School of Nursing DePaul University TRIFOLD AREA – THIS GUIDE WILL BE REMOVED BEFORE PRINTING – TRIFOLD AREA – THIS GUIDE WILL BE REMOVED BEFORE PRINTING – TRIFOLD AREA – THIS GUIDE WILL BE REMOVED BEFORE PRINTING – TRIFOLD AREA – THIS GUIDE WILL BE REMOVED BEFORE PRINTING – TRIFOLD Adverse Psychological Effects of Patients in Medical Isolation Due to Healthcare-Associated Infections Kristin Brill School of Nursing DePaul University BACKGROUND MATERIALS AND METHODS CONCEPTUAL FRAMEWORK Design An integrative literature review design was used to examine the literature to identify the adverse psychological effects of patients placed in medical isolation due to healthcare-associated infections as well as coping strategies that can be used to decrease these adverse effects. The integrative literature review design allows the chosen literature to be analyzed and compared, and it contains specific search criteria. Literature Search Process This review searched the databases of CINAHL, PsychInfo, PubMed, and PsychArticles and used the government website of the Centers for Disease Control and Prevention. All searches were performed using combinations of these key words: adverse effects, negative effects, effects, adverse outcomes, negative outcomes, isolation precautions, contact isolation, droplet isolation, airborne isolation, isolation, coping, and psychology. Inclusion Criteria The inclusion criteria used during the first search to identify the adverse effects of patients in medical isolation with results found in figure 1 were: A population of individuals which includes patients who have been placed in medical isolation due to healthcare-associated infections Published between 2003 and 2016 Documentation of adverse effects of patients placed in isolation The inclusion criteria used during the second search to identify coping strategies used by patients identified to have adverse effects of medical isolation with results shown in figure 2 were: A population of individuals which includes patients who have had adverse effects from being placed in medical isolation Documentation of coping strategies used to decrease the adverse effects of being placed in isolation Healthcare-associated infections (HAIs) cause illness and death among thousands of patients treated in the U.S. healthcare institutions and add billions of dollars to healthcare costs every year (Centers for Disease Control and Prevention [CDC], 2015). Transmission-based isolation precautions are put into effect to decrease this spread of disease. These include droplet precautions, contact precautions and airborne precautions, each playing an important role in the healthcare setting. Patients placed in medical isolation due to healthcare-associated infections experience adverse psychological effects that can impact their quality of life. With a decrease in typical sources of coping such as the support systems of family and friends, patients in medical isolation need to look to other coping mechanisms for support. Teaching proper coping strategies has been found to be effective in reducing stress as well as increasing problem-solving skills (Ahmadi, Ahmadi, and Sanaei, 2014). Peplau’s Theory of Interpersonal Relations was selected to describe the importance of the nurse-patient relationship (Wayne, 2014). Lazarus and Folkman’s Transactional Theory was also selected to describe the relationship between stress and coping and to emphasize the importance of using coping strategies to decrease the potential adverse effects of medical isolation. The theory recognizes two constructs, cognitive appraisal and coping (Lazarus and Folkman, 1987). Using cognitive appraisal and coping strategies, patients can establish the positive outcome of successful coping (figure 3). DISCUSSION Through this integrative literature review, five major adverse effects related to patients in medical isolation were identified including depression, anxiety, anger, stress and dissatisfaction of care. Anxiety was shown to be the most common adverse effect. Three coping strategies were identified that aided in the minimization of these effects: support of family, adequate knowledge and maintaining contact with the outside world. While this list is not exhaustive, these are the common strategies. SUGGESTIONS FOR FURTHER RESEARCH CINAHL Found: 30 Selected: 5 Repeated: Used: PubMed 29 3 2 PsychInfo 17 1 PsychArticles 18 PURPOSE CINAHL Found: 2 Selected: Repeated: Used: PubMed 18 3 PsychInfo 61 1 PsychArticles 41 While strong evidence exists indicating the adverse effects of medical isolation, further research may be helpful to identify a greater number of coping strategies that may be used to decrease these adverse effects. Other research may be possible to better understand the consequences these adverse effects have on patients’ quality of life following the discontinuation of isolation. The purpose of this integrative literature review was to identify the adverse effects of patients in medical isolation as well as explore coping strategies that can be used to decrease these adverse effects. The following research questions were discussed in this literature review: What are the adverse psychological effects of patients placed in medical isolation due to healthcare-associated infections? What coping strategies can be used to decrease the adverse effects of medical isolation due to healthcare-associated infections? IMPLICATIONS FOR NURSING These findings can help nurses to better understand the psychological effects inflicted on patients throughout the isolation process, allowing nurses to better care for patients’ mental status during this time. Nurses may also be able to encourage patients to use coping strategies that have been identified to aid them in resolving these adverse effects Figure 1. Literature Search and Results on Adverse Psychological Effects Figure 2. Literature Search and Results on Coping Strategies RESULTS The literature that was reviewed included studies done using observation, questionnaires, and interviews. All adverse effects that were identified resulted directly from medical isolation, and these factors are suspected to have a direct effect on the patient’s quality of life during and directly after the period of isolation from healthcare-associated infections. Five major adverse psychological effects of patients in medical isolation were identified. Those included: depression; anxiety; anger; stress; and dissatisfaction of care. Coping strategies commonly used to decrease the adverse effects of medical isolation included support of family, adequate knowledge, and maintaining contact with the outside world. REFERENCES Ahmadi, S., Ahmadi, S., Sanaei, B. (2014). The effectiveness of coping stress skills training on stress and problem solving skill. The Neurosciece Journal of Shefaye Khatam 2(3) Centers for Disease Control and Prevention. (2015). Healthcare-associated infections. Retrieved from http://www.cdc.gov/HAI/research/research.html Lazarus, R. S., Folkman, S. (1987). Transactional theory and research on emotions and coping. European Journal of Personality 1, 141-169 Wayne, G. (2014). Hildegard Peplau’s Interpersonal Relations Theory. Retrieved from http://nurseslabs.com/hildegard-peplaus-interpersonal-relations-theory/ Figure 3. Application of Theory of Interpersonal Relations and Transactional Theory