The Effects of Source Isolation on Psychological Well-being in Hospitalized Patients

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The Effects of Source Isolation on Psychological
Well-being in Hospitalized Patients

• Ashanti Starr Johnson, BSN, RN
• University of Central Florida

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Research Question

• In hospitalized patients, does source isolation
  negatively affect psychological well-being?

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(No Transcript)
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Background Significance

• The of source isolated patients for MDRO is
  steadily increasing
• Isolating patients may negatively affect
  psychological well-being such as depression,
  anxiety, etc.
• Risk factors for suicide include depression,
  isolation and physical illness.
• Anxiety and depression can be found in adults and
  children

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Background Significance

• Approximately 1/10 adult Americans suffer from
  depression
• The national suicide rate increased from 13 to 15
  people per 100,000 people, from the year
  2000-2006
• Possible correlation between negative
  psychological effects and source isolation be
  identified and researched thoroughly
• Interdisciplinary interest/importance

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Relevance

• Isolation poses potential psychological harm to
  patients.
• Affects Coping
• Leads to depression, anxiety, etc.
• Counter productive
• Contrary to goal of holistic nursing of patient
  to wellness state.
• Interdisciplinary interest
• Public interest

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Methods

• Search Terms
• Databases CINAHL Plus with Full text, Cochran
  Systematic Review, PsycARTICLES, Google Scholar
  and MEDLINE
• Terms hospital, hospitalized, isolate,
  isolation, psychological, well-being and well
  being

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Methods
Inclusion Criteria Exclusion Criteria
Articles published between 2005 and 2011 All ages English literature Human Source isolation Both genders. Social or protective isolation b) Non-peer reviewed journals
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Methods

• Validity of Findings
• Two articles were systematic reviews of cohort
  studies (level 1)
• Five articles were individual cohort studies
  (level 2)
• Four studies were qualitative (level 4)
• Study Characteristics
• 475 from CINAHL 10 from MEDLINE 6 from
  PsycARTICLES 1 from Google Scholar
• 11met criteria 8 from CINAHL, 2 from MEDLINE, 1
  from Google Scholar

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Methods

• Coding
• Negative psychological effects of source
  isolation (including decreased coping)
• Lack of education on isolation and treatments
• Decrease in healthcare worker contact
• Association between decreased contact and
  increase in adverse events and delayed care.

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Findings Negative psychological effects of
source isolation

• Anxiety Depression
• Abad, et al. 2010 (N1288) Depression Plt.01
  Anxiety Plt.02
• Catalano, et al. 2003 (N51) Depression Plt0.001
  Anxiety Plt0.001
• Day, 2011, (N102) P.47- OR1.81(0.61-5.67)-hig
  her scores but not significant (HADS)
• Tarzi, et al. 2001 (N44) Depression Anxiety
  Plt0.01
• Morgan, 2009 (15 studies)-P.06
• Wassenberg, 2010 (N126) P.480 findings not
  significant.

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Findings Negative psychological effects of
source isolation

• Fear, anger, frustration, concern for others
  guilt
• Barratt, et al. 2011(N10)
• Guilt, shame, confined, alienated unwelcome
• Skyman 2010 (N6)
• Sadness, loneliness distress
• Koller, et al. 2006 (N23)
• Pacheco Spyropoulos, 2010 (n10)

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Findings Lack of education on isolation and
treatments

• Inconsistency of education given
• Barratt et al. 2011(N10)
• Pacheco Spyropoulos, 2010 (N10)
• Decreased Education
• Gasink, 2008 (N86) P.007
• Barratt et al. 2011(N10)
• Pacheco Spyropoulos 2010 (N10)
• Skyman et al., 2010 (N6)

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Findings Decreased Quality of Care

• Decreased contact with Healthcare worker (HCW)
• Abad, et al. 2010 Plt.05
• Barratt, et al, 2011 (N10)
• Morgan et al. 2009 plt.001
• Skyman 2010 (N6)
• Decrease in patient satisfaction
• Abad et al. 2010 Plt.008
• Morgan 2009 (15 studies) Plt.001
• Pacheco Spyropoulos, 2010 (n10)
• Gasink 2008 (N86) P.02 (not significant)
• Increased adverse events
• Abad, et al. 2010 Plt.001
• Morgan et al. 2009 Plt.001

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Limitations

• Small sample sizes
• Qualitative studies
• Inability to conduct blind studies due to nature
  of topic
• Sample sizes not always included for one SLR
• Non-validated survey tool
• Short study duration
• Recall bias
• No adjustment for mental health history/illness

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Recommendations

• Educating Healthcare Providers and Nurses
• Educating patients, families and community
• Implementing preventative measures
• Conducting further research

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Recommendations for Future Research

• Development of a well-validated standardized
  tools
• Research for identification of nursing
  interventions to ameliorate the negative effects
• Research to find definitive link between
  isolation, decreased healthcare worker contact
  and adverse events.
• Reconsideration of isolation precautions as
  preventative measure

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Conclusion

• Current evidence does suggest that source
  isolation has negative effects on psychological
  well-being, decreased patient satisfaction,
  decreased patient education, decreased healthcare
  worker contact and an increase in adverse events.

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• Questions??