Social Isolation in Barrier Nursing
Published on the 04 May 2017
Published on the 04 May 2017
As agency staff, it is not my place to question who I will be nursing for the day so I smile, accept, and gaze down at my dry, sore hands. Two out of six of my patients are an infection control risk. I know that this will worsen the state of my hands.
I put aside my concerns and prepare for the day ahead. It is the patients who are secluded from the rest of the ward who seem to suffer from inpatient social isolation the most.
In making my rounds that morning, I change into personal protective equipment over twenty times.
While making one patient’s bed, I strike up a conversation. After discussing the doctor’s plans for the patient, we switch to something on a more personal level: “What’s going on in your world today?”
I touch on the basics before detailing my excitement about a visit from my parents at the weekend. I point at the sheet of grey clouds looming over the hospital and tell him he’s not missing out on any good weather.
Our conversation is interrupted by the kitchen staff who stand in the doorway without setting foot in the room to take my patient’s order for a hot drink. As I lower the hospital bed for my patient, he asks whether the newspaper trolley has been around yet. I am uncertain if it has but I promise to keep an eye out for it. I leave his room and head to the next isolated patient.
I visit a lady who has been in a side room for three days. As I walk in the door and introduce myself she expresses her excitement at having someone to talk to. She is in a specialist hospital which is far from her home and her relatives have not made it in to visit for a couple of days.
“It gets terribly lonely in here…”, she wistfully remarks. Next is a question regarding lab results as she is desperate to be moved into a bay. I promise to chase them up and leave feeling saddened.
The following week I am assigned to the side rooms of another ward. This time, none of my patients are infection risks, just overflow from the bays.
Despite not having the barrier nursing signs displayed on the outside of their doors next to the tell-tale trolley of red aprons and gloves, some staff members are still treating them as isolated patients.
I stand in the room of one of my patients as my afternoon seems much tamer than the morning. We discuss our love of art, recent exhibitions we’ve visited in London, and compare notes on living in Cornwall. At the end of our conversation, he asks whether I saw the newspaper trolley going around in the morning. He expresses his dismay at missing it and soon I realise that it seems to be a recurring theme.
In my second year of university, I cared for a patient who was isolated due to MRSA. Despite numerous requests asking the patient to stay in his room, he refused to adhere to infection control procedures.
As he was mobile and had capacity, we were limited in methods, besides verbal advice, for convincing him to remain in the room. On one occasion, he walked off the ward to the bakery in the hospital.
Upon his return, we were presented with doughnuts in open bags that he had purchased for the staff. Due to the infection risk, they were discarded immediately and the patient was again asked to return to his room.
At the time, I found it difficult to empathise with the patient as I could not understand why someone with a contagious infection would knowingly expose others to it.
Having gained an understanding of the social isolation experienced by these patients, his situation began to make more sense.
Despite our best efforts at maintaining relationships with our patients, it seems the ones most in need of our company are suffering.
While some enjoy the luxury of a private room, those with greater social needs are negatively impacted. Due to being barrier nursed, patients are limited in their contact with others.
It should be the responsibility of the hospital to address deficits in training to minimise adverse effects. Through increasing understanding of how to use precautions, staff members can gain confidence in interacting with these patients. With the rising pressures in nursing, it is not always feasible to be solely responsible for providing support.
In conjunction with experiencing a decrease in standard social exchanges with healthcare professionals, these patients are also secluded from others.
In ward bays, it is not uncommon for patients to form relationships and become familiar with one another, almost like an adopted hospital family. These simple interactions are therapeutic and crucial to some in enabling them to discuss and manage their experiences.
By occupying a side room, those who are isolated cannot benefit from the formation of these additional relationships. It then becomes our duty to attempt to fill in the gaps.
Allocating a small amount of time (where possible) to spend talking to patients who feel isolated could assist in curbing some of their feelings of seclusion.
While this is not always feasible, there are other ways of promoting social inclusion. Raising awareness to ensure the promotion and protection of equality is also of significant importance.
Some patients find it demoralising enough watching visitors enter their room wearing aprons and gloves—it can only cause further damage in acknowledging that members of staff are actively avoiding their rooms.
As mediators and patient advocates, we must identify the needs of our patients and act accordingly to ensure appropriate support is provided. It becomes detrimental to emotional wellbeing, morale, and the nurse-patient relationship if these roles are ignored.
Florence Bull BSc (Hons) is a registered adult nurse. She has a background in neurosciences and emergency medicine. Currently she is working as a nurse practitioner in sexual and reproductive health and is an accredited sonographer in early pregnancy. Her work has been published by the Guardian and she writes her own blog, Subcutaneous. Florence has an interest in global health which was sparked by an elective placement in Tanzania during her studies. She aims to pursue a Master’s degree in this field in upcoming years.