Patients experience of source isolation: a litterature review

Patients´ experience of source isolation - a literature review Title: Patients experience of source isolation – a literature review Authors: Nina Kragbak*, Didde Pedersen*, Kamilla Johansen* and Peter E. Jensen** *students, **lecturer, bachelor in science and Ph.D., at VIA University College, Nursing education in Århus, Hedeager 2, 8200 Aarhus N, Denmark. Background: Medical treatment and care of patients with infections may include source isolation of the patient, to avoid spreading of the infection. However, isolation is a potential physiological and psychological stress factor to the patients, and it is important to gain insight in the patients perspectives of being isolated, to develop treatment and caring strategies that may reduce the negative side effects of isolation. Aim: To make a systematic literature review, and analyse the literature to describe the state of the art knowledge of the patients perspectives of being isolated to identify areas of potential interest for developing new caring strategies to minimize the negative side effects of isolation. Methods: Literature was systematically searched in CINAHL, Nursing Reference Center, Social Care Online, SveMed+, The Cochrane Library, OTseeker, Pedro, PubMed, Bibliotek.dk, Psychology & Behavioural Science Collection, Science Direct and in the magazines Sygeplejersken, Klinisk Sygepleje and Journal of Hospital Infection. Inclusion criteria were: literature was from 1993 to 2013, the ages of the participants in the articles were 16 years and older and articles were peer reviewed. 11 articles were included and analysed by means of systematic text condensation. Results: Five themes were found; (1) Insufficient information, (2) Quality of care, (3) Physical environment, (4) Importance of relatives and (5) Psychological consequence. Insufficient information: Even though verbal and written information were given to the patients, the patients express needs for more information about the reasons for the isolation and the isolation precautions. Patients expressed the need for more time to meaningful communication with the nurses. Quality of Care: The patients felt abandoned and forgotten by the nurses, because of fewer visits and time limited communication. This led to emotions such as frustrations, insecurity and neglect. While isolated the patients felt it difficult to achieve contact and have an optimal relation with the nurses. Physical environment: Some patients felt lonely and imprison, while other patients enjoyed time alone and not having to worry about other patients. A view to the life outside the physical boundaries of the isolation helped to avoid boredom. Importance of relatives: Relatives were a major source of comfort, and they were a contact with the outside world and reduced feeling lonely. Patients thought that relatives may not want to visit because they were afraid of the infection. Psychological consequence: The patients generally felt stigmatized because of their infection especially when the nurses and relatives have to use protective precaution equipment while entering the room. Isolation was associated with anxiety and depression and isolated patients experienced both lower self-esteem and sense of control. Previous experiences with isolation helped them cope with their situation. Conclusion: Patients experience both positive and negative effects of source isolation, and areas of potential interest for developing new strategies to improve care of isolated patients were identified. Surprisingly, despite both verbal and written information, the information has not been understood by the patients. Repetitive communication with focus on the understanding of the information could be a strategy, and involving relatives in the communication might also help to gain understanding as well as involving the relatives in the treatment and caring process of the patient. Another key area could be the physical environment. The design of the ward with a balance between source isolation and visual and communicative opening to the outside is important to reduce the negative impact from isolation. Keywords: literature review, isolation, source isolation, patients experiences, patients perspectives, depression, coping, information, care, relatives.