The hospitalised patients' experience of being in protective/source isolation: A systematic review of qualitative evidence.

BACKGROUND: The placement of hospitalised patients in isolation is either done to protect the immunocompromised patient from others (reverse or protective isolation) or to protect others from the patient's infectious process (isolation). Both situations require limiting the contact between the patient and others to prevent the spread of pathogens or to protect the immunocompromised patient. Isolating patients remains a primary treatment in the hospital setting. There is no formal meta-aggregation of the qualitative research literature that describes the meaning of this experience. Explication of the meaning will provide valuable information for clinicians as they care for persons in isolation.

OBJECTIVES: The aim of this review was to synthesise the best available qualitative evidence on the experience of hospitalised patients being placed in isolation.

INCLUSION CRITERIA: The participants were adult (> 18 years old) hospitalised patients in isolation.The phenomenon of interest was the meaning of being in isolation from the hospitalised patient's perspective.The studies of interest were qualitative studies that focused on adult hospitalized patients and their experience with being cared for in isolation.

SEARCH STRATEGY: The search strategy sought to find both published and unpublished research studies from 1971 to May 2010. This review was limited to papers written in English. A three step search strategy was utilised. An initial limited search of MEDLINE and CINAHL was undertaken, followed by an analysis of text words contained in the title and abstract, and of index terms used to describe the article. A second extensive search was then undertaken using all identified key words and index terms. Lastly, a final hand search of the reference lists from included papers was employed.

METHODOLOGICAL QUALITY: Each paper was assessed independently by two reviewers for methodological quality prior to inclusion in the review using the appropriate Joanna Briggs Institute critical appraisal instrument from the System for the Unified Management, Assessment and Review of Information (SUMARI) package.

DATA COLLECTION: Data was extracted from papers included in the review using the standardised data extraction tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument.

DATA SYNTHESIS: Categories were formed based on aggregation of similar findings with like meaning. The categories were analysed to identify synthesised findings that were presented as declamatory and generalisable statements to guide and inform practice.

RESULTS: A total of 12 studies were reviewed and, of those, 4 were excluded for methodological concerns and 8 were included in the review. The qualitative studies examined the hospitalised patients' experiences of being in isolation. A total of 56 findings were extracted from included studies. Findings were then synthesised in 11 categories. Two synthesised findings were developed from these categories: (1) The isolation experience causes fractured human connectivity and nurses must provide care that mitigates the negative effects of this; and (2) nurses must attend to the reality that a variety of factors affect the patient's ability to adapt to an artificial environment.

CONCLUSION: The patient in isolation temporarily resides in an artificial environment, removed from the normalcy of their life. The experience of being in isolation causes severe limitation in or loss of self-determination and autonomy, resulting in the patient being caught in a restrictive environment in which they have little control. The isolated patient must relinquish their autonomy and due to limited contact with others there is disjointed and fractured human connection.

IMPLICATIONS FOR PRACTICE: In order to moderate the detrimental psychosocial effects of isolation, institutional policies need to reflect the higher acuity of care required, allow the patient to have choices, design rooms that consider the long-term patient, and support nursing care that is considerate of the unique needs of the isolated patient.

IMPLICATIONS FOR RESEARCH: Further exploration of the effects of isolation on the achievement of desired patient outcomes is needed. In-depth comparative studies between nurses' perceptions of the care they provide versus the patients' perception of the care they receive would provide valuable insights. Additionally, studies that explore patients' perception of how helpful they find nursing interventions aimed at meeting their psychosocial care needs would also provide useful data. Lastly, studies that explore the barriers perceived by nursing staff to implementing patient-centered care in the isolation environment would be helpful in informing nursing practice.