1. Ashanti Starr Johnson, BSN, RN University of Central Florida

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

4.  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

5.  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

6.  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

7.  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

8. Inclusion CriteriaExclusion Criteria a)Articles published between 2005 and 2011 b)All ages c)English literature d)Human e)Source isolation f)Both genders. a)Social or protective isolation b) Non-peer reviewed journals

9.  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

10.  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.

11.  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.

12.  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)

13.  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)

14.  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 satisfactio n ◦ 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

15.  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

16.  Educating Healthcare Providers and Nurses  Educating patients, families and community  Implementing preventative measures  Conducting further research

17.  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

18.  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.

19. Questions??