Ashanti Starr Johnson, BSN, RNUniversity of Central Florida

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

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

Approximately 1/10 adult American’s 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

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 interestPublic interest

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

Inclusion Criteria

Exclusion Criteria

a)Articles published between 2005 and 2011

b)All ages c) English literatured)Human e)Source isolation f) Both genders.

a) Social or protective isolation

b) Non-peer reviewed journals

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

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.

Anxiety & Depression◦ Abad, et al. 2010 (N=1288); Depression P<.01;

Anxiety P<.02◦ Catalano, et al. 2003 (N=51); Depression P<0.001;

Anxiety P<0.001◦ Day, 2011, (N=102); P=.47- OR=1.81(0.61-5.67)-

higher scores but not significant (HADS)◦ Tarzi, et al. 2001 (N=44); Depression & Anxiety

P<0.01◦ Morgan, 2009 (15 studies)-P=.06◦ Wassenberg, 2010 (N=126) P=.480 findings not

significant.

Fear, anger, frustration, concern for others & guilt

◦ Barratt, et al. 2011(N=10) Guilt, shame, confined, alienated &

unwelcome◦ Skyman 2010 (N=6) Sadness, loneliness & distress◦ Koller, et al. 2006 (N=23)◦ Pacheco & Spyropoulos, 2010 (n=10)

Inconsistency of education given Barratt et al. 2011(N=10) Pacheco & Spyropoulos, 2010 (N=10)

Decreased Education ◦ Gasink, 2008 (N=86); P=.007◦ Barratt et al. 2011(N=10)◦ Pacheco & Spyropoulos 2010 (N=10)◦ Skyman et al., 2010 (N=6)

Decreased contact with Healthcare worker (HCW) Abad, et al. 2010 ; P<.05 Barratt, et al, 2011 (N=10) Morgan et al. 2009; p<.001 Skyman 2010 (N=6)

Decrease in patient satisfaction◦ Abad et al. 2010; P<.008◦ Morgan 2009 (15 studies) P<.001◦ Pacheco & Spyropoulos, 2010 (n=10)◦ Gasink 2008 (N=86); P=.02 (not significant) Increased adverse events◦ Abad, et al. 2010 = P<.001◦ Morgan et al. 2009= P<.001

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

Educating Healthcare Providers and Nurses

Educating patients, families and community

Implementing preventative measures

Conducting further 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

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.

Questions??