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Home , Isolation (health care), Isolation (psychology)

Determining the Psychological Impact of Isolation Precautions on Families of ICU KATHRYN RADTKE1, RACHELLE DASH1, SANDY SWOBODA1,2, PAMELA LIPSETT1,2

1JOHNS HOPKINS UNIVERSITY SCHOOL OF ; 2JOHNS HOPKINS UNIVERSITY SCHOOL OF , BALTIMORE, MD, 21205

Background Results Conclusions Contact isolation precautions for resistant Data combined with pre-existing interviews for • Indications for isolation precautions and such as methicillin-resistant a total of 44 family members interviewed (30 modes of are not Staphylococcus aureus (MRSA) and Isolation, 14 Non-Isolation). well understood by family members vancomycin-resistant enterococci (VRE) • Isolation is underdiscussed between several thousand patients in the Johns Qualitative Results healthcare providers and families Hopkins ’s surgical ICUs each year and incidence is growing worldwide (Wassenberg, Major Themes • Providers should deliver information Severs, & Bonten 2010). Isolation precautions 1. Lack of clarity on indication for isolation about the benefits and purposes of impact patients’ mental well-being, increasing precautions and transmission of pathogens isolation precautions to family members frequently through structured , , and . Furthermore, - “I can only imagine that it’s because of some type communication protocols (Dayton & healthcare providers are less likely to spend of that she either has or had in the past, Henriksen, 2007) time with isolation patients (Abad, Fearday & and they’re worried about that spreading.” Safdar, 2010). (Husband) - “I don’t know if he has or hasn’t [benefitted from Future Directions Studies show that isolation protocols can add precautions] to be honest with you, because he’s Assess family coping at outset. Provide stress to visiting family members, but their • got so many people coming in…All the germs are referrals to chaplains, , and experience is not well understood (Sengupta going to be in the air anyway so it doesn’t really other multidisciplinary resources et al., 2011). In order to improve care delivery, matter then does it if you’re going to go out the Create hospital protocols and update we must understand the needs of families as • doorway.” (Wife) flowsheets regarding family education of they relate to control measures. This isolation precautions and delineating the family-centered effort also has implications 2. Providers are not consistently explaining discipline/care provider responsible for improving adherence to safety measures, isolation precautions to families • Initiate competency trainings for providers to possibly reducing transmission of life- - “No, no[one from the hospital explained need for refresh knowledge on contact precautions threatening infections, as well as increasing isolation precautions], but I learned from other • Improve signage on room doors patient and family satisfaction with care hospitalizations so I never asked.” (Wife) • Expand language capacity of survey tools for (Ponte et al., 2003, Pronovost, 2010). increasingly diverse patient population 3. Isolation precautions are not a barrier • Create isolation family support groups for closeness or staff care - “I can hold her hand with gloves on, I feel safer than holding her hand without a glove on. This way

she’s safe and so am I.” (Husband) References - “I think that they’re more precautionary [with Abad, C., Fearday, A., & Safdar, N. (2010). Adverse effects of isolation in hospitalised patients: a systematic review. Journal of Hospital gowns and gloves], but honestly I this hospital, Infection, 76(2), 97-102. doi: 10.1016/j.jhin.2010.04.027 Dayton, E. & Henriksen, K. (2007). Communication failure: Basic I think that they’re trying to provide her with components, contributing factors, and the call for structure. Joint maximum care.” (Daughter) Commission Journal on Quality and Patient Safety, 33(1), 34-47. Objectives Ponte, P. R., Conlin, G., Conway, J. B., Grant, S., Medeiros, C., Nies, J., 4. Transitioning settings is an area for Shulman, L., Branowicki, P., & Conley, K. (2003). Making patient- Determine if family members of isolation centered care come alive: Achieving the full integration of the teaching patient’s perspective. The Journal of Nursing Administration, 33(2), patients: 82-90. - “I said, ‘when I go home, what you want me to Pronovost, P. & Vohr, E. (2010). Safe patients, smart . New York, -- understand the reason for isolation do?’ And they told me, ‘No problem, only in the NY: Penguin Group. -- experience different attitudes, Sengupta, A., Rand, C., Perl, T. M., Milstone, A. M. (2011). Knowledge, hospital…because we got all different kinds of awareness, and attitudes regarding methicillin-resistant or interactions with the patient or staff patients and we don’t want it to spread.’” (Mother) Staphylococcus aureus among caregivers of hospitalized children. The Journal of Pediatrics, 158(3), 416-421. -- have increased anxiety or depression Wassenberg, M. W., Severs, D., & Bonten, M. J. (2010). Psychological impact

of short-term isolation measures in hospitalised patients. Journal of Quantitative Results Hospital Infection, 75, 124-127. doi: 10.1016/j.jhin.2010.01.023 Methods IMAGES: Critical Care Family Needs Inventory: Johns Hopkins Hospital. 2008. Contact precautions door sign. [Poster]. IRB-approved, mixed methods study of Retrieved from 84% of all families satisfied with overall patient care http://www.hopkinsmedicine.org/nursing/_downloads/summary_ho family members in 2 surgical ICUs. irrespective of isolation status. spital_orientation.pdf Subjects were selected from a Swoboda, S. 2013. Family at bedside. [Photograph]. Personal collection Tillis, H. 2013. Gown and gloves. [Photograph]. Retrieved from convenience sample of isolation and non- Differences in Explanations and http://harveytillisphotography.com/photography/gown-and-gloves isolation patients with an ICU length of Understanding 80 stay >48 hours. Funding Source: 70 60 The Helene Fuld Leadership Program for the Qualitative surveys included questions on NS 50 Advancement of Patient Care Quality and Safety understanding, thoughts, feelings of 40 30 isolation precautions and quantitative 20 surveys assessed levels of anxiety, 10 depression and satisfaction with their 0 Explanations Not Equipment not Explained loved one’s care: Understood • Critical Care Family Needs Inventory Isolation Families Non-Isolation Families (CCFNI) • Anxiety Survey Anxiety and Depression Scales: • Center for Epidemiological Studies Depression Scale (CED-S) There were no significant differences in depression symptoms or in reported symptoms of anxiety (dizziness, , nervous, heart pounding) related to isolation. Family members of isolation patients were less likely to be terrified vs. non- isolation patients (27% vs. 40%, p = 0.05).