESIGN: Discussion Paper. DATA SOURCES: Personal experience as a trainer of novice researchers for over 25 years, and classic and contemporary literature on phenomenological research methodology and interview technique. IMPLICATIONS FOR NURSING: Phenomenological methodology is one of the most widely used research approaches across the globe in nursing and other human science disciplines. Current nursing literature contains reports in which a phenomenological approach is espoused, but the procedures are not consistent with the tenets of phenomenological philosophy. In particular, problems related to interview technique are evident. Interview training is essential for development of skill in eliciting comprehensive descriptions of the phenomena of concern to nurses, such as chronic pain and spiritual distress. Enhancing nurses' understanding of these phenomena ultimately impacts the provision of sensitive and compassionate care. CONCLUSION: Tensions in phenomenological interviewing can be diminished by trainee grounding in phenomenological philosophy, bracketing and pilot interviews, constructive peer critique, and guidance of research mentors. IMPACT: Problems in interview technique indicate the need to provide novice interviewers with rigorous training. A richly evocative interview is critical for powerful, credible, phenomenological research. This paper makes a unique contribution by identifying five tensions confronting the phenomenological interviewer, and ways to diminish them. Principles of the interviewer training program can be replicated in other locales by supervisors of student research in nursing and other human sciences.

Phase 1 studies of central memory-derived CD19 CAR T-cell therapy following autologous HSCT in patients with B-cell NHL.

Myeloablative autologous hematopoietic stem cell transplantation (HSCT) is a mainstay of therapy for relapsed intermediate-grade B-cell non-Hodgkin lymphoma (NHL); however, relapse rates are high. In phase 1 studies designed to improve long-term remission rates, we administered adoptive T-cell immunotherapy after HSCT, using ex vivo-expanded autologous central memory-enriched T cells (TCM) transduced with lentivirus expressing CD19-specific chimeric antigen receptors (CARs). We present results from 2 safety/feasibility studies, NHL1 and NHL2, investigating different T-cell populations and CAR constructs. Engineered TCM-derived CD19 CAR T cells were infused 2 days after HSCT at doses of 25 to 200 × 10(6) in a single infusion. In NHL1, 8 patients safely received T-cell products engineered from enriched CD8(+) TCM subsets, expressing a first-generation CD19 CAR containing only the CD3ζ endodomain (CD19R:ζ). Four of 8 patients (50%; 95% confidence interval [CI]: 16-84%) were progression free at both 1 and 2 years. In NHL2, 8 patients safely received T-cell products engineered from enriched CD4(+) and CD8(+) TCM subsets and expressing a second-generation CD19 CAR containing the CD28 and CD3ζ endodomains (CD19R:28ζ). Six of 8 patients (75%; 95% CI: 35-97%) were progression free at 1 year. The CD4(+)/CD8(+) TCM-derived CD19 CAR T cells (NHL2) exhibited improvement in expansion; however, persistence was ≤28 days, similar to that seen by others using CD28 CARs. Neither cytokine release syndrome nor delayed hematopoietic engraftment was observed in either trial. These data demonstrate the safety and feasibility of CD19 CAR TCM therapy after HSCT. Trials were registered at www.clinicaltrials.gov as #NCT01318317 and #NCT01815749.

Finding Inspiration From the Philosophy of Maurice Merleau-Ponty for the Practice of Psychiatric-mental Health Nursing.

The philosophy of Maurice Merleau-Ponty, a unique blend of existentialism and phenomenology, deserves to be better known in psychiatric-mental health nursing. This philosophy is particularly pertinent to the contemporary recovery movement that seeks to dispel the therapeutic nihilism regarding conditions such as schizophrenia, borderline personality, and substance use disorders. This paper provides an overview of Merleau-Ponty's life and work, with emphasis on selected elements of his philosophy that are inspirational for the clinical practice of psychiatric-mental health nursing.